SUPERSEDED LCD Reference Article Billing and Coding Article

Billing and Coding: Peripheral Nerve Stimulation

A55531

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Draft Article
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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Note History

Contractor Information

Article Information

General Information

Source Article ID
N/A
Article ID
A55531
Original ICD-9 Article ID
Not Applicable
Article Title
Billing and Coding: Peripheral Nerve Stimulation
Article Type
Billing and Coding
Original Effective Date
08/27/2018
Revision Effective Date
03/01/2024
Revision Ending Date
09/30/2024
Retirement Date
N/A

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CMS National Coverage Policy

Title XVIII of the Social Security Act, §1833(e). Prohibits Medicare payment for any claim lacking the necessary documentation to process the claim.

Article Guidance

Article Text

The following billing and coding guidance is to be used with its associated Local Coverage Determination.

Noridian has found the current peer-reviewed data is insufficient to warrant the medical necessity of coverage for Peripheral Nerve Field Stimulation (PNFS), also known as Peripheral Subcutaneous Field Stimulation (PSFS) for any condition. Therefore, this service will not be covered for any condition.

To bill for denial, providers must bill CPT® code 64999 for both the trial and permanent insertion of the electrode array when billing for these procedures and report the following information.

Part B claims

  • Enter 1 units of service (UOS)
  • Enter Peripheral Nerve Field Stimulation, PNFS, Peripheral Subcutaneous Field Stimulation, or PSFS adjacent to the CPT® code 64999 and whether the procedure is for a permanent or trial in the comment/narrative field/types:
    • Loop 2400 or SV101-7 for the 5010A1 837P
    • Item 19 for paper claim
  • Restorative Neurostimulation Therapy (i.e. ReActiv8) for treatment of multifidus muscle dysfunction does not require a temporary trial or psychological evaluation. Lead implantation should be reported with CPT® code 64555 for each lead and implantable pulse generator should be reported with CPT code 64590.
  • Restorative Neurostimulation Therapy (i.e. ReActiv8) should be reported with ICD-10-CM code M62.5A2 and the device implanted must be a Class III medical device with product classification QLK as defined by the FDA.

Part A claims

  • Enter 1 UOS
  • Enter Peripheral Nerve Field Stimulation, PNFS, Peripheral Subcutaneous Field Stimulation, or PSFS adjacent to the CPT® code 64999 and whether the procedure is for a permanent or trial in the comment/narrative field/types:
    • Line SV02-7 for 837I electronic claim
    • Block 80 on the UB04 claim form

Response To Comments

Number Comment Response
1
N/A

Coding Information

Bill Type Codes

Code Description

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Revenue Codes

Code Description

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CPT/HCPCS Codes

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CPT/HCPCS Modifiers

Group 1

Group 1 Paragraph

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Group 1 Codes

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ICD-10-CM Codes that Support Medical Necessity

Group 1

(54 Codes)
Group 1 Paragraph

Group 1 codes do not apply to CPT® code 64585 for the purposes of this policy.

Group 1 Codes
Code Description
B02.0 Zoster encephalitis
B02.22 Postherpetic trigeminal neuralgia
B02.23 Postherpetic polyneuropathy
B02.29 Other postherpetic nervous system involvement
E08.41 Diabetes mellitus due to underlying condition with diabetic mononeuropathy
E09.41 Drug or chemical induced diabetes mellitus with neurological complications with diabetic mononeuropathy
E10.41 Type 1 diabetes mellitus with diabetic mononeuropathy
E11.41 Type 2 diabetes mellitus with diabetic mononeuropathy
E13.41 Other specified diabetes mellitus with diabetic mononeuropathy
G43.011 Migraine without aura, intractable, with status migrainosus
G43.019 Migraine without aura, intractable, without status migrainosus
G43.111 Migraine with aura, intractable, with status migrainosus
G43.A1 Cyclical vomiting, in migraine, intractable
G43.B1 Ophthalmoplegic migraine, intractable
G43.C1 Periodic headache syndromes in child or adult, intractable
G43.D1 Abdominal migraine, intractable
G43.811 Other migraine, intractable, with status migrainosus
G43.819 Other migraine, intractable, without status migrainosus
G43.E11 Chronic migraine with aura, intractable, with status migrainosus
G43.E19 Chronic migraine with aura, intractable, without status migrainosus
G44.021 Chronic cluster headache, intractable
G44.029 Chronic cluster headache, not intractable
G44.321 Chronic post-traumatic headache, intractable
G44.329 Chronic post-traumatic headache, not intractable
G44.59 Other complicated headache syndrome
G44.86 Cervicogenic headache
G50.0 Trigeminal neuralgia
G54.1 Lumbosacral plexus disorders
G54.2 Cervical root disorders, not elsewhere classified
G54.3 Thoracic root disorders, not elsewhere classified
G54.4 Lumbosacral root disorders, not elsewhere classified
G54.8 Other nerve root and plexus disorders
G54.9 Nerve root and plexus disorder, unspecified
G55 Nerve root and plexus compressions in diseases classified elsewhere
G56.41 Causalgia of right upper limb
G56.42 Causalgia of left upper limb
G56.43 Causalgia of bilateral upper limbs
G57.71 Causalgia of right lower limb
G57.72 Causalgia of left lower limb
G57.73 Causalgia of bilateral lower limbs
G58.8 Other specified mononeuropathies
G58.9 Mononeuropathy, unspecified
G59 Mononeuropathy in diseases classified elsewhere
G89.22 Chronic post-thoracotomy pain
G90.50 Complex regional pain syndrome I, unspecified
G90.511 Complex regional pain syndrome I of right upper limb
G90.512 Complex regional pain syndrome I of left upper limb
G90.513 Complex regional pain syndrome I of upper limb, bilateral
G90.521 Complex regional pain syndrome I of right lower limb
G90.522 Complex regional pain syndrome I of left lower limb
G90.523 Complex regional pain syndrome I of lower limb, bilateral
G90.59 Complex regional pain syndrome I of other specified site
M54.81 Occipital neuralgia
M62.5A2* Muscle wasting and atrophy, not elsewhere classified, back, lumbosacral
Group 1 Medical Necessity ICD-10-CM Codes Asterisk Explanation

* Reporting of this diagnosis code should be for patients diagnosed with multifidus muscle dysfunction and only services/devices that have FDA approval for the treatment of this condition and appropriate product classification (QLK) shall be billed.

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

Group 1

Group 1 Paragraph

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Group 1 Codes

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ICD-10-PCS Codes

Group 1

Group 1 Paragraph

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Group 1 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.

Code Description

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N/A

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.

9999
Code Description

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N/A

Other Coding Information

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

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Coding Table Information

Excluded CPT/HCPCS Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
N/A N/A
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Non-Excluded CPT/HCPCS Ended Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
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Revision History Information

Revision History Date Revision History Number Revision History Explanation
03/01/2024 R7

Added the diagnosis code M62.5A2 to Group 1 codes – Muscle wasting and atrophy, not elsewhere classified, back, lumbosacral.

Added language related to use of Restorative Neurostimulation Therapy and no requirement for a temporary trial or psychological evaluation.

Added language for use of Product Classification QLK with the ICD-10-CM code in the Additional ICD-10-CM section.

01/01/2024 R6

Per 2024 CPT/HCPCS Updates:

The following codes were added to the Group 1 Codes: 64596, 64597, 64598

Either the short and/or long code description was changed for the following code(s). Please Note: Depending on which descriptor was used, there may not be any changes to the code display in this document: 64585, 64590, 64595

This update is effective 01/01/2024.

10/01/2023 R5

Updated to indicate this article is an LCD Reference Article.

10/01/2023 R4

Per Annual ICD-10 Updates:

The following codes were added to Group 1: G43.E11, G43.E19

01/01/2023 R3

Per 2023 CPT/HCPCS updates, either the long or short description of CPT codes 64999 has been updated. 

10/01/2021 R2

Added the diagnosis code G44.86 – Cervicogenic headache per the Annual ICD-10-CM Update effective 10/01/2021.

12/01/2019 R1

This article was converted to a Billing and Coding Article type and is to be used with its associated Local Coverage Determination.

The article title was changed to from "Noncoverage of Peripheral Nerve Field Stimulation - Coding and Billing" to "Billing and Coding: Peripheral Nerve Stimulation" to match the title of the LCD.

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Associated Documents

Medicare BPM Ch 15.50.2 SAD Determinations
Medicare BPM Ch 15.50.2
Related Local Coverage Documents
LCDs
L37360 - Peripheral Nerve Stimulation
Related National Coverage Documents
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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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CMS Manual Explanations URLs
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Other URLs
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Public Versions
Updated On Effective Dates Status
10/09/2024 10/01/2024 - N/A Currently in Effect View
09/26/2024 10/01/2024 - N/A Superseded View
04/17/2024 03/01/2024 - 09/30/2024 Superseded You are here
12/19/2023 01/01/2024 - 02/29/2024 Superseded View
11/08/2023 10/01/2023 - 12/31/2023 Superseded View
08/24/2023 10/01/2023 - N/A Superseded View
Some older versions have been archived. Please visit the MCD Archive Site to retrieve them.

Keywords

  • Part A
  • Part B
  • electronic claim form
  • Peripheral
  • Nerve
  • Field
  • Stimulation
  • Item 19
  • UB04
  • 64999
  • restorative neurostimulation