LCD Reference Article Billing and Coding Article

Billing and Coding: Auricular Peripheral Nerve Stimulation (Electro-Acupuncture Device)

A55240

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Draft Articles are works in progress and not necessarily a reflection of the current billing and coding practices. Revisions to codes are carefully and thoroughly reviewed and are not intended to change the original intent of the LCD.
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This article is not in direct support of an LCD.

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General Information

Source Article ID
N/A
Article ID
A55240
Original ICD-9 Article ID
Not Applicable
Article Title
Billing and Coding: Auricular Peripheral Nerve Stimulation (Electro-Acupuncture Device)
Article Type
Billing and Coding
Original Effective Date
08/11/2016
Revision Effective Date
01/01/2023
Revision Ending Date
N/A
Retirement Date
N/A

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Article Guidance

Article Text

It has come to Novitas’ attention that auricular peripheral nerve stimulation has been billed to Medicare using the CPT code 64555. CPT code 64555 is described as: Percutaneous implantation of Neurostimulator electrode array; peripheral nerve (excludes sacral nerve).

Coding Guidance

Notice
: It is not appropriate to bill Medicare for services that are not covered as if they are covered. When billing for non-covered services, use the appropriate modifier.

Background:

The following devices are listed under the Food and Drug Administration (FDA) approval documents as electro-acupuncture devices used for stimulation of auricular acupuncture points and as such are non-covered. Acupuncture for stimulation of auricular points is not a covered Medicare benefit.

  • NeuroStim system/NSS
  • P-Stim
  • ANSiStim
  • E-Pulse

The following device is FDA classified as a percutaneous nerve stimulator for substance use disorders; Class II device:

  • NSS-2 Bridge

This device is an electrical nerve stimulator (percutaneous nerve field stimulator [PNFS] system) that is placed behind the patient’s ear (auricular). The NSS-2 Bridge is described as nearly identical to the Electronic Auricular Device (EAD) for a different intended use (to aid in the reduction of opioid withdrawal symptoms). This device is non-covered by Medicare when used for acupuncture (stimulation of auricular acupuncture points) for any indication.

For additional information, please refer to National Coverage Determination (NCD) 30.3 for Acupuncture.

Coding Guidelines:

The CPT code 64555, does not describe the procedure of auricular acupuncture stimulation and it should be coded using the NOC CPT code 64999 - unlisted procedure, nervous system.

Reporting:

When billing for auricular peripheral nerve stimulation, use the NOC CPT code 64999 - unlisted procedure, nervous system. The term for the device used for this procedure (e.g. NeuroStim/NSS, P-Stim, ANSiStim, E-Pulse, Electro-Acupuncture, NSS-2 Bridge) should be reported in the Remarks area of the claim for Part A and the Narrative area of the claim for Part B.

The service for auricular peripheral nerve stimulation (CPT code 64999) will be denied as non-covered. This service is not a covered Medicare benefit because acupuncture for auricular stimulation does not meet the definition of reasonable and necessary under Section 1862(a)(1) of the Act.

While the information given in this article is directed to Neurostim system/NSS, P-Stim, ANSiStim, E-Pulse, and NSS-2 Bridge, other current or future devices when used for the procedure auricular peripheral nerve stimulation or electro-acupuncture, would also be considered a non-covered service.

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 ICD-10-CM code(s). The submitted CPT/HCPCS code must describe the service performed.

Response To Comments

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Coding Information

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CPT/HCPCS Modifiers

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ICD-10-CM Codes that Support Medical Necessity

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

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ICD-10-PCS Codes

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Additional ICD-10 Information

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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.

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Revenue Codes

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Other Coding Information

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Coding Table Information

Excluded CPT/HCPCS Codes - Table Format
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Revision History Information

Revision History Date Revision History Number Revision History Explanation
01/01/2023 R4

Article revised and published on 01/26/2023 effective for dates of service on and after 01/01/2023 to reflect the Annual HCPCS/CPT Code Updates. For the following CPT code either the short description and/or the long description was changed. Depending on which description is used in this article, there may not be any change in how the code displays: 64999 in Group 1 Codes.

01/21/2020 R3

Article revised and published on 7/23/2020 effective for dates of service on and after 01/21/2020 to clarify that, consistent with CR 11755, these services remain non-covered.

11/21/2019 R2

Article revised and published on 11/21/2019 consistent with CMS Change Request 10901. Due to system changes, the order of the Coding Section has been revised and new sections for CPT/HCPCS Modifiers and Other Coding Information have been added.

06/14/2018 R1

Article revised and published on 06/14/2018 to add background information and reporting guidelines on the NSS-2 Bridge device.

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Associated Documents

Medicare BPM Ch 15.50.2 SAD Determinations
Medicare BPM Ch 15.50.2
Related Local Coverage Documents
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Related National Coverage Documents
NCDs
30.3 - Acupuncture
SAD Process URL 1
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SAD Process URL 2
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Statutory Requirements URLs
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Rules and Regulations URLs
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Public Versions
Updated On Effective Dates Status
01/20/2023 01/01/2023 - N/A Currently in Effect You are here
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