Local Coverage Article Billing and Coding

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

A57949

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Contractor Information

Article Information

General Information

Article ID
A57949
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
10/01/2020
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 2020 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.

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CMS National Coverage Policy

N/A

Article Guidance

Article Text

Refer to the Local Coverage Determination (LCD) L38312, 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 utilizes 2 CPT codes:

  • CPT code 64568 - Incision for implantation of cranial nerve (e.g., vagus nerve) neurostimulator electrode array and pulse generator
  • CPT code +0466T - Insertion of chest wall respiratory sensor electrode or electrode array, including connection to pulse generator (list separately in addition to code for primary procedure)

 

*Note: Per AMA CPT, use 0466T in conjunction with 64568

Revision or replacement of HSN for treatment of OSA is reported with:

  • CPT code 0467T - Revision or replacement of chest wall respiratory sensor electrode or electrode array, including connection to existing pulse generator

Removal of HSN for treatment of OSA is reported with:

  • CPT code 0468T - Removal of chest wall respiratory sensor electrode or electrode array

Coding Information

  • CPT codes 64568 is for both the neurostimulator and its corresponding electrode array
  • CPT codes 0466T, 0467T and 0468T are codes for the insertion, revision or replacement, and removal respectively

 

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

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
64568 INCISION FOR IMPLANTATION OF CRANIAL NERVE (EG, VAGUS NERVE) NEUROSTIMULATOR ELECTRODE ARRAY AND PULSE GENERATOR
0466T INSERTION OF CHEST WALL RESPIRATORY SENSOR ELECTRODE OR ELECTRODE ARRAY, INCLUDING CONNECTION TO PULSE GENERATOR (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
0467T REVISION OR REPLACEMENT OF CHEST WALL RESPIRATORY SENSOR ELECTRODE OR ELECTRODE ARRAY, INCLUDING CONNECTION TO EXISTING PULSE GENERATOR
0468T REMOVAL OF CHEST WALL RESPIRATORY SENSOR ELECTRODE OR ELECTRODE ARRAY

CPT/HCPCS Modifiers

N/A

ICD-10-CM Codes that Support Medical Necessity

Group 1

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 L38312 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 0468T will have no diagnosis to procedure code restriction at this time.

Medicare is establishing the following limited coverage for CPT codes: 64568 when reported with add on code 0466T and for 0467T.

Primary Diagnosis

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

Group 2

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 policy.

Group 1 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.

CodeDescription
99999 Not Applicable

Other Coding Information

N/A

Revision History Information

Revision History DateRevision History NumberRevision History Explanation
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
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Statutory Requirements URLs
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Rules and Regulations URLs
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CMS Manual Explanations URLs
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Other URLs
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Public Versions
Updated On Effective Dates Status
09/25/2020 10/01/2020 - N/A Currently in Effect You are here
Some older versions have been archived. Please visit the MCD Archive Site to retrieve them.

Keywords

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