Local Coverage Article Billing and Coding

Billing and Coding: Billing Medicare for the SphenoCath® and Other Similar Devices

A55585

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Contractor Information

Article Information

General Information

Article ID
A55585
Article Title
Billing and Coding: Billing Medicare for the SphenoCath® and Other Similar Devices
Article Type
Billing and Coding
Original Effective Date
01/01/2017
Revision Effective Date
01/01/2023
Revision Ending Date
N/A
Retirement Date
N/A
AMA CPT / ADA CDT / AHA NUBC Copyright Statement

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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

Noridian is issuing coding guidance for billing the use of Dolor Technologies SphenoCath® device or similar delivery devices. To bill for use of these devices use CPT® 64999 as described in CPT Assistant (July 2014. Volume 24, Issue 7, pages 8-9).

Source:

Internet Only Manual, CMS Pub 100-4 - Medicare Claims Processing Manual, Chapter 12 - Physicians/Nonphysicians Practitioners, Section 50.K:

"If the physician performing the medical or surgical procedure also provides the level of anesthesia lower in intensity than moderate sedation, such as a local or topical anesthesia, then the moderate sedation code should not be reported and no separate payment should be allowed by the A/B MAC (B)."

 

Coding Information

CPT/HCPCS Codes

Group 1

(1 Code)
Group 1 Paragraph

To bill for this service, enter 64999 in the comment field as listed below with the description SphenoCath® or the name of the delivery device used.

For Part A:

  • 2300 loop, NTE segment for the electronic claim
  • Form Locator 80 Remarks on the UB04 form

Part B:

  • Loop 2400/SV101-7 for the electronic claim or
  • Item 19 on the CMS-1500 paper claim form

Do not use CPT® 64400 and/or 64505 to bill for this device.

 

Group 1 Codes
CodeDescription
64999 UNLISTED PROCEDURE, NERVOUS SYSTEM

CPT/HCPCS Modifiers

N/A

ICD-10-CM Codes that Support Medical Necessity

N/A

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.

CodeDescription
99999 Not Applicable

Other Coding Information

N/A

Revision History Information

Revision History DateRevision History NumberRevision History Explanation
01/01/2023 R3

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

04/29/2020 R2

Converted to Billing and Coding article and added 64999 to the CPT/HCPCS Coding section. No Change in coverage was made.

01/01/2017 R1

Updated the Article Title, Text and Group 1 Paragraph to allow for other approved devices used for Sphenopalatine Ganglion Blocks and updated the IOM Source and quotation in the Article Text.

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
12/16/2022 01/01/2023 - N/A Currently in Effect You are here
01/13/2021 04/29/2020 - 12/31/2022 Superseded View
Some older versions have been archived. Please visit the MCD Archive Site to retrieve them.

Keywords

  • SphenoCath®
  • Sphenopalatine
  • 64400
  • 64505
  • 64999