Local Coverage Article Billing and Coding

Billing and Coding: Posterior Tibial Nerve Stimulation Coverage

A52965

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Contractor Information

Article Information

General Information

Article ID
A52965
Article Title
Billing and Coding: Posterior Tibial Nerve Stimulation Coverage
Article Type
Billing and Coding
Original Effective Date
10/01/2015
Revision Effective Date
10/01/2021
Revision Ending Date
N/A
Retirement Date
N/A
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CMS National Coverage Policy

N/A

Article Guidance

Article Text
Posterior Tibial Nerve Stimulation (PTNS) is a minimally invasive neuromodulation system designed to deliver retrograde electrical stimulation to the sacral nerve plexus through percutaneous electrical stimulation of the posterior tibial nerve. Noridian has determined that PTNS will be covered for treatment of urinary urgency, urinary frequency, and urge incontinence. This article does not address the following NCD: CMS Internet Only Manual (IOM) Medicare National Coverage Determination (NCD) Manual, Publication 100-03, Section 230.16 Bladder Stimulators (Pacemakers). Noridian covers Sacral Nerve Stimulation with restrictions in a separate coverage article.

PTNS Procedure Description
The posterior tibial nerve contains mixed sensory motor nerve fibers that originate from L4 through S3, which modulate the innervation to the bladder, urinary sphincter and pelvic floor. The specific mechanism of action of neuromodulation is unclear, although theories include improved blood flow and change in neurochemical balance along the neurons. Neuromodulation may have a direct effect on the detrusor or a central effect on the micturition centers of the brain.

Using a battery-powered, handheld stimulator and a 34-gauge needle electrode, one can access and stimulate the tibial nerve. Patients receive one 30-minute weekly treatment in the office for 12 weeks. Patients treated with PTNS may begin to see changes in their voiding patterns after four to six treatments, with nocturia and urge incontinence decreases usually reported first. Patients who respond to the treatment require additional therapy at individually-defined treatment intervals for sustained relief of symptoms.

Coverage Guidelines
Consistent with Noridian, manufacturer instructions, and existing literature descriptions of appropriate clinical usage, Noridian expects this treatment to be (generally) delivered in an office setting (Place of Service 11) and that the standard treatment regimen will consist of one 30-minute sessions given once weekly for 12 weeks.

Coverage for initial therapy must document failed standard anticholinergic drug therapy or that the patient demonstrates intolerance to the anticholinergic drug therapy despite best attempts at management of the most common side effects of such therapy, such as dry mouth and constipation.

Coverage for maintenance therapy on an every-three-weeks basis can be extended for a longer time to patients who demonstrate significant improvement in overactive bladder (OAB) symptoms during and at the end of the standard 12-week course of therapy. Documentation must support the initial improvement and the need for the additional treatments.

Bill no more than three Evaluation and Management (E&M) services during any initial course of PTNS treatment:
1. On the initial visit;
2. At the 5th or 6th visit to assess progress; and
3. At the end of the initial 12-week course of therapy.

The patient’s medical record must contain adequate documentation identifying the CPT® and ICD-10-CM coding, and the need for and level of these visits. Noridian reminds the provider community that this coverage decision may be modified or terminated depending upon future literature or clinical experience and usage.

Coding Information

CPT/HCPCS Codes

Group 1

(5 Codes)
Group 1 Paragraph

Covered CPT/HCPCS Codes:

Group 1 Codes
CodeDescription
64566 POSTERIOR TIBIAL NEUROSTIMULATION, PERCUTANEOUS NEEDLE ELECTRODE, SINGLE TREATMENT, INCLUDES PROGRAMMING
0587T PERCUTANEOUS IMPLANTATION OR REPLACEMENT OF INTEGRATED SINGLE DEVICE NEUROSTIMULATION SYSTEM INCLUDING ELECTRODE ARRAY AND RECEIVER OR PULSE GENERATOR, INCLUDING ANALYSIS, PROGRAMMING, AND IMAGING GUIDANCE WHEN PERFORMED, POSTERIOR TIBIAL NERVE
0588T REVISION OR REMOVAL OF INTEGRATED SINGLE DEVICE NEUROSTIMULATION SYSTEM INCLUDING ELECTRODE ARRAY AND RECEIVER OR PULSE GENERATOR, INCLUDING ANALYSIS, PROGRAMMING, AND IMAGING GUIDANCE WHEN PERFORMED, POSTERIOR TIBIAL NERVE
0589T ELECTRONIC ANALYSIS WITH SIMPLE PROGRAMMING OF IMPLANTED INTEGRATED NEUROSTIMULATION SYSTEM (EG, ELECTRODE ARRAY AND RECEIVER), INCLUDING CONTACT GROUP(S), AMPLITUDE, PULSE WIDTH, FREQUENCY (HZ), ON/OFF CYCLING, BURST, DOSE LOCKOUT, PATIENT-SELECTABLE PARAMETERS, RESPONSIVE NEUROSTIMULATION, DETECTION ALGORITHMS, CLOSED-LOOP PARAMETERS, AND PASSIVE PARAMETERS, WHEN PERFORMED BY PHYSICIAN OR OTHER QUALIFIED HEALTH CARE PROFESSIONAL, POSTERIOR TIBIAL NERVE, 1-3 PARAMETERS
0590T ELECTRONIC ANALYSIS WITH COMPLEX PROGRAMMING OF IMPLANTED INTEGRATED NEUROSTIMULATION SYSTEM (EG, ELECTRODE ARRAY AND RECEIVER), INCLUDING CONTACT GROUP(S), AMPLITUDE, PULSE WIDTH, FREQUENCY (HZ), ON/OFF CYCLING, BURST, DOSE LOCKOUT, PATIENT-SELECTABLE PARAMETERS, RESPONSIVE NEUROSTIMULATION, DETECTION ALGORITHMS, CLOSED-LOOP PARAMETERS, AND PASSIVE PARAMETERS, WHEN PERFORMED BY PHYSICIAN OR OTHER QUALIFIED HEALTH CARE PROFESSIONAL, POSTERIOR TIBIAL NERVE, 4 OR MORE PARAMETERS

CPT/HCPCS Modifiers

N/A

ICD-10-CM Codes that Support Medical Necessity

Group 1

(16 Codes)
Group 1 Paragraph

Use of ICD-10-CM code R35.0 requires that documentation also show that potential causes of the frequency not amenable to PTNS therapy have been clinically ruled out.

The only reimbursable ICD-10-CM diagnosis codes are:

Group 1 Codes
CodeDescription
N30.10 Interstitial cystitis (chronic) without hematuria
N30.11 Interstitial cystitis (chronic) with hematuria
N39.41 Urge incontinence
N39.42 Incontinence without sensory awareness
N39.46 Mixed incontinence
N39.490 Overflow incontinence
N39.498 Other specified urinary incontinence
R32 Unspecified urinary incontinence
R33.0 Drug induced retention of urine
R33.8 Other retention of urine
R33.9 Retention of urine, unspecified
R35.0 Frequency of micturition
R35.81 Nocturnal polyuria
R35.89 Other polyuria
R39.14 Feeling of incomplete bladder emptying
R39.15 Urgency of urination

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

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.

NA
N/A

Other Coding Information

N/A

Revision History Information

Revision History DateRevision History NumberRevision History Explanation
10/01/2021 R6

Effective 01/01/2020 added 0587T-0590T to the CPT HCPCS Codes section.

Effective 10/01/2021 added R35.81 & R35.89 to the ICD-10 Codes That Support Medical Necessity per the Annual ICD-10-CM Update.

07/01/2016 R5

Article converted to Billing and Coding, no change in coverage made.

07/01/2016 R4

Remove this rev history when next approved. MCD bug and the wrong rev history (V14) recorded. This revision adds back 3/2/19 annual review date as well as 3/2/18 annual review date since that version was deleted.

07/01/2016 R3 Removed "for up to two years" and added "during and" in the Coverage of maintenance...paragraph to clarify this type of therapy.
07/01/2016 R2 Revised to add for a "longer time" in the 3rd paragraph under Coverage Guidelines in the article Text. Part A article combined with Part B
10/01/2015 R1 Article is revised to remove introductory paragraph which references previous Medicare News Issues and is considered a new article under ICD-10-CM Medicare Coverage Database guidelines.

Associated Documents

Related Local Coverage Documents
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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
09/08/2021 10/01/2021 - N/A Currently in Effect You are here
Some older versions have been archived. Please visit the MCD Archive Site to retrieve them.

Keywords

  • 64566
  • posterior
  • tibial
  • nerve
  • neurostimulator
  • stimulator
  • PTNS