LCD Reference Article Billing and Coding Article

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

A56938

Expand All | Collapse All
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.

Document Note

Note History

Contractor Information

Article Information

General Information

Source Article ID
N/A
Article ID
A56938
Original ICD-9 Article ID
Not Applicable
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
01/01/2022
Revision Ending Date
N/A
Retirement Date
N/A

CPT codes, descriptions, and other data only are copyright 2023 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.

Current Dental Terminology © 2023 American Dental Association. All rights reserved.

Copyright © 2024, the American Hospital Association, Chicago, Illinois. Reproduced with permission. No portion of the AHA copyrighted materials contained within this publication may be copied without the express written consent of the AHA. AHA copyrighted materials including the UB‐04 codes and descriptions may not be removed, copied, or utilized within any software, product, service, solution, or derivative work without the written consent of the AHA. If an entity wishes to utilize any AHA materials, please contact the AHA at 312‐893‐6816.

Making copies or utilizing the content of the UB‐04 Manual, including the codes and/or descriptions, for internal purposes, resale and/or to be used in any product or publication; creating any modified or derivative work of the UB‐04 Manual and/or codes and descriptions; and/or making any commercial use of UB‐04 Manual or any portion thereof, including the codes and/or descriptions, is only authorized with an express license from the American Hospital Association. The American Hospital Association (the "AHA") has not reviewed, and is not responsible for, the completeness or accuracy of any information contained in this material, nor was the AHA or any of its affiliates, involved in the preparation of this material, or the analysis of information provided in the material. The views and/or positions presented in the material do not necessarily represent the views of the AHA. CMS and its products and services are not endorsed by the AHA or any of its affiliates.

CMS National Coverage Policy

Social Security Act (Title XVIII) Standard References:

  • Title XVIII of the Social Security Act, Section 1833(e) states that no payment shall be made to any provider of services or other person under this part unless there has been furnished such information as may be necessary in order to determine the amounts due such provider or other person under this part for the period with respect to which the amounts are being paid or for any prior period.

Article Guidance

Article Text

This Billing and Coding Article provides billing and coding guidance for Local Coverage Determination (LCD) L38385, Hypoglossal Nerve Stimulation for the Treatment of Obstructive Sleep Apnea. Please refer to the LCD for reasonable and necessary requirements.

Coding Guidance

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

Implantation of a Hypoglossal Nerve Stimulator (HNS) for treatment of Obstructive Sleep Apnea (OSA) is reported with:

CPT code 64582 - Open implantation of both the neurostimulator and its corresponding electrode array.

Revision or Replacement of HNS for treatment of OSA is reported with:

CPT code 64583 - Revision or replacement of chest wall respiratory sensor electrode or electrode array, including connection to existing pulse generator.

Replacement of HNS for treatment of OSA is reported with:

Per AMA CPT, use CPT code 61886 for the Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to two or more electrode arrays.

Removal of HNS for treatment of OSA is reported with:

CPT code 64584 - Removal of chest wall respiratory sensor electrode or electrode array.

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

Number Comment Response
1
N/A

Coding Information

Bill Type Codes

Code Description

Please accept the License to see the codes.

N/A

Revenue Codes

Code Description

Please accept the License to see the codes.

N/A

CPT/HCPCS Codes

Please accept the License to see the codes.

N/A

CPT/HCPCS Modifiers

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

ICD-10-CM Codes that Support Medical Necessity

Group 1

(1 Code)
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 L38385 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 Group1 Codes and a secondary diagnosis code from Group 2 Codes below.

Note:
CPT code 64584 will have no diagnosis to procedure code restriction at this time.

The following ICD-10-CM codes support medical necessity and provide coverage for CPT codes 64582 and 64583.

Primary Diagnosis

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

Group 2

(16 Codes)
Group 2 Paragraph

The following ICD-10-CM codes support medical necessity and provide coverage for CPT codes 64582 and 64583.


Secondary Diagnosis

Group 2 Codes
Code Description
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
N/A

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

Group 1

(1 Code)
Group 1 Paragraph

All those not listed under the "ICD-10 Codes that Support Medical Necessity" section of this article.

Group 1 Codes
Code Description
XX000 Not Applicable
N/A

ICD-10-PCS Codes

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

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.

Code Description

Please accept the License to see the codes.

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.

Code Description

Please accept the License to see the codes.

N/A

Other Coding Information

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

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

Revision History Information

Revision History Date Revision History Number Revision History Explanation
01/01/2022 R4

Article revised and published on 01/20/2022 effective for dates of service on and after 01/01/2022 to reflect the Annual CPT/HCPCS Code Updates.

The CPT code 64568 has been removed from the article and replaced with CPT code 64582.

The following CPT codes have been added to the CPT/HCPCS Group 1 codes and Coding Guidance sections: 64582, 64583, and 64584. The CPT codes 64582 and 64583 have also been added to the ICD-10-CM Codes that Support Medical Necessity/Group 1 and Group 2 Paragraph sections.

The following CPT codes have been deleted and therefore have been removed from the article: 0466T, 0467T, and 0468T have been removed from the CPT/HCPCS Group 1 codes and Coding Guidance sections. Codes 0466T and 0467T have been removed from the ICD-10-CM Codes that Support Medical Necessity/Group 1 Paragraph section.

Minor formatting changes have been made throughout the Article.

10/01/2021 R3

Article revised and published on 10/14/2021 effective for dates of service on and after 10/01/2021 to reflect the Annual ICD-10-CM Code Updates. The following ICD-10-CM code has undergone a descriptor change: Group 2 Codes: Z68.30. In addition, minor formatting changes were made throughout the article.

10/01/2020 R2

Article revised and published on 10/01/2020 effective for dates of service on and after 10/01/2020 to reflect the Annual ICD-10-CM Code Updates. The following ICD-10-CM code(s) have undergone a descriptor change: Group 2 Codes: 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 and Z68.34. In addition, formatting changes were made throughout the article.

03/15/2020 R1

Future billing and coding article related to L38385, Hypoglossal Nerve Stimulation for the Treatment of Obstructive Sleep Apnea published on 01/30/2020 and will become effective on 03/15/2020.

N/A

Associated Documents

Medicare BPM Ch 15.50.2 SAD Determinations
Medicare BPM Ch 15.50.2
Related National Coverage Documents
N/A
SAD Process URL 1
N/A
SAD Process URL 2
N/A
Statutory Requirements URLs
N/A
Rules and Regulations URLs
N/A
CMS Manual Explanations URLs
N/A
Other URLs
N/A
Public Versions
Updated On Effective Dates Status
01/14/2022 01/01/2022 - N/A Currently in Effect You are here
Some older versions have been archived. Please visit the MCD Archive Site to retrieve them.

Keywords

N/A