Local Coverage Article Billing and Coding

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

A56953

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Contractor Information

Article Information

General Information

Article ID
A56953
Article Title
Billing and Coding: Hypoglossal Nerve Stimulation for the Treatment of Obstructive Sleep Apnea
Article Type
Billing and Coding
Original Effective Date
03/16/2020
Revision Effective Date
01/01/2022
Revision Ending Date
N/A
Retirement Date
N/A
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Article Guidance

Article Text

This Billing and Coding Article provides billing and coding guidance for Local Coverage Determination (LCD) L38398, 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.

Coding Information

CPT/HCPCS Codes

Group 1

(3 Codes)
Group 1 Paragraph

Note: Providers are reminded to refer to the long descriptors of the CPT codes in their CPT book.

Group 1 Codes
CodeDescription
64582 Opn mpltj hpglsl nstm ary pg
64583 Rev/rplct hpglsl nstm ary pg
64584 Rmvl hpglsl nstim ary pg

CPT/HCPCS Modifiers

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 L38398 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
CodeDescription
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
CodeDescription
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

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
CodeDescription
XX000 Not Applicable

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
01/01/2022 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 services 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: Z68.30 in Group 2 Codes.

10/01/2020 R2

Revision Number: 2
Publication: September 2020 Connection
LCR A/B2020-065

Explanation of Revision: Based on CR 11895 and CR 11845 (Annual 2021 ICD-10-CM Update), the following ICD-10-CM codes in the “ICD-10 Codes that Support Medical Necessity/ Group 2 Codes:” section of this billing and coding article, have undergone a descriptor change: 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 have been made throughout the article. The effective date of this revision is based on date of service.

03/16/2020 R1

Billing and coding article related to L38398, Hypoglossal Nerve Stimulation for the Treatment of Obstructive Sleep Apnea published on 01/30/2020.

Associated Documents

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