Refer to the Proposed Local Coverage Determination (LCD) DL38528, Hypoglossal Nerve Stimulation for the Treatment of Obstructive Sleep Apnea, for reasonable and necessary requirements.
The Current Procedural Terminology (CPT)/Healthcare Common Procedure Coding System (HCPCS) code(s) may be subject to National Correct Coding Initiative (NCCI) edits. This information does not take precedence over NCCI edits. Please refer to NCCI for correct coding guidelines and specific applicable code combinations prior to billing Medicare.
Implantation of a Hypoglossal Nerve Stimulator (HSN) for treatment of OSA CPT code:
- CPT code 64582 - Open implantation of hypoglossal nerve neurostimulator array, pulse generator, and distal respiratory sensor electrode or electrode array
Revision or replacement of HSN for treatment of OSA is reported with:
- CPT code 64583 - Revision or replacement of hypoglossal nerve neurostimulator array and distal respiratory sensor electrode or electrode array, including connection to existing pulse generator
Reduced services-Use modifier 52 for revision or replacement of either the hypoglossal nerve stimulator electrode array or distal respiratory sensor, and bill at a reduced rate.
Removal of HSN for treatment of OSA is reported with:
- CPT code 64584 - Removal of hypoglossal nerve neurostimulator array, pulse generator, and distal respiratory sensor electrode array
Reduced services- Use modifier 52 for removal of one or two components of the hypoglossal nerve stimulator electrode array, pulse generator, or distal respiratory sensor, and bill at a reduced rate.
- Do not bill CPT code 64582 in conjunction with 64583, 64584, or 61888
- Do not bill CPT code 64583 in conjunction with 64582, 64584, or 61888
- Do not bill CPT code 64584 in conjunction with 64582, 64583, or 61888
- All documentation must be maintained in the patient's medical record and made available to the contractor upon request.
- Every page of the record must be legible and include appropriate patient identification information (e.g., complete name, dates of service[s]). The documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing the care to the patient.
- The submitted medical record must support the use of the selected diagnosis code(s).