Local Coverage Article Billing and Coding

Billing and Coding: Hypoglossal Nerve Stimulation for the Treatment of Obstructive Sleep Apnea

A57948

Expand All | Collapse All

Contractor Information

Article Information

General Information

Article ID
A57948
Article Title
Billing and Coding: Hypoglossal Nerve Stimulation for the Treatment of Obstructive Sleep Apnea
Article Type
Billing and Coding
Original Effective Date
03/15/2020
Revision Effective Date
01/01/2022
Revision Ending Date
N/A
Retirement Date
N/A
AMA CPT / ADA CDT / AHA NUBC Copyright Statement

CPT codes, descriptions and other data only are copyright 2021 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.

Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

Current Dental Terminology © 2021 American Dental Association. All rights reserved.

Copyright © 2022, the American Hospital Association, Chicago, Illinois. Reproduced with permission. No portion of the American Hospital Association (AHA) copyrighted materials contained within this publication may be copied without the express written consent of the AHA. AHA copyrighted materials including the UB‐04 codes and descriptions may not be removed, copied, or utilized within any software, product, service, solution or derivative work without the written consent of the AHA. If an entity wishes to utilize any AHA materials, please contact the AHA at 312‐893‐6816.

Making copies or utilizing the content of the UB‐04 Manual, including the codes and/or descriptions, for internal purposes, resale and/or to be used in any product or publication; creating any modified or derivative work of the UB‐04 Manual and/or codes and descriptions; and/or making any commercial use of UB‐04 Manual or any portion thereof, including the codes and/or descriptions, is only authorized with an express license from the American Hospital Association. The American Hospital Association (the "AHA") has not reviewed, and is not responsible for, the completeness or accuracy of any information contained in this material, nor was the AHA or any of its affiliates, involved in the preparation of this material, or the analysis of information provided in the material. The views and/or positions presented in the material do not necessarily represent the views of the AHA. CMS and its products and services are not endorsed by the AHA or any of its affiliates.

CMS National Coverage Policy

N/A

Article Guidance

Article Text

Refer to the Local Coverage Determination (LCD) L38310, 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.

Coding Guidelines

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 or 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

Coding Guidance

  • Do not bill CPT code 64582 in conjunction with 64583 or 64584
  • Do not bill CPT code 64583 in conjunction with 64582 or 64584
  • Do not bill CPT code 64584 in conjunction with 64582 or 64583

Documentation Requirements

  1. All documentation must be maintained in the patient's medical record and made available to the contractor upon request.
  2. 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.
  3. The submitted medical record must support the use of the selected diagnosis code(s).

Coding Information

CPT/HCPCS Codes

Group 1

(3 Codes)
Group 1 Paragraph

Note: Providers are reminded to refer to the long descriptors of the CPT codes in their CPT book.

Group 1 Codes
CodeDescription
64582 OPEN IMPLANTATION OF HYPOGLOSSAL NERVE NEUROSTIMULATOR ARRAY, PULSE GENERATOR, AND DISTAL RESPIRATORY SENSOR ELECTRODE OR ELECTRODE ARRAY
64583 REVISION OR REPLACEMENT OF HYPOGLOSSAL NERVE NEUROSTIMULATOR ARRAY AND DISTAL RESPIRATORY SENSOR ELECTRODE OR ELECTRODE ARRAY, INCLUDING CONNECTION TO EXISTING PULSE GENERATOR
64584 REMOVAL OF HYPOGLOSSAL NERVE NEUROSTIMULATOR ARRAY, PULSE GENERATOR, AND DISTAL RESPIRATORY SENSOR ELECTRODE OR ELECTRODE ARRAY

CPT/HCPCS Modifiers

Group 1

(1 Code)
Group 1 Paragraph

N/A

Group 1 Codes
CodeDescription
52 REDUCED SERVICES: UNDER CERTAIN CIRCUMSTANCES A SERVICE OR PROCEDURE IS PARTIALLY REDUCED OR ELIMINATED AT THE PHYSICIAN'S DISCRETION. UNDER THESE CIRCUMSTANCES THE SERVICE PROVIDED CAN BE IDENTIFIED BY ITS USUAL PROCEDURE NUMBER AND THE ADDITION OF THE MODIFIER -52, SIGNIFYING THAT THE SERVICE IS REDUCED. THIS PROVIDES A MEANS OF REPORTING REDUCED SERVICES WITHOUT DISTURBING THE IDENTIFICATION OF THE BASIC SERVICE. MODIFIER CODE 09952 MAY BE USED AS AN ALTERNATIVE TO MODIFIER -52. NOTE: FOR HOSPITAL OUTPATIENT REPORTING OF A PREVIOUSLY SCHEDULED PROCEDURE/SERVICE THAT IS PARTIALLY REDUCED OR CANCELLED AS A RESULT OF EXTENUATING CIRCUMSTANCES OR THOSE THAT THREATEN THE WELL-BEING OF THE PATIENT PRIOR TO OR AFTER ADMINISTRATION OF ANESTHESIA, SEE MODIFIERS -73 AND -74 (SEE MODIFIERS APPROVED FOR ASC HOSPITAL OUTPATIENT USE).

ICD-10-CM Codes that Support Medical Necessity

Group 1

(1 Code)
Group 1 Paragraph

It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted.

Note: Dual diagnosis requirement

Coverage for hypoglossal nerve stimulation procedures on patients who meet coverage criteria set forth in LCD L38310 must include both a primary ICD-10-CM diagnosis code indicating the reason for the procedure and a secondary ICD-10-CM diagnosis code indicating the Body Mass Index (BMI) is less than 35 kg/m2 as set forth in the LCD Covered Indications. Report a primary diagnosis code from Group 1 Codes and a secondary diagnosis code from Group 2 below.

Note: CPT code 64584 will have no diagnosis to procedure code restriction at this time.

Primary Diagnosis 

Group 1 Codes
CodeDescription
G47.33 Obstructive sleep apnea (adult) (pediatric)

Group 2

(16 Codes)
Group 2 Paragraph

Secondary Diagnoses

Group 2 Codes
CodeDescription
Z68.1 Body mass index [BMI] 19.9 or less, adult
Z68.20 Body mass index [BMI] 20.0-20.9, adult
Z68.21 Body mass index [BMI] 21.0-21.9, adult
Z68.22 Body mass index [BMI] 22.0-22.9, adult
Z68.23 Body mass index [BMI] 23.0-23.9, adult
Z68.24 Body mass index [BMI] 24.0-24.9, adult
Z68.25 Body mass index [BMI] 25.0-25.9, adult
Z68.26 Body mass index [BMI] 26.0-26.9, adult
Z68.27 Body mass index [BMI] 27.0-27.9, adult
Z68.28 Body mass index [BMI] 28.0-28.9, adult
Z68.29 Body mass index [BMI] 29.0-29.9, adult
Z68.30 Body mass index [BMI] 30.0-30.9, adult
Z68.31 Body mass index [BMI] 31.0-31.9, adult
Z68.32 Body mass index [BMI] 32.0-32.9, adult
Z68.33 Body mass index [BMI] 33.0-33.9, adult
Z68.34 Body mass index [BMI] 34.0-34.9, adult

ICD-10-CM Codes that DO NOT Support Medical Necessity

Group 1

Group 1 Paragraph

All those not listed under the “ICD-10 Codes that Support Medical Necessity” section of this article.

Group 1 Codes

N/A

ICD-10-PCS Codes

N/A

Additional ICD-10 Information

N/A

Bill Type Codes

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the article should be assumed to apply equally to all claims.

CodeDescription
999x Not Applicable

Revenue Codes

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the article should be assumed to apply equally to all Revenue Codes.

N/A

Other Coding Information

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

Revision History Information

Revision History DateRevision History NumberRevision History Explanation
01/01/2022 R2

CPT/HCPCS Code update; Deleted Group 1 Codes 0466T, 0467T and 0468T and added 64582, 64583 and 64584. Throughout document deleted 0466T and replaced with 64582, deleted 0467T and replaced with 64583 and deleted 0468T and replaced with 64584 with code description changes. Under Coding Guidelines Revision or replacement added 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 and under Removal added 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. Under CPT/HCPCS Modifiers Group 1 Codes added modifier 52. Deleted 64568 under CPT/HCPCs codes Group 1. Added billing instructions under Coding Guidance.

10/01/2020 R1

10/01/2020: The following ICD-10 code descriptions were changed in the Covered ICD-10 Codes field Group 2:
Z68.1; Z68.20; Z68.21; Z68.22; Z68.23; Z68.24; Z68.25; Z68.26; Z68.27; Z68.28; Z68.29; Z68.30; Z68.31; Z68.32; Z68.33; Z68.34.

Revisions due to the Annual ICD-10 Updates, effective 10/1/2020.

Associated Documents

Related National Coverage Documents
N/A
Statutory Requirements URLs
N/A
Rules and Regulations URLs
N/A
CMS Manual Explanations URLs
N/A
Other URLs
N/A
Public Versions
Updated On Effective Dates Status
12/29/2021 01/01/2022 - N/A Currently in Effect You are here
09/25/2020 10/01/2020 - 12/31/2021 Superseded View
Some older versions have been archived. Please visit the MCD Archive Site to retrieve them.

Keywords

  • hypoglossal
  • nerve
  • stimulation
  • hsa
  • hns
  • osa
  • sleep
  • apnea