Refer to the Local Coverage Determination (LCD) L38307, Hypoglossal Nerve Stimulation for the Treatment of Obstructive Sleep Apnea, for reasonable and necessary requirements.
The Current Procedural Terminology (CPT)/Healthcare Common Procedure Coding System (HCPCS) code(s) may be subject to National Correct Coding Initiative (NCCI) edits. This information does not take precedence over NCCI edits. Please refer to NCCI for correct coding guidelines and specific applicable code combinations prior to billing Medicare.
Coding Guidelines
Implantation of a Hypoglossal Nerve Stimulator (HSN) for treatment of OSA utilizes 2 CPT codes:
Beginning 01/01/2022 use single code:
- CPT 64582 Open implantation of hypoglossal nerve stimulator array, pulse generator, and distal respiratory sensor electrode or electrode array
Coding Information
- Effective 1/1/22 CPT code 64568 is no longer used for hypoglossal nerve stimulator due to development of specific CPT codes for this technology 64582-64584
Documentation Requirements
- All documentation must be maintained in the patient's medical record and made available to the contractor upon request.
- 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.
- The submitted medical record must support the use of the selected diagnosis code(s).
Informational Only:
Removal, revisions and replacements related to implantable devices are addressed in Medicare Benefit Policy Manual, Chapter 16, Section 180, “Services Related to and Required as a Result of Services Which Are Not Covered Under Medicare”
Effective 1/1/22 0466T, 0467T and 0468T are deleted codes. Services for revision, replacement or removal of hypoglossal nerve stimulator components should be billed with:
- CPT 64583 Revision or replacement of hypoglossal nerve stimulator array and distal respiratory sensor electrode or electrode array, including connections to existing pulse generator
- CPT 64584 removal of hypoglossal nerve rose stimulator array pulse generator, and distal respiratory sensor electrode or electrode array
Utilization Guidelines
In accordance with CMS Ruling 95-1 (V), utilization of these services should be consistent with locally acceptable standards of practice.
