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1996
|
Daily Hospital Management Of Epidural Or Subarachnoid Continuous Drug Administration
|
HCPCS
|
Because of the number of healthcare claims processed and paid by the Medicare Part B program, NCCI policies have been in place since 1996 to ensure that only appropriate claims are paid. The system has been expanded to include claims submitted under the Outpatient Prospective Payment System (OPPS) and claims submitted by skilled nursing facilities (SNFs). HCPCS Codes and NCCI
Medical billers and medical coders need to be aware of the current guidance established by the NCCI when they submit claims to Medicare. While the guidelines are updated quarterly, a basic understanding of the use of HCPCS, and how they are meant to be used according to the NCCI, is essential to adapt to the ongoing changes in the healthcare industry. Employers can be assured that professional medical billers and certified medical coders have this understanding after they have successfully completed a formal program of study offered by an accredited institution that teaches medical billing and medical coding.
|
63650
|
PR PRQ IMPLTJ NSTIM ELECTRODE ARRAY EPIDURAL
|
HCPCS
|
Centers for Medicare and Medicaid Services (CMS). National Coverage Determination for Electrical Nerve Stimulators (160.7). Available online at: http://www.cms.hhs.gov. Last accessed November, 2011. |CPT||63650||Percutaneous implantation of neurostimulator electrode array; epidural|
|63655||Laminectomy for implantation of neurostimulator electrode plate/paddle; epidural|
|63661||Removal of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63662||Removal of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy (new code 1/1/10)|
|63663||Revision including replacement, when performed, of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63664||Revision including replacement, when performed, of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy, including fluoroscopy, when performed (new code 1/1/10)|
|63685||Insertion or replacement of spinal neurostimulator pulse generator or receiver, direct or inductive coupling|
|63688||Revision or removal of implanted spinal neurostimulator pulse generator or receiver|
|95970, 95971, 95972, 95973||Neurostimulator programming and analysis code range|
|ICD-9 Procedure||03.93||Insertion or replacement of spinal neurostimulator|
|03.94||Removal of spinal neurostimulator lead(s)|
|86.05||Incision with removal of foreign body or device from skin and subcutaneous tissue (used to report removal of a neurostimulator pulse generator)|
|86.94||Insertion or replacement of single array neurostimulator pulse generator, not specified as rechargeable|
|86.95||Insertion or replacement of dual array neurostimulator pulse generator, not specified as rechargeable|
|86.97||Insertion or replacement of single array rechargeable neurostimulator pulse generator (new code effective 10/1/05)|
|86.98||Insertion or replacement of dual array rechargeable neurostimulator pulse generation (new code effective 10/1/05)|
|ICD-9 Diagnosis||See “Pain” in ICD-9 diagnosis index|
|HCPCS||L8680||Implantable neurostimulator electrode, each (new code effective 1/1/06)|
|L8685||Implantable neurostimulator pulse generator, single array, rechargeable, includes extension (new code effective 1/1/06)|
|L8686||Implantable neurostimulator pulse generator, single array, nonrechargeable, includes extension (new code effective 1/1/06)|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension (new code effective 1/1/06)|
|L8688||Implantable neurostimulator pulse generator, dual array, nonrechargeable, includes extension (new code effective 1/1/06)|
|ICD-10-CM (effective 10/1/14)||This list is a representative list of severe and chronic pain of the trunk and limbs diagnosis codes.|
|G56.40 -G56.42||Causalgia of upper limb code range|
|G57.70 -G57.72||Causalgia of lower limb code range|
|G89.21 -G89.8||Chronic pain, not elsewhere classified, code range|
|G89.4||Chronic pain syndrome|
|G90.50 -G90.59||Complex regional pain syndrome I (CRPS I), code range|
|M25.50 -M25.579||Pain in joint, code range|
|M54.10 -M54.18||Radiculopathy, code range|
|M54.30 -M54.32||Sciatica, code range|
|M54.40 -M54.42||Lumbago with sciatica, code range|
|M54.5||Low back pain|
|M54.6||Pain in thoracic spine|
|M54.81, M54.89||Other dorsalgia codes|
|M79.60 -M79.676||Pain in limb, hand, foot, fingers and toes code range|
|ICD-10-PCS (effective 10/1/14)||ICD-10-PCS codes are only used for inpatient services.|
|Surgical, central nervous system, insertion, spinal canal, neurostimulator lead, code by approach|
|00HV0MZ, 00HV3MZ, 00HV4MZ||Surgical, central nervous system, insertion, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, removal, spinal canal, neurostimulator lead, code by approach|
|00PV0MZ, 00PV3MZ, 00PV4MZ||Surgical, central nervous system, removal, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, revision, spinal canal, neurostimulator lead, code by approach|
|00WV0MZ, 00WV3MZ, 00WV4MZ||Surgical, central nervous system, revision, spinal cord, neurostimulator lead, code by approach|
|0JH60M6, 0JH60M7, 0JH60M8, 0JH60M9, 0JH63M6, 0JH63M7, 0JH63M8, 0JH63M9, 0JH70M6, 0JH70M7, 0JH70M8, 0JH70M9, 0JH73M6, 0JH73M7, 0JH73M8, 0JH73M9, 0JH80M6, 0JH80M7, 0JH80M8, 0JH80M9, 0JH83M6, 0JH83M7, 0JH83M8, 0JH83M9||Surgical, subcutaneous tissue and fascia, insertion, stimulator generator, code by body part, approach, number of arrays and whether rechargeable or not|
|0JPT0MZ, 0JPT3MZ||Surgical, subcutaneous tissue and fascia, removal, subcutaneous tissue and fascia, trunk, stimulator generator, code by approach (there aren’t ICD-10-PCS codes for removal of stimulator generator from other body parts)|
|Type of Service||Surgical|
|Place of Service||Inpatient/Outpatient|
Electrical Nerve Stimulation, Spinal
Spinal Cord Stimulation
Stimulation, Electrical, Spinal Cord
|03/31/96||Add to Surgery section||New policy|
|04/01/98||Replace policy||Policy cross-referenced to No.
|
63661
|
Remove spine eltrd perq aray
|
HCPCS
|
Centers for Medicare and Medicaid Services (CMS). National Coverage Determination for Electrical Nerve Stimulators (160.7). Available online at: http://www.cms.hhs.gov. Last accessed November, 2011. |CPT||63650||Percutaneous implantation of neurostimulator electrode array; epidural|
|63655||Laminectomy for implantation of neurostimulator electrode plate/paddle; epidural|
|63661||Removal of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63662||Removal of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy (new code 1/1/10)|
|63663||Revision including replacement, when performed, of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63664||Revision including replacement, when performed, of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy, including fluoroscopy, when performed (new code 1/1/10)|
|63685||Insertion or replacement of spinal neurostimulator pulse generator or receiver, direct or inductive coupling|
|63688||Revision or removal of implanted spinal neurostimulator pulse generator or receiver|
|95970, 95971, 95972, 95973||Neurostimulator programming and analysis code range|
|ICD-9 Procedure||03.93||Insertion or replacement of spinal neurostimulator|
|03.94||Removal of spinal neurostimulator lead(s)|
|86.05||Incision with removal of foreign body or device from skin and subcutaneous tissue (used to report removal of a neurostimulator pulse generator)|
|86.94||Insertion or replacement of single array neurostimulator pulse generator, not specified as rechargeable|
|86.95||Insertion or replacement of dual array neurostimulator pulse generator, not specified as rechargeable|
|86.97||Insertion or replacement of single array rechargeable neurostimulator pulse generator (new code effective 10/1/05)|
|86.98||Insertion or replacement of dual array rechargeable neurostimulator pulse generation (new code effective 10/1/05)|
|ICD-9 Diagnosis||See “Pain” in ICD-9 diagnosis index|
|HCPCS||L8680||Implantable neurostimulator electrode, each (new code effective 1/1/06)|
|L8685||Implantable neurostimulator pulse generator, single array, rechargeable, includes extension (new code effective 1/1/06)|
|L8686||Implantable neurostimulator pulse generator, single array, nonrechargeable, includes extension (new code effective 1/1/06)|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension (new code effective 1/1/06)|
|L8688||Implantable neurostimulator pulse generator, dual array, nonrechargeable, includes extension (new code effective 1/1/06)|
|ICD-10-CM (effective 10/1/14)||This list is a representative list of severe and chronic pain of the trunk and limbs diagnosis codes.|
|G56.40 -G56.42||Causalgia of upper limb code range|
|G57.70 -G57.72||Causalgia of lower limb code range|
|G89.21 -G89.8||Chronic pain, not elsewhere classified, code range|
|G89.4||Chronic pain syndrome|
|G90.50 -G90.59||Complex regional pain syndrome I (CRPS I), code range|
|M25.50 -M25.579||Pain in joint, code range|
|M54.10 -M54.18||Radiculopathy, code range|
|M54.30 -M54.32||Sciatica, code range|
|M54.40 -M54.42||Lumbago with sciatica, code range|
|M54.5||Low back pain|
|M54.6||Pain in thoracic spine|
|M54.81, M54.89||Other dorsalgia codes|
|M79.60 -M79.676||Pain in limb, hand, foot, fingers and toes code range|
|ICD-10-PCS (effective 10/1/14)||ICD-10-PCS codes are only used for inpatient services.|
|Surgical, central nervous system, insertion, spinal canal, neurostimulator lead, code by approach|
|00HV0MZ, 00HV3MZ, 00HV4MZ||Surgical, central nervous system, insertion, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, removal, spinal canal, neurostimulator lead, code by approach|
|00PV0MZ, 00PV3MZ, 00PV4MZ||Surgical, central nervous system, removal, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, revision, spinal canal, neurostimulator lead, code by approach|
|00WV0MZ, 00WV3MZ, 00WV4MZ||Surgical, central nervous system, revision, spinal cord, neurostimulator lead, code by approach|
|0JH60M6, 0JH60M7, 0JH60M8, 0JH60M9, 0JH63M6, 0JH63M7, 0JH63M8, 0JH63M9, 0JH70M6, 0JH70M7, 0JH70M8, 0JH70M9, 0JH73M6, 0JH73M7, 0JH73M8, 0JH73M9, 0JH80M6, 0JH80M7, 0JH80M8, 0JH80M9, 0JH83M6, 0JH83M7, 0JH83M8, 0JH83M9||Surgical, subcutaneous tissue and fascia, insertion, stimulator generator, code by body part, approach, number of arrays and whether rechargeable or not|
|0JPT0MZ, 0JPT3MZ||Surgical, subcutaneous tissue and fascia, removal, subcutaneous tissue and fascia, trunk, stimulator generator, code by approach (there aren’t ICD-10-PCS codes for removal of stimulator generator from other body parts)|
|Type of Service||Surgical|
|Place of Service||Inpatient/Outpatient|
Electrical Nerve Stimulation, Spinal
Spinal Cord Stimulation
Stimulation, Electrical, Spinal Cord
|03/31/96||Add to Surgery section||New policy|
|04/01/98||Replace policy||Policy cross-referenced to No.
|
95972
|
PR ELEC ALYS IMPLT NPGT CPLX SP/PN PRGRMG
|
HCPCS
|
Centers for Medicare and Medicaid Services (CMS). National Coverage Determination for Electrical Nerve Stimulators (160.7). Available online at: http://www.cms.hhs.gov. Last accessed November, 2011. |CPT||63650||Percutaneous implantation of neurostimulator electrode array; epidural|
|63655||Laminectomy for implantation of neurostimulator electrode plate/paddle; epidural|
|63661||Removal of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63662||Removal of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy (new code 1/1/10)|
|63663||Revision including replacement, when performed, of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63664||Revision including replacement, when performed, of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy, including fluoroscopy, when performed (new code 1/1/10)|
|63685||Insertion or replacement of spinal neurostimulator pulse generator or receiver, direct or inductive coupling|
|63688||Revision or removal of implanted spinal neurostimulator pulse generator or receiver|
|95970, 95971, 95972, 95973||Neurostimulator programming and analysis code range|
|ICD-9 Procedure||03.93||Insertion or replacement of spinal neurostimulator|
|03.94||Removal of spinal neurostimulator lead(s)|
|86.05||Incision with removal of foreign body or device from skin and subcutaneous tissue (used to report removal of a neurostimulator pulse generator)|
|86.94||Insertion or replacement of single array neurostimulator pulse generator, not specified as rechargeable|
|86.95||Insertion or replacement of dual array neurostimulator pulse generator, not specified as rechargeable|
|86.97||Insertion or replacement of single array rechargeable neurostimulator pulse generator (new code effective 10/1/05)|
|86.98||Insertion or replacement of dual array rechargeable neurostimulator pulse generation (new code effective 10/1/05)|
|ICD-9 Diagnosis||See “Pain” in ICD-9 diagnosis index|
|HCPCS||L8680||Implantable neurostimulator electrode, each (new code effective 1/1/06)|
|L8685||Implantable neurostimulator pulse generator, single array, rechargeable, includes extension (new code effective 1/1/06)|
|L8686||Implantable neurostimulator pulse generator, single array, nonrechargeable, includes extension (new code effective 1/1/06)|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension (new code effective 1/1/06)|
|L8688||Implantable neurostimulator pulse generator, dual array, nonrechargeable, includes extension (new code effective 1/1/06)|
|ICD-10-CM (effective 10/1/14)||This list is a representative list of severe and chronic pain of the trunk and limbs diagnosis codes.|
|G56.40 -G56.42||Causalgia of upper limb code range|
|G57.70 -G57.72||Causalgia of lower limb code range|
|G89.21 -G89.8||Chronic pain, not elsewhere classified, code range|
|G89.4||Chronic pain syndrome|
|G90.50 -G90.59||Complex regional pain syndrome I (CRPS I), code range|
|M25.50 -M25.579||Pain in joint, code range|
|M54.10 -M54.18||Radiculopathy, code range|
|M54.30 -M54.32||Sciatica, code range|
|M54.40 -M54.42||Lumbago with sciatica, code range|
|M54.5||Low back pain|
|M54.6||Pain in thoracic spine|
|M54.81, M54.89||Other dorsalgia codes|
|M79.60 -M79.676||Pain in limb, hand, foot, fingers and toes code range|
|ICD-10-PCS (effective 10/1/14)||ICD-10-PCS codes are only used for inpatient services.|
|Surgical, central nervous system, insertion, spinal canal, neurostimulator lead, code by approach|
|00HV0MZ, 00HV3MZ, 00HV4MZ||Surgical, central nervous system, insertion, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, removal, spinal canal, neurostimulator lead, code by approach|
|00PV0MZ, 00PV3MZ, 00PV4MZ||Surgical, central nervous system, removal, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, revision, spinal canal, neurostimulator lead, code by approach|
|00WV0MZ, 00WV3MZ, 00WV4MZ||Surgical, central nervous system, revision, spinal cord, neurostimulator lead, code by approach|
|0JH60M6, 0JH60M7, 0JH60M8, 0JH60M9, 0JH63M6, 0JH63M7, 0JH63M8, 0JH63M9, 0JH70M6, 0JH70M7, 0JH70M8, 0JH70M9, 0JH73M6, 0JH73M7, 0JH73M8, 0JH73M9, 0JH80M6, 0JH80M7, 0JH80M8, 0JH80M9, 0JH83M6, 0JH83M7, 0JH83M8, 0JH83M9||Surgical, subcutaneous tissue and fascia, insertion, stimulator generator, code by body part, approach, number of arrays and whether rechargeable or not|
|0JPT0MZ, 0JPT3MZ||Surgical, subcutaneous tissue and fascia, removal, subcutaneous tissue and fascia, trunk, stimulator generator, code by approach (there aren’t ICD-10-PCS codes for removal of stimulator generator from other body parts)|
|Type of Service||Surgical|
|Place of Service||Inpatient/Outpatient|
Electrical Nerve Stimulation, Spinal
Spinal Cord Stimulation
Stimulation, Electrical, Spinal Cord
|03/31/96||Add to Surgery section||New policy|
|04/01/98||Replace policy||Policy cross-referenced to No.
|
L8688
|
Implt nrostm pls gen dua non
|
HCPCS
|
Centers for Medicare and Medicaid Services (CMS). National Coverage Determination for Electrical Nerve Stimulators (160.7). Available online at: http://www.cms.hhs.gov. Last accessed November, 2011. |CPT||63650||Percutaneous implantation of neurostimulator electrode array; epidural|
|63655||Laminectomy for implantation of neurostimulator electrode plate/paddle; epidural|
|63661||Removal of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63662||Removal of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy (new code 1/1/10)|
|63663||Revision including replacement, when performed, of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63664||Revision including replacement, when performed, of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy, including fluoroscopy, when performed (new code 1/1/10)|
|63685||Insertion or replacement of spinal neurostimulator pulse generator or receiver, direct or inductive coupling|
|63688||Revision or removal of implanted spinal neurostimulator pulse generator or receiver|
|95970, 95971, 95972, 95973||Neurostimulator programming and analysis code range|
|ICD-9 Procedure||03.93||Insertion or replacement of spinal neurostimulator|
|03.94||Removal of spinal neurostimulator lead(s)|
|86.05||Incision with removal of foreign body or device from skin and subcutaneous tissue (used to report removal of a neurostimulator pulse generator)|
|86.94||Insertion or replacement of single array neurostimulator pulse generator, not specified as rechargeable|
|86.95||Insertion or replacement of dual array neurostimulator pulse generator, not specified as rechargeable|
|86.97||Insertion or replacement of single array rechargeable neurostimulator pulse generator (new code effective 10/1/05)|
|86.98||Insertion or replacement of dual array rechargeable neurostimulator pulse generation (new code effective 10/1/05)|
|ICD-9 Diagnosis||See “Pain” in ICD-9 diagnosis index|
|HCPCS||L8680||Implantable neurostimulator electrode, each (new code effective 1/1/06)|
|L8685||Implantable neurostimulator pulse generator, single array, rechargeable, includes extension (new code effective 1/1/06)|
|L8686||Implantable neurostimulator pulse generator, single array, nonrechargeable, includes extension (new code effective 1/1/06)|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension (new code effective 1/1/06)|
|L8688||Implantable neurostimulator pulse generator, dual array, nonrechargeable, includes extension (new code effective 1/1/06)|
|ICD-10-CM (effective 10/1/14)||This list is a representative list of severe and chronic pain of the trunk and limbs diagnosis codes.|
|G56.40 -G56.42||Causalgia of upper limb code range|
|G57.70 -G57.72||Causalgia of lower limb code range|
|G89.21 -G89.8||Chronic pain, not elsewhere classified, code range|
|G89.4||Chronic pain syndrome|
|G90.50 -G90.59||Complex regional pain syndrome I (CRPS I), code range|
|M25.50 -M25.579||Pain in joint, code range|
|M54.10 -M54.18||Radiculopathy, code range|
|M54.30 -M54.32||Sciatica, code range|
|M54.40 -M54.42||Lumbago with sciatica, code range|
|M54.5||Low back pain|
|M54.6||Pain in thoracic spine|
|M54.81, M54.89||Other dorsalgia codes|
|M79.60 -M79.676||Pain in limb, hand, foot, fingers and toes code range|
|ICD-10-PCS (effective 10/1/14)||ICD-10-PCS codes are only used for inpatient services.|
|Surgical, central nervous system, insertion, spinal canal, neurostimulator lead, code by approach|
|00HV0MZ, 00HV3MZ, 00HV4MZ||Surgical, central nervous system, insertion, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, removal, spinal canal, neurostimulator lead, code by approach|
|00PV0MZ, 00PV3MZ, 00PV4MZ||Surgical, central nervous system, removal, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, revision, spinal canal, neurostimulator lead, code by approach|
|00WV0MZ, 00WV3MZ, 00WV4MZ||Surgical, central nervous system, revision, spinal cord, neurostimulator lead, code by approach|
|0JH60M6, 0JH60M7, 0JH60M8, 0JH60M9, 0JH63M6, 0JH63M7, 0JH63M8, 0JH63M9, 0JH70M6, 0JH70M7, 0JH70M8, 0JH70M9, 0JH73M6, 0JH73M7, 0JH73M8, 0JH73M9, 0JH80M6, 0JH80M7, 0JH80M8, 0JH80M9, 0JH83M6, 0JH83M7, 0JH83M8, 0JH83M9||Surgical, subcutaneous tissue and fascia, insertion, stimulator generator, code by body part, approach, number of arrays and whether rechargeable or not|
|0JPT0MZ, 0JPT3MZ||Surgical, subcutaneous tissue and fascia, removal, subcutaneous tissue and fascia, trunk, stimulator generator, code by approach (there aren’t ICD-10-PCS codes for removal of stimulator generator from other body parts)|
|Type of Service||Surgical|
|Place of Service||Inpatient/Outpatient|
Electrical Nerve Stimulation, Spinal
Spinal Cord Stimulation
Stimulation, Electrical, Spinal Cord
|03/31/96||Add to Surgery section||New policy|
|04/01/98||Replace policy||Policy cross-referenced to No.
|
L8680
|
KIT NRSTM 40CM STIMLOC .
|
HCPCS
|
Centers for Medicare and Medicaid Services (CMS). National Coverage Determination for Electrical Nerve Stimulators (160.7). Available online at: http://www.cms.hhs.gov. Last accessed November, 2011. |CPT||63650||Percutaneous implantation of neurostimulator electrode array; epidural|
|63655||Laminectomy for implantation of neurostimulator electrode plate/paddle; epidural|
|63661||Removal of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63662||Removal of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy (new code 1/1/10)|
|63663||Revision including replacement, when performed, of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63664||Revision including replacement, when performed, of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy, including fluoroscopy, when performed (new code 1/1/10)|
|63685||Insertion or replacement of spinal neurostimulator pulse generator or receiver, direct or inductive coupling|
|63688||Revision or removal of implanted spinal neurostimulator pulse generator or receiver|
|95970, 95971, 95972, 95973||Neurostimulator programming and analysis code range|
|ICD-9 Procedure||03.93||Insertion or replacement of spinal neurostimulator|
|03.94||Removal of spinal neurostimulator lead(s)|
|86.05||Incision with removal of foreign body or device from skin and subcutaneous tissue (used to report removal of a neurostimulator pulse generator)|
|86.94||Insertion or replacement of single array neurostimulator pulse generator, not specified as rechargeable|
|86.95||Insertion or replacement of dual array neurostimulator pulse generator, not specified as rechargeable|
|86.97||Insertion or replacement of single array rechargeable neurostimulator pulse generator (new code effective 10/1/05)|
|86.98||Insertion or replacement of dual array rechargeable neurostimulator pulse generation (new code effective 10/1/05)|
|ICD-9 Diagnosis||See “Pain” in ICD-9 diagnosis index|
|HCPCS||L8680||Implantable neurostimulator electrode, each (new code effective 1/1/06)|
|L8685||Implantable neurostimulator pulse generator, single array, rechargeable, includes extension (new code effective 1/1/06)|
|L8686||Implantable neurostimulator pulse generator, single array, nonrechargeable, includes extension (new code effective 1/1/06)|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension (new code effective 1/1/06)|
|L8688||Implantable neurostimulator pulse generator, dual array, nonrechargeable, includes extension (new code effective 1/1/06)|
|ICD-10-CM (effective 10/1/14)||This list is a representative list of severe and chronic pain of the trunk and limbs diagnosis codes.|
|G56.40 -G56.42||Causalgia of upper limb code range|
|G57.70 -G57.72||Causalgia of lower limb code range|
|G89.21 -G89.8||Chronic pain, not elsewhere classified, code range|
|G89.4||Chronic pain syndrome|
|G90.50 -G90.59||Complex regional pain syndrome I (CRPS I), code range|
|M25.50 -M25.579||Pain in joint, code range|
|M54.10 -M54.18||Radiculopathy, code range|
|M54.30 -M54.32||Sciatica, code range|
|M54.40 -M54.42||Lumbago with sciatica, code range|
|M54.5||Low back pain|
|M54.6||Pain in thoracic spine|
|M54.81, M54.89||Other dorsalgia codes|
|M79.60 -M79.676||Pain in limb, hand, foot, fingers and toes code range|
|ICD-10-PCS (effective 10/1/14)||ICD-10-PCS codes are only used for inpatient services.|
|Surgical, central nervous system, insertion, spinal canal, neurostimulator lead, code by approach|
|00HV0MZ, 00HV3MZ, 00HV4MZ||Surgical, central nervous system, insertion, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, removal, spinal canal, neurostimulator lead, code by approach|
|00PV0MZ, 00PV3MZ, 00PV4MZ||Surgical, central nervous system, removal, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, revision, spinal canal, neurostimulator lead, code by approach|
|00WV0MZ, 00WV3MZ, 00WV4MZ||Surgical, central nervous system, revision, spinal cord, neurostimulator lead, code by approach|
|0JH60M6, 0JH60M7, 0JH60M8, 0JH60M9, 0JH63M6, 0JH63M7, 0JH63M8, 0JH63M9, 0JH70M6, 0JH70M7, 0JH70M8, 0JH70M9, 0JH73M6, 0JH73M7, 0JH73M8, 0JH73M9, 0JH80M6, 0JH80M7, 0JH80M8, 0JH80M9, 0JH83M6, 0JH83M7, 0JH83M8, 0JH83M9||Surgical, subcutaneous tissue and fascia, insertion, stimulator generator, code by body part, approach, number of arrays and whether rechargeable or not|
|0JPT0MZ, 0JPT3MZ||Surgical, subcutaneous tissue and fascia, removal, subcutaneous tissue and fascia, trunk, stimulator generator, code by approach (there aren’t ICD-10-PCS codes for removal of stimulator generator from other body parts)|
|Type of Service||Surgical|
|Place of Service||Inpatient/Outpatient|
Electrical Nerve Stimulation, Spinal
Spinal Cord Stimulation
Stimulation, Electrical, Spinal Cord
|03/31/96||Add to Surgery section||New policy|
|04/01/98||Replace policy||Policy cross-referenced to No.
|
63662
|
Remove spine eltrd plate
|
HCPCS
|
Centers for Medicare and Medicaid Services (CMS). National Coverage Determination for Electrical Nerve Stimulators (160.7). Available online at: http://www.cms.hhs.gov. Last accessed November, 2011. |CPT||63650||Percutaneous implantation of neurostimulator electrode array; epidural|
|63655||Laminectomy for implantation of neurostimulator electrode plate/paddle; epidural|
|63661||Removal of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63662||Removal of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy (new code 1/1/10)|
|63663||Revision including replacement, when performed, of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63664||Revision including replacement, when performed, of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy, including fluoroscopy, when performed (new code 1/1/10)|
|63685||Insertion or replacement of spinal neurostimulator pulse generator or receiver, direct or inductive coupling|
|63688||Revision or removal of implanted spinal neurostimulator pulse generator or receiver|
|95970, 95971, 95972, 95973||Neurostimulator programming and analysis code range|
|ICD-9 Procedure||03.93||Insertion or replacement of spinal neurostimulator|
|03.94||Removal of spinal neurostimulator lead(s)|
|86.05||Incision with removal of foreign body or device from skin and subcutaneous tissue (used to report removal of a neurostimulator pulse generator)|
|86.94||Insertion or replacement of single array neurostimulator pulse generator, not specified as rechargeable|
|86.95||Insertion or replacement of dual array neurostimulator pulse generator, not specified as rechargeable|
|86.97||Insertion or replacement of single array rechargeable neurostimulator pulse generator (new code effective 10/1/05)|
|86.98||Insertion or replacement of dual array rechargeable neurostimulator pulse generation (new code effective 10/1/05)|
|ICD-9 Diagnosis||See “Pain” in ICD-9 diagnosis index|
|HCPCS||L8680||Implantable neurostimulator electrode, each (new code effective 1/1/06)|
|L8685||Implantable neurostimulator pulse generator, single array, rechargeable, includes extension (new code effective 1/1/06)|
|L8686||Implantable neurostimulator pulse generator, single array, nonrechargeable, includes extension (new code effective 1/1/06)|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension (new code effective 1/1/06)|
|L8688||Implantable neurostimulator pulse generator, dual array, nonrechargeable, includes extension (new code effective 1/1/06)|
|ICD-10-CM (effective 10/1/14)||This list is a representative list of severe and chronic pain of the trunk and limbs diagnosis codes.|
|G56.40 -G56.42||Causalgia of upper limb code range|
|G57.70 -G57.72||Causalgia of lower limb code range|
|G89.21 -G89.8||Chronic pain, not elsewhere classified, code range|
|G89.4||Chronic pain syndrome|
|G90.50 -G90.59||Complex regional pain syndrome I (CRPS I), code range|
|M25.50 -M25.579||Pain in joint, code range|
|M54.10 -M54.18||Radiculopathy, code range|
|M54.30 -M54.32||Sciatica, code range|
|M54.40 -M54.42||Lumbago with sciatica, code range|
|M54.5||Low back pain|
|M54.6||Pain in thoracic spine|
|M54.81, M54.89||Other dorsalgia codes|
|M79.60 -M79.676||Pain in limb, hand, foot, fingers and toes code range|
|ICD-10-PCS (effective 10/1/14)||ICD-10-PCS codes are only used for inpatient services.|
|Surgical, central nervous system, insertion, spinal canal, neurostimulator lead, code by approach|
|00HV0MZ, 00HV3MZ, 00HV4MZ||Surgical, central nervous system, insertion, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, removal, spinal canal, neurostimulator lead, code by approach|
|00PV0MZ, 00PV3MZ, 00PV4MZ||Surgical, central nervous system, removal, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, revision, spinal canal, neurostimulator lead, code by approach|
|00WV0MZ, 00WV3MZ, 00WV4MZ||Surgical, central nervous system, revision, spinal cord, neurostimulator lead, code by approach|
|0JH60M6, 0JH60M7, 0JH60M8, 0JH60M9, 0JH63M6, 0JH63M7, 0JH63M8, 0JH63M9, 0JH70M6, 0JH70M7, 0JH70M8, 0JH70M9, 0JH73M6, 0JH73M7, 0JH73M8, 0JH73M9, 0JH80M6, 0JH80M7, 0JH80M8, 0JH80M9, 0JH83M6, 0JH83M7, 0JH83M8, 0JH83M9||Surgical, subcutaneous tissue and fascia, insertion, stimulator generator, code by body part, approach, number of arrays and whether rechargeable or not|
|0JPT0MZ, 0JPT3MZ||Surgical, subcutaneous tissue and fascia, removal, subcutaneous tissue and fascia, trunk, stimulator generator, code by approach (there aren’t ICD-10-PCS codes for removal of stimulator generator from other body parts)|
|Type of Service||Surgical|
|Place of Service||Inpatient/Outpatient|
Electrical Nerve Stimulation, Spinal
Spinal Cord Stimulation
Stimulation, Electrical, Spinal Cord
|03/31/96||Add to Surgery section||New policy|
|04/01/98||Replace policy||Policy cross-referenced to No.
|
L8687
|
KIT NEUROSTIMULATOR SENZA IPG STERILE LATEX FREE DISPOSABLE
|
HCPCS
|
Centers for Medicare and Medicaid Services (CMS). National Coverage Determination for Electrical Nerve Stimulators (160.7). Available online at: http://www.cms.hhs.gov. Last accessed November, 2011. |CPT||63650||Percutaneous implantation of neurostimulator electrode array; epidural|
|63655||Laminectomy for implantation of neurostimulator electrode plate/paddle; epidural|
|63661||Removal of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63662||Removal of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy (new code 1/1/10)|
|63663||Revision including replacement, when performed, of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63664||Revision including replacement, when performed, of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy, including fluoroscopy, when performed (new code 1/1/10)|
|63685||Insertion or replacement of spinal neurostimulator pulse generator or receiver, direct or inductive coupling|
|63688||Revision or removal of implanted spinal neurostimulator pulse generator or receiver|
|95970, 95971, 95972, 95973||Neurostimulator programming and analysis code range|
|ICD-9 Procedure||03.93||Insertion or replacement of spinal neurostimulator|
|03.94||Removal of spinal neurostimulator lead(s)|
|86.05||Incision with removal of foreign body or device from skin and subcutaneous tissue (used to report removal of a neurostimulator pulse generator)|
|86.94||Insertion or replacement of single array neurostimulator pulse generator, not specified as rechargeable|
|86.95||Insertion or replacement of dual array neurostimulator pulse generator, not specified as rechargeable|
|86.97||Insertion or replacement of single array rechargeable neurostimulator pulse generator (new code effective 10/1/05)|
|86.98||Insertion or replacement of dual array rechargeable neurostimulator pulse generation (new code effective 10/1/05)|
|ICD-9 Diagnosis||See “Pain” in ICD-9 diagnosis index|
|HCPCS||L8680||Implantable neurostimulator electrode, each (new code effective 1/1/06)|
|L8685||Implantable neurostimulator pulse generator, single array, rechargeable, includes extension (new code effective 1/1/06)|
|L8686||Implantable neurostimulator pulse generator, single array, nonrechargeable, includes extension (new code effective 1/1/06)|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension (new code effective 1/1/06)|
|L8688||Implantable neurostimulator pulse generator, dual array, nonrechargeable, includes extension (new code effective 1/1/06)|
|ICD-10-CM (effective 10/1/14)||This list is a representative list of severe and chronic pain of the trunk and limbs diagnosis codes.|
|G56.40 -G56.42||Causalgia of upper limb code range|
|G57.70 -G57.72||Causalgia of lower limb code range|
|G89.21 -G89.8||Chronic pain, not elsewhere classified, code range|
|G89.4||Chronic pain syndrome|
|G90.50 -G90.59||Complex regional pain syndrome I (CRPS I), code range|
|M25.50 -M25.579||Pain in joint, code range|
|M54.10 -M54.18||Radiculopathy, code range|
|M54.30 -M54.32||Sciatica, code range|
|M54.40 -M54.42||Lumbago with sciatica, code range|
|M54.5||Low back pain|
|M54.6||Pain in thoracic spine|
|M54.81, M54.89||Other dorsalgia codes|
|M79.60 -M79.676||Pain in limb, hand, foot, fingers and toes code range|
|ICD-10-PCS (effective 10/1/14)||ICD-10-PCS codes are only used for inpatient services.|
|Surgical, central nervous system, insertion, spinal canal, neurostimulator lead, code by approach|
|00HV0MZ, 00HV3MZ, 00HV4MZ||Surgical, central nervous system, insertion, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, removal, spinal canal, neurostimulator lead, code by approach|
|00PV0MZ, 00PV3MZ, 00PV4MZ||Surgical, central nervous system, removal, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, revision, spinal canal, neurostimulator lead, code by approach|
|00WV0MZ, 00WV3MZ, 00WV4MZ||Surgical, central nervous system, revision, spinal cord, neurostimulator lead, code by approach|
|0JH60M6, 0JH60M7, 0JH60M8, 0JH60M9, 0JH63M6, 0JH63M7, 0JH63M8, 0JH63M9, 0JH70M6, 0JH70M7, 0JH70M8, 0JH70M9, 0JH73M6, 0JH73M7, 0JH73M8, 0JH73M9, 0JH80M6, 0JH80M7, 0JH80M8, 0JH80M9, 0JH83M6, 0JH83M7, 0JH83M8, 0JH83M9||Surgical, subcutaneous tissue and fascia, insertion, stimulator generator, code by body part, approach, number of arrays and whether rechargeable or not|
|0JPT0MZ, 0JPT3MZ||Surgical, subcutaneous tissue and fascia, removal, subcutaneous tissue and fascia, trunk, stimulator generator, code by approach (there aren’t ICD-10-PCS codes for removal of stimulator generator from other body parts)|
|Type of Service||Surgical|
|Place of Service||Inpatient/Outpatient|
Electrical Nerve Stimulation, Spinal
Spinal Cord Stimulation
Stimulation, Electrical, Spinal Cord
|03/31/96||Add to Surgery section||New policy|
|04/01/98||Replace policy||Policy cross-referenced to No.
|
63663
|
Revise spine eltrd perq aray
|
HCPCS
|
Centers for Medicare and Medicaid Services (CMS). National Coverage Determination for Electrical Nerve Stimulators (160.7). Available online at: http://www.cms.hhs.gov. Last accessed November, 2011. |CPT||63650||Percutaneous implantation of neurostimulator electrode array; epidural|
|63655||Laminectomy for implantation of neurostimulator electrode plate/paddle; epidural|
|63661||Removal of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63662||Removal of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy (new code 1/1/10)|
|63663||Revision including replacement, when performed, of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63664||Revision including replacement, when performed, of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy, including fluoroscopy, when performed (new code 1/1/10)|
|63685||Insertion or replacement of spinal neurostimulator pulse generator or receiver, direct or inductive coupling|
|63688||Revision or removal of implanted spinal neurostimulator pulse generator or receiver|
|95970, 95971, 95972, 95973||Neurostimulator programming and analysis code range|
|ICD-9 Procedure||03.93||Insertion or replacement of spinal neurostimulator|
|03.94||Removal of spinal neurostimulator lead(s)|
|86.05||Incision with removal of foreign body or device from skin and subcutaneous tissue (used to report removal of a neurostimulator pulse generator)|
|86.94||Insertion or replacement of single array neurostimulator pulse generator, not specified as rechargeable|
|86.95||Insertion or replacement of dual array neurostimulator pulse generator, not specified as rechargeable|
|86.97||Insertion or replacement of single array rechargeable neurostimulator pulse generator (new code effective 10/1/05)|
|86.98||Insertion or replacement of dual array rechargeable neurostimulator pulse generation (new code effective 10/1/05)|
|ICD-9 Diagnosis||See “Pain” in ICD-9 diagnosis index|
|HCPCS||L8680||Implantable neurostimulator electrode, each (new code effective 1/1/06)|
|L8685||Implantable neurostimulator pulse generator, single array, rechargeable, includes extension (new code effective 1/1/06)|
|L8686||Implantable neurostimulator pulse generator, single array, nonrechargeable, includes extension (new code effective 1/1/06)|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension (new code effective 1/1/06)|
|L8688||Implantable neurostimulator pulse generator, dual array, nonrechargeable, includes extension (new code effective 1/1/06)|
|ICD-10-CM (effective 10/1/14)||This list is a representative list of severe and chronic pain of the trunk and limbs diagnosis codes.|
|G56.40 -G56.42||Causalgia of upper limb code range|
|G57.70 -G57.72||Causalgia of lower limb code range|
|G89.21 -G89.8||Chronic pain, not elsewhere classified, code range|
|G89.4||Chronic pain syndrome|
|G90.50 -G90.59||Complex regional pain syndrome I (CRPS I), code range|
|M25.50 -M25.579||Pain in joint, code range|
|M54.10 -M54.18||Radiculopathy, code range|
|M54.30 -M54.32||Sciatica, code range|
|M54.40 -M54.42||Lumbago with sciatica, code range|
|M54.5||Low back pain|
|M54.6||Pain in thoracic spine|
|M54.81, M54.89||Other dorsalgia codes|
|M79.60 -M79.676||Pain in limb, hand, foot, fingers and toes code range|
|ICD-10-PCS (effective 10/1/14)||ICD-10-PCS codes are only used for inpatient services.|
|Surgical, central nervous system, insertion, spinal canal, neurostimulator lead, code by approach|
|00HV0MZ, 00HV3MZ, 00HV4MZ||Surgical, central nervous system, insertion, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, removal, spinal canal, neurostimulator lead, code by approach|
|00PV0MZ, 00PV3MZ, 00PV4MZ||Surgical, central nervous system, removal, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, revision, spinal canal, neurostimulator lead, code by approach|
|00WV0MZ, 00WV3MZ, 00WV4MZ||Surgical, central nervous system, revision, spinal cord, neurostimulator lead, code by approach|
|0JH60M6, 0JH60M7, 0JH60M8, 0JH60M9, 0JH63M6, 0JH63M7, 0JH63M8, 0JH63M9, 0JH70M6, 0JH70M7, 0JH70M8, 0JH70M9, 0JH73M6, 0JH73M7, 0JH73M8, 0JH73M9, 0JH80M6, 0JH80M7, 0JH80M8, 0JH80M9, 0JH83M6, 0JH83M7, 0JH83M8, 0JH83M9||Surgical, subcutaneous tissue and fascia, insertion, stimulator generator, code by body part, approach, number of arrays and whether rechargeable or not|
|0JPT0MZ, 0JPT3MZ||Surgical, subcutaneous tissue and fascia, removal, subcutaneous tissue and fascia, trunk, stimulator generator, code by approach (there aren’t ICD-10-PCS codes for removal of stimulator generator from other body parts)|
|Type of Service||Surgical|
|Place of Service||Inpatient/Outpatient|
Electrical Nerve Stimulation, Spinal
Spinal Cord Stimulation
Stimulation, Electrical, Spinal Cord
|03/31/96||Add to Surgery section||New policy|
|04/01/98||Replace policy||Policy cross-referenced to No.
|
95970
|
PR ELEC ALYS IMPLT NPGT PHYS/QHP W/O PROGRAMMING
|
HCPCS
|
Centers for Medicare and Medicaid Services (CMS). National Coverage Determination for Electrical Nerve Stimulators (160.7). Available online at: http://www.cms.hhs.gov. Last accessed November, 2011. |CPT||63650||Percutaneous implantation of neurostimulator electrode array; epidural|
|63655||Laminectomy for implantation of neurostimulator electrode plate/paddle; epidural|
|63661||Removal of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63662||Removal of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy (new code 1/1/10)|
|63663||Revision including replacement, when performed, of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63664||Revision including replacement, when performed, of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy, including fluoroscopy, when performed (new code 1/1/10)|
|63685||Insertion or replacement of spinal neurostimulator pulse generator or receiver, direct or inductive coupling|
|63688||Revision or removal of implanted spinal neurostimulator pulse generator or receiver|
|95970, 95971, 95972, 95973||Neurostimulator programming and analysis code range|
|ICD-9 Procedure||03.93||Insertion or replacement of spinal neurostimulator|
|03.94||Removal of spinal neurostimulator lead(s)|
|86.05||Incision with removal of foreign body or device from skin and subcutaneous tissue (used to report removal of a neurostimulator pulse generator)|
|86.94||Insertion or replacement of single array neurostimulator pulse generator, not specified as rechargeable|
|86.95||Insertion or replacement of dual array neurostimulator pulse generator, not specified as rechargeable|
|86.97||Insertion or replacement of single array rechargeable neurostimulator pulse generator (new code effective 10/1/05)|
|86.98||Insertion or replacement of dual array rechargeable neurostimulator pulse generation (new code effective 10/1/05)|
|ICD-9 Diagnosis||See “Pain” in ICD-9 diagnosis index|
|HCPCS||L8680||Implantable neurostimulator electrode, each (new code effective 1/1/06)|
|L8685||Implantable neurostimulator pulse generator, single array, rechargeable, includes extension (new code effective 1/1/06)|
|L8686||Implantable neurostimulator pulse generator, single array, nonrechargeable, includes extension (new code effective 1/1/06)|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension (new code effective 1/1/06)|
|L8688||Implantable neurostimulator pulse generator, dual array, nonrechargeable, includes extension (new code effective 1/1/06)|
|ICD-10-CM (effective 10/1/14)||This list is a representative list of severe and chronic pain of the trunk and limbs diagnosis codes.|
|G56.40 -G56.42||Causalgia of upper limb code range|
|G57.70 -G57.72||Causalgia of lower limb code range|
|G89.21 -G89.8||Chronic pain, not elsewhere classified, code range|
|G89.4||Chronic pain syndrome|
|G90.50 -G90.59||Complex regional pain syndrome I (CRPS I), code range|
|M25.50 -M25.579||Pain in joint, code range|
|M54.10 -M54.18||Radiculopathy, code range|
|M54.30 -M54.32||Sciatica, code range|
|M54.40 -M54.42||Lumbago with sciatica, code range|
|M54.5||Low back pain|
|M54.6||Pain in thoracic spine|
|M54.81, M54.89||Other dorsalgia codes|
|M79.60 -M79.676||Pain in limb, hand, foot, fingers and toes code range|
|ICD-10-PCS (effective 10/1/14)||ICD-10-PCS codes are only used for inpatient services.|
|Surgical, central nervous system, insertion, spinal canal, neurostimulator lead, code by approach|
|00HV0MZ, 00HV3MZ, 00HV4MZ||Surgical, central nervous system, insertion, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, removal, spinal canal, neurostimulator lead, code by approach|
|00PV0MZ, 00PV3MZ, 00PV4MZ||Surgical, central nervous system, removal, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, revision, spinal canal, neurostimulator lead, code by approach|
|00WV0MZ, 00WV3MZ, 00WV4MZ||Surgical, central nervous system, revision, spinal cord, neurostimulator lead, code by approach|
|0JH60M6, 0JH60M7, 0JH60M8, 0JH60M9, 0JH63M6, 0JH63M7, 0JH63M8, 0JH63M9, 0JH70M6, 0JH70M7, 0JH70M8, 0JH70M9, 0JH73M6, 0JH73M7, 0JH73M8, 0JH73M9, 0JH80M6, 0JH80M7, 0JH80M8, 0JH80M9, 0JH83M6, 0JH83M7, 0JH83M8, 0JH83M9||Surgical, subcutaneous tissue and fascia, insertion, stimulator generator, code by body part, approach, number of arrays and whether rechargeable or not|
|0JPT0MZ, 0JPT3MZ||Surgical, subcutaneous tissue and fascia, removal, subcutaneous tissue and fascia, trunk, stimulator generator, code by approach (there aren’t ICD-10-PCS codes for removal of stimulator generator from other body parts)|
|Type of Service||Surgical|
|Place of Service||Inpatient/Outpatient|
Electrical Nerve Stimulation, Spinal
Spinal Cord Stimulation
Stimulation, Electrical, Spinal Cord
|03/31/96||Add to Surgery section||New policy|
|04/01/98||Replace policy||Policy cross-referenced to No.
|
63688
|
Rev/rmv imp sp npg/r dtch cn
|
HCPCS
|
Centers for Medicare and Medicaid Services (CMS). National Coverage Determination for Electrical Nerve Stimulators (160.7). Available online at: http://www.cms.hhs.gov. Last accessed November, 2011. |CPT||63650||Percutaneous implantation of neurostimulator electrode array; epidural|
|63655||Laminectomy for implantation of neurostimulator electrode plate/paddle; epidural|
|63661||Removal of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63662||Removal of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy (new code 1/1/10)|
|63663||Revision including replacement, when performed, of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63664||Revision including replacement, when performed, of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy, including fluoroscopy, when performed (new code 1/1/10)|
|63685||Insertion or replacement of spinal neurostimulator pulse generator or receiver, direct or inductive coupling|
|63688||Revision or removal of implanted spinal neurostimulator pulse generator or receiver|
|95970, 95971, 95972, 95973||Neurostimulator programming and analysis code range|
|ICD-9 Procedure||03.93||Insertion or replacement of spinal neurostimulator|
|03.94||Removal of spinal neurostimulator lead(s)|
|86.05||Incision with removal of foreign body or device from skin and subcutaneous tissue (used to report removal of a neurostimulator pulse generator)|
|86.94||Insertion or replacement of single array neurostimulator pulse generator, not specified as rechargeable|
|86.95||Insertion or replacement of dual array neurostimulator pulse generator, not specified as rechargeable|
|86.97||Insertion or replacement of single array rechargeable neurostimulator pulse generator (new code effective 10/1/05)|
|86.98||Insertion or replacement of dual array rechargeable neurostimulator pulse generation (new code effective 10/1/05)|
|ICD-9 Diagnosis||See “Pain” in ICD-9 diagnosis index|
|HCPCS||L8680||Implantable neurostimulator electrode, each (new code effective 1/1/06)|
|L8685||Implantable neurostimulator pulse generator, single array, rechargeable, includes extension (new code effective 1/1/06)|
|L8686||Implantable neurostimulator pulse generator, single array, nonrechargeable, includes extension (new code effective 1/1/06)|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension (new code effective 1/1/06)|
|L8688||Implantable neurostimulator pulse generator, dual array, nonrechargeable, includes extension (new code effective 1/1/06)|
|ICD-10-CM (effective 10/1/14)||This list is a representative list of severe and chronic pain of the trunk and limbs diagnosis codes.|
|G56.40 -G56.42||Causalgia of upper limb code range|
|G57.70 -G57.72||Causalgia of lower limb code range|
|G89.21 -G89.8||Chronic pain, not elsewhere classified, code range|
|G89.4||Chronic pain syndrome|
|G90.50 -G90.59||Complex regional pain syndrome I (CRPS I), code range|
|M25.50 -M25.579||Pain in joint, code range|
|M54.10 -M54.18||Radiculopathy, code range|
|M54.30 -M54.32||Sciatica, code range|
|M54.40 -M54.42||Lumbago with sciatica, code range|
|M54.5||Low back pain|
|M54.6||Pain in thoracic spine|
|M54.81, M54.89||Other dorsalgia codes|
|M79.60 -M79.676||Pain in limb, hand, foot, fingers and toes code range|
|ICD-10-PCS (effective 10/1/14)||ICD-10-PCS codes are only used for inpatient services.|
|Surgical, central nervous system, insertion, spinal canal, neurostimulator lead, code by approach|
|00HV0MZ, 00HV3MZ, 00HV4MZ||Surgical, central nervous system, insertion, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, removal, spinal canal, neurostimulator lead, code by approach|
|00PV0MZ, 00PV3MZ, 00PV4MZ||Surgical, central nervous system, removal, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, revision, spinal canal, neurostimulator lead, code by approach|
|00WV0MZ, 00WV3MZ, 00WV4MZ||Surgical, central nervous system, revision, spinal cord, neurostimulator lead, code by approach|
|0JH60M6, 0JH60M7, 0JH60M8, 0JH60M9, 0JH63M6, 0JH63M7, 0JH63M8, 0JH63M9, 0JH70M6, 0JH70M7, 0JH70M8, 0JH70M9, 0JH73M6, 0JH73M7, 0JH73M8, 0JH73M9, 0JH80M6, 0JH80M7, 0JH80M8, 0JH80M9, 0JH83M6, 0JH83M7, 0JH83M8, 0JH83M9||Surgical, subcutaneous tissue and fascia, insertion, stimulator generator, code by body part, approach, number of arrays and whether rechargeable or not|
|0JPT0MZ, 0JPT3MZ||Surgical, subcutaneous tissue and fascia, removal, subcutaneous tissue and fascia, trunk, stimulator generator, code by approach (there aren’t ICD-10-PCS codes for removal of stimulator generator from other body parts)|
|Type of Service||Surgical|
|Place of Service||Inpatient/Outpatient|
Electrical Nerve Stimulation, Spinal
Spinal Cord Stimulation
Stimulation, Electrical, Spinal Cord
|03/31/96||Add to Surgery section||New policy|
|04/01/98||Replace policy||Policy cross-referenced to No.
|
63685
|
PR INSJ/RPLCMT SPINAL NPG/RCVR POCKET CRTJ&CONNJ
|
HCPCS
|
Centers for Medicare and Medicaid Services (CMS). National Coverage Determination for Electrical Nerve Stimulators (160.7). Available online at: http://www.cms.hhs.gov. Last accessed November, 2011. |CPT||63650||Percutaneous implantation of neurostimulator electrode array; epidural|
|63655||Laminectomy for implantation of neurostimulator electrode plate/paddle; epidural|
|63661||Removal of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63662||Removal of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy (new code 1/1/10)|
|63663||Revision including replacement, when performed, of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63664||Revision including replacement, when performed, of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy, including fluoroscopy, when performed (new code 1/1/10)|
|63685||Insertion or replacement of spinal neurostimulator pulse generator or receiver, direct or inductive coupling|
|63688||Revision or removal of implanted spinal neurostimulator pulse generator or receiver|
|95970, 95971, 95972, 95973||Neurostimulator programming and analysis code range|
|ICD-9 Procedure||03.93||Insertion or replacement of spinal neurostimulator|
|03.94||Removal of spinal neurostimulator lead(s)|
|86.05||Incision with removal of foreign body or device from skin and subcutaneous tissue (used to report removal of a neurostimulator pulse generator)|
|86.94||Insertion or replacement of single array neurostimulator pulse generator, not specified as rechargeable|
|86.95||Insertion or replacement of dual array neurostimulator pulse generator, not specified as rechargeable|
|86.97||Insertion or replacement of single array rechargeable neurostimulator pulse generator (new code effective 10/1/05)|
|86.98||Insertion or replacement of dual array rechargeable neurostimulator pulse generation (new code effective 10/1/05)|
|ICD-9 Diagnosis||See “Pain” in ICD-9 diagnosis index|
|HCPCS||L8680||Implantable neurostimulator electrode, each (new code effective 1/1/06)|
|L8685||Implantable neurostimulator pulse generator, single array, rechargeable, includes extension (new code effective 1/1/06)|
|L8686||Implantable neurostimulator pulse generator, single array, nonrechargeable, includes extension (new code effective 1/1/06)|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension (new code effective 1/1/06)|
|L8688||Implantable neurostimulator pulse generator, dual array, nonrechargeable, includes extension (new code effective 1/1/06)|
|ICD-10-CM (effective 10/1/14)||This list is a representative list of severe and chronic pain of the trunk and limbs diagnosis codes.|
|G56.40 -G56.42||Causalgia of upper limb code range|
|G57.70 -G57.72||Causalgia of lower limb code range|
|G89.21 -G89.8||Chronic pain, not elsewhere classified, code range|
|G89.4||Chronic pain syndrome|
|G90.50 -G90.59||Complex regional pain syndrome I (CRPS I), code range|
|M25.50 -M25.579||Pain in joint, code range|
|M54.10 -M54.18||Radiculopathy, code range|
|M54.30 -M54.32||Sciatica, code range|
|M54.40 -M54.42||Lumbago with sciatica, code range|
|M54.5||Low back pain|
|M54.6||Pain in thoracic spine|
|M54.81, M54.89||Other dorsalgia codes|
|M79.60 -M79.676||Pain in limb, hand, foot, fingers and toes code range|
|ICD-10-PCS (effective 10/1/14)||ICD-10-PCS codes are only used for inpatient services.|
|Surgical, central nervous system, insertion, spinal canal, neurostimulator lead, code by approach|
|00HV0MZ, 00HV3MZ, 00HV4MZ||Surgical, central nervous system, insertion, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, removal, spinal canal, neurostimulator lead, code by approach|
|00PV0MZ, 00PV3MZ, 00PV4MZ||Surgical, central nervous system, removal, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, revision, spinal canal, neurostimulator lead, code by approach|
|00WV0MZ, 00WV3MZ, 00WV4MZ||Surgical, central nervous system, revision, spinal cord, neurostimulator lead, code by approach|
|0JH60M6, 0JH60M7, 0JH60M8, 0JH60M9, 0JH63M6, 0JH63M7, 0JH63M8, 0JH63M9, 0JH70M6, 0JH70M7, 0JH70M8, 0JH70M9, 0JH73M6, 0JH73M7, 0JH73M8, 0JH73M9, 0JH80M6, 0JH80M7, 0JH80M8, 0JH80M9, 0JH83M6, 0JH83M7, 0JH83M8, 0JH83M9||Surgical, subcutaneous tissue and fascia, insertion, stimulator generator, code by body part, approach, number of arrays and whether rechargeable or not|
|0JPT0MZ, 0JPT3MZ||Surgical, subcutaneous tissue and fascia, removal, subcutaneous tissue and fascia, trunk, stimulator generator, code by approach (there aren’t ICD-10-PCS codes for removal of stimulator generator from other body parts)|
|Type of Service||Surgical|
|Place of Service||Inpatient/Outpatient|
Electrical Nerve Stimulation, Spinal
Spinal Cord Stimulation
Stimulation, Electrical, Spinal Cord
|03/31/96||Add to Surgery section||New policy|
|04/01/98||Replace policy||Policy cross-referenced to No.
|
63655
|
PR LAM IMPLTJ NSTIM ELTRDS PLATE/PADDLE EDRL
|
HCPCS
|
Centers for Medicare and Medicaid Services (CMS). National Coverage Determination for Electrical Nerve Stimulators (160.7). Available online at: http://www.cms.hhs.gov. Last accessed November, 2011. |CPT||63650||Percutaneous implantation of neurostimulator electrode array; epidural|
|63655||Laminectomy for implantation of neurostimulator electrode plate/paddle; epidural|
|63661||Removal of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63662||Removal of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy (new code 1/1/10)|
|63663||Revision including replacement, when performed, of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63664||Revision including replacement, when performed, of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy, including fluoroscopy, when performed (new code 1/1/10)|
|63685||Insertion or replacement of spinal neurostimulator pulse generator or receiver, direct or inductive coupling|
|63688||Revision or removal of implanted spinal neurostimulator pulse generator or receiver|
|95970, 95971, 95972, 95973||Neurostimulator programming and analysis code range|
|ICD-9 Procedure||03.93||Insertion or replacement of spinal neurostimulator|
|03.94||Removal of spinal neurostimulator lead(s)|
|86.05||Incision with removal of foreign body or device from skin and subcutaneous tissue (used to report removal of a neurostimulator pulse generator)|
|86.94||Insertion or replacement of single array neurostimulator pulse generator, not specified as rechargeable|
|86.95||Insertion or replacement of dual array neurostimulator pulse generator, not specified as rechargeable|
|86.97||Insertion or replacement of single array rechargeable neurostimulator pulse generator (new code effective 10/1/05)|
|86.98||Insertion or replacement of dual array rechargeable neurostimulator pulse generation (new code effective 10/1/05)|
|ICD-9 Diagnosis||See “Pain” in ICD-9 diagnosis index|
|HCPCS||L8680||Implantable neurostimulator electrode, each (new code effective 1/1/06)|
|L8685||Implantable neurostimulator pulse generator, single array, rechargeable, includes extension (new code effective 1/1/06)|
|L8686||Implantable neurostimulator pulse generator, single array, nonrechargeable, includes extension (new code effective 1/1/06)|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension (new code effective 1/1/06)|
|L8688||Implantable neurostimulator pulse generator, dual array, nonrechargeable, includes extension (new code effective 1/1/06)|
|ICD-10-CM (effective 10/1/14)||This list is a representative list of severe and chronic pain of the trunk and limbs diagnosis codes.|
|G56.40 -G56.42||Causalgia of upper limb code range|
|G57.70 -G57.72||Causalgia of lower limb code range|
|G89.21 -G89.8||Chronic pain, not elsewhere classified, code range|
|G89.4||Chronic pain syndrome|
|G90.50 -G90.59||Complex regional pain syndrome I (CRPS I), code range|
|M25.50 -M25.579||Pain in joint, code range|
|M54.10 -M54.18||Radiculopathy, code range|
|M54.30 -M54.32||Sciatica, code range|
|M54.40 -M54.42||Lumbago with sciatica, code range|
|M54.5||Low back pain|
|M54.6||Pain in thoracic spine|
|M54.81, M54.89||Other dorsalgia codes|
|M79.60 -M79.676||Pain in limb, hand, foot, fingers and toes code range|
|ICD-10-PCS (effective 10/1/14)||ICD-10-PCS codes are only used for inpatient services.|
|Surgical, central nervous system, insertion, spinal canal, neurostimulator lead, code by approach|
|00HV0MZ, 00HV3MZ, 00HV4MZ||Surgical, central nervous system, insertion, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, removal, spinal canal, neurostimulator lead, code by approach|
|00PV0MZ, 00PV3MZ, 00PV4MZ||Surgical, central nervous system, removal, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, revision, spinal canal, neurostimulator lead, code by approach|
|00WV0MZ, 00WV3MZ, 00WV4MZ||Surgical, central nervous system, revision, spinal cord, neurostimulator lead, code by approach|
|0JH60M6, 0JH60M7, 0JH60M8, 0JH60M9, 0JH63M6, 0JH63M7, 0JH63M8, 0JH63M9, 0JH70M6, 0JH70M7, 0JH70M8, 0JH70M9, 0JH73M6, 0JH73M7, 0JH73M8, 0JH73M9, 0JH80M6, 0JH80M7, 0JH80M8, 0JH80M9, 0JH83M6, 0JH83M7, 0JH83M8, 0JH83M9||Surgical, subcutaneous tissue and fascia, insertion, stimulator generator, code by body part, approach, number of arrays and whether rechargeable or not|
|0JPT0MZ, 0JPT3MZ||Surgical, subcutaneous tissue and fascia, removal, subcutaneous tissue and fascia, trunk, stimulator generator, code by approach (there aren’t ICD-10-PCS codes for removal of stimulator generator from other body parts)|
|Type of Service||Surgical|
|Place of Service||Inpatient/Outpatient|
Electrical Nerve Stimulation, Spinal
Spinal Cord Stimulation
Stimulation, Electrical, Spinal Cord
|03/31/96||Add to Surgery section||New policy|
|04/01/98||Replace policy||Policy cross-referenced to No.
|
95971
|
PR ELEC ALYS IMPLT NPGT SMPL SP/PN NPGT PRGRMG
|
HCPCS
|
Centers for Medicare and Medicaid Services (CMS). National Coverage Determination for Electrical Nerve Stimulators (160.7). Available online at: http://www.cms.hhs.gov. Last accessed November, 2011. |CPT||63650||Percutaneous implantation of neurostimulator electrode array; epidural|
|63655||Laminectomy for implantation of neurostimulator electrode plate/paddle; epidural|
|63661||Removal of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63662||Removal of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy (new code 1/1/10)|
|63663||Revision including replacement, when performed, of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63664||Revision including replacement, when performed, of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy, including fluoroscopy, when performed (new code 1/1/10)|
|63685||Insertion or replacement of spinal neurostimulator pulse generator or receiver, direct or inductive coupling|
|63688||Revision or removal of implanted spinal neurostimulator pulse generator or receiver|
|95970, 95971, 95972, 95973||Neurostimulator programming and analysis code range|
|ICD-9 Procedure||03.93||Insertion or replacement of spinal neurostimulator|
|03.94||Removal of spinal neurostimulator lead(s)|
|86.05||Incision with removal of foreign body or device from skin and subcutaneous tissue (used to report removal of a neurostimulator pulse generator)|
|86.94||Insertion or replacement of single array neurostimulator pulse generator, not specified as rechargeable|
|86.95||Insertion or replacement of dual array neurostimulator pulse generator, not specified as rechargeable|
|86.97||Insertion or replacement of single array rechargeable neurostimulator pulse generator (new code effective 10/1/05)|
|86.98||Insertion or replacement of dual array rechargeable neurostimulator pulse generation (new code effective 10/1/05)|
|ICD-9 Diagnosis||See “Pain” in ICD-9 diagnosis index|
|HCPCS||L8680||Implantable neurostimulator electrode, each (new code effective 1/1/06)|
|L8685||Implantable neurostimulator pulse generator, single array, rechargeable, includes extension (new code effective 1/1/06)|
|L8686||Implantable neurostimulator pulse generator, single array, nonrechargeable, includes extension (new code effective 1/1/06)|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension (new code effective 1/1/06)|
|L8688||Implantable neurostimulator pulse generator, dual array, nonrechargeable, includes extension (new code effective 1/1/06)|
|ICD-10-CM (effective 10/1/14)||This list is a representative list of severe and chronic pain of the trunk and limbs diagnosis codes.|
|G56.40 -G56.42||Causalgia of upper limb code range|
|G57.70 -G57.72||Causalgia of lower limb code range|
|G89.21 -G89.8||Chronic pain, not elsewhere classified, code range|
|G89.4||Chronic pain syndrome|
|G90.50 -G90.59||Complex regional pain syndrome I (CRPS I), code range|
|M25.50 -M25.579||Pain in joint, code range|
|M54.10 -M54.18||Radiculopathy, code range|
|M54.30 -M54.32||Sciatica, code range|
|M54.40 -M54.42||Lumbago with sciatica, code range|
|M54.5||Low back pain|
|M54.6||Pain in thoracic spine|
|M54.81, M54.89||Other dorsalgia codes|
|M79.60 -M79.676||Pain in limb, hand, foot, fingers and toes code range|
|ICD-10-PCS (effective 10/1/14)||ICD-10-PCS codes are only used for inpatient services.|
|Surgical, central nervous system, insertion, spinal canal, neurostimulator lead, code by approach|
|00HV0MZ, 00HV3MZ, 00HV4MZ||Surgical, central nervous system, insertion, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, removal, spinal canal, neurostimulator lead, code by approach|
|00PV0MZ, 00PV3MZ, 00PV4MZ||Surgical, central nervous system, removal, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, revision, spinal canal, neurostimulator lead, code by approach|
|00WV0MZ, 00WV3MZ, 00WV4MZ||Surgical, central nervous system, revision, spinal cord, neurostimulator lead, code by approach|
|0JH60M6, 0JH60M7, 0JH60M8, 0JH60M9, 0JH63M6, 0JH63M7, 0JH63M8, 0JH63M9, 0JH70M6, 0JH70M7, 0JH70M8, 0JH70M9, 0JH73M6, 0JH73M7, 0JH73M8, 0JH73M9, 0JH80M6, 0JH80M7, 0JH80M8, 0JH80M9, 0JH83M6, 0JH83M7, 0JH83M8, 0JH83M9||Surgical, subcutaneous tissue and fascia, insertion, stimulator generator, code by body part, approach, number of arrays and whether rechargeable or not|
|0JPT0MZ, 0JPT3MZ||Surgical, subcutaneous tissue and fascia, removal, subcutaneous tissue and fascia, trunk, stimulator generator, code by approach (there aren’t ICD-10-PCS codes for removal of stimulator generator from other body parts)|
|Type of Service||Surgical|
|Place of Service||Inpatient/Outpatient|
Electrical Nerve Stimulation, Spinal
Spinal Cord Stimulation
Stimulation, Electrical, Spinal Cord
|03/31/96||Add to Surgery section||New policy|
|04/01/98||Replace policy||Policy cross-referenced to No.
|
L8686
|
Implt nrostm pls gen sng non
|
HCPCS
|
Centers for Medicare and Medicaid Services (CMS). National Coverage Determination for Electrical Nerve Stimulators (160.7). Available online at: http://www.cms.hhs.gov. Last accessed November, 2011. |CPT||63650||Percutaneous implantation of neurostimulator electrode array; epidural|
|63655||Laminectomy for implantation of neurostimulator electrode plate/paddle; epidural|
|63661||Removal of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63662||Removal of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy (new code 1/1/10)|
|63663||Revision including replacement, when performed, of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63664||Revision including replacement, when performed, of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy, including fluoroscopy, when performed (new code 1/1/10)|
|63685||Insertion or replacement of spinal neurostimulator pulse generator or receiver, direct or inductive coupling|
|63688||Revision or removal of implanted spinal neurostimulator pulse generator or receiver|
|95970, 95971, 95972, 95973||Neurostimulator programming and analysis code range|
|ICD-9 Procedure||03.93||Insertion or replacement of spinal neurostimulator|
|03.94||Removal of spinal neurostimulator lead(s)|
|86.05||Incision with removal of foreign body or device from skin and subcutaneous tissue (used to report removal of a neurostimulator pulse generator)|
|86.94||Insertion or replacement of single array neurostimulator pulse generator, not specified as rechargeable|
|86.95||Insertion or replacement of dual array neurostimulator pulse generator, not specified as rechargeable|
|86.97||Insertion or replacement of single array rechargeable neurostimulator pulse generator (new code effective 10/1/05)|
|86.98||Insertion or replacement of dual array rechargeable neurostimulator pulse generation (new code effective 10/1/05)|
|ICD-9 Diagnosis||See “Pain” in ICD-9 diagnosis index|
|HCPCS||L8680||Implantable neurostimulator electrode, each (new code effective 1/1/06)|
|L8685||Implantable neurostimulator pulse generator, single array, rechargeable, includes extension (new code effective 1/1/06)|
|L8686||Implantable neurostimulator pulse generator, single array, nonrechargeable, includes extension (new code effective 1/1/06)|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension (new code effective 1/1/06)|
|L8688||Implantable neurostimulator pulse generator, dual array, nonrechargeable, includes extension (new code effective 1/1/06)|
|ICD-10-CM (effective 10/1/14)||This list is a representative list of severe and chronic pain of the trunk and limbs diagnosis codes.|
|G56.40 -G56.42||Causalgia of upper limb code range|
|G57.70 -G57.72||Causalgia of lower limb code range|
|G89.21 -G89.8||Chronic pain, not elsewhere classified, code range|
|G89.4||Chronic pain syndrome|
|G90.50 -G90.59||Complex regional pain syndrome I (CRPS I), code range|
|M25.50 -M25.579||Pain in joint, code range|
|M54.10 -M54.18||Radiculopathy, code range|
|M54.30 -M54.32||Sciatica, code range|
|M54.40 -M54.42||Lumbago with sciatica, code range|
|M54.5||Low back pain|
|M54.6||Pain in thoracic spine|
|M54.81, M54.89||Other dorsalgia codes|
|M79.60 -M79.676||Pain in limb, hand, foot, fingers and toes code range|
|ICD-10-PCS (effective 10/1/14)||ICD-10-PCS codes are only used for inpatient services.|
|Surgical, central nervous system, insertion, spinal canal, neurostimulator lead, code by approach|
|00HV0MZ, 00HV3MZ, 00HV4MZ||Surgical, central nervous system, insertion, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, removal, spinal canal, neurostimulator lead, code by approach|
|00PV0MZ, 00PV3MZ, 00PV4MZ||Surgical, central nervous system, removal, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, revision, spinal canal, neurostimulator lead, code by approach|
|00WV0MZ, 00WV3MZ, 00WV4MZ||Surgical, central nervous system, revision, spinal cord, neurostimulator lead, code by approach|
|0JH60M6, 0JH60M7, 0JH60M8, 0JH60M9, 0JH63M6, 0JH63M7, 0JH63M8, 0JH63M9, 0JH70M6, 0JH70M7, 0JH70M8, 0JH70M9, 0JH73M6, 0JH73M7, 0JH73M8, 0JH73M9, 0JH80M6, 0JH80M7, 0JH80M8, 0JH80M9, 0JH83M6, 0JH83M7, 0JH83M8, 0JH83M9||Surgical, subcutaneous tissue and fascia, insertion, stimulator generator, code by body part, approach, number of arrays and whether rechargeable or not|
|0JPT0MZ, 0JPT3MZ||Surgical, subcutaneous tissue and fascia, removal, subcutaneous tissue and fascia, trunk, stimulator generator, code by approach (there aren’t ICD-10-PCS codes for removal of stimulator generator from other body parts)|
|Type of Service||Surgical|
|Place of Service||Inpatient/Outpatient|
Electrical Nerve Stimulation, Spinal
Spinal Cord Stimulation
Stimulation, Electrical, Spinal Cord
|03/31/96||Add to Surgery section||New policy|
|04/01/98||Replace policy||Policy cross-referenced to No.
|
63664
|
Revise spine eltrd plate
|
HCPCS
|
Centers for Medicare and Medicaid Services (CMS). National Coverage Determination for Electrical Nerve Stimulators (160.7). Available online at: http://www.cms.hhs.gov. Last accessed November, 2011. |CPT||63650||Percutaneous implantation of neurostimulator electrode array; epidural|
|63655||Laminectomy for implantation of neurostimulator electrode plate/paddle; epidural|
|63661||Removal of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63662||Removal of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy (new code 1/1/10)|
|63663||Revision including replacement, when performed, of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63664||Revision including replacement, when performed, of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy, including fluoroscopy, when performed (new code 1/1/10)|
|63685||Insertion or replacement of spinal neurostimulator pulse generator or receiver, direct or inductive coupling|
|63688||Revision or removal of implanted spinal neurostimulator pulse generator or receiver|
|95970, 95971, 95972, 95973||Neurostimulator programming and analysis code range|
|ICD-9 Procedure||03.93||Insertion or replacement of spinal neurostimulator|
|03.94||Removal of spinal neurostimulator lead(s)|
|86.05||Incision with removal of foreign body or device from skin and subcutaneous tissue (used to report removal of a neurostimulator pulse generator)|
|86.94||Insertion or replacement of single array neurostimulator pulse generator, not specified as rechargeable|
|86.95||Insertion or replacement of dual array neurostimulator pulse generator, not specified as rechargeable|
|86.97||Insertion or replacement of single array rechargeable neurostimulator pulse generator (new code effective 10/1/05)|
|86.98||Insertion or replacement of dual array rechargeable neurostimulator pulse generation (new code effective 10/1/05)|
|ICD-9 Diagnosis||See “Pain” in ICD-9 diagnosis index|
|HCPCS||L8680||Implantable neurostimulator electrode, each (new code effective 1/1/06)|
|L8685||Implantable neurostimulator pulse generator, single array, rechargeable, includes extension (new code effective 1/1/06)|
|L8686||Implantable neurostimulator pulse generator, single array, nonrechargeable, includes extension (new code effective 1/1/06)|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension (new code effective 1/1/06)|
|L8688||Implantable neurostimulator pulse generator, dual array, nonrechargeable, includes extension (new code effective 1/1/06)|
|ICD-10-CM (effective 10/1/14)||This list is a representative list of severe and chronic pain of the trunk and limbs diagnosis codes.|
|G56.40 -G56.42||Causalgia of upper limb code range|
|G57.70 -G57.72||Causalgia of lower limb code range|
|G89.21 -G89.8||Chronic pain, not elsewhere classified, code range|
|G89.4||Chronic pain syndrome|
|G90.50 -G90.59||Complex regional pain syndrome I (CRPS I), code range|
|M25.50 -M25.579||Pain in joint, code range|
|M54.10 -M54.18||Radiculopathy, code range|
|M54.30 -M54.32||Sciatica, code range|
|M54.40 -M54.42||Lumbago with sciatica, code range|
|M54.5||Low back pain|
|M54.6||Pain in thoracic spine|
|M54.81, M54.89||Other dorsalgia codes|
|M79.60 -M79.676||Pain in limb, hand, foot, fingers and toes code range|
|ICD-10-PCS (effective 10/1/14)||ICD-10-PCS codes are only used for inpatient services.|
|Surgical, central nervous system, insertion, spinal canal, neurostimulator lead, code by approach|
|00HV0MZ, 00HV3MZ, 00HV4MZ||Surgical, central nervous system, insertion, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, removal, spinal canal, neurostimulator lead, code by approach|
|00PV0MZ, 00PV3MZ, 00PV4MZ||Surgical, central nervous system, removal, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, revision, spinal canal, neurostimulator lead, code by approach|
|00WV0MZ, 00WV3MZ, 00WV4MZ||Surgical, central nervous system, revision, spinal cord, neurostimulator lead, code by approach|
|0JH60M6, 0JH60M7, 0JH60M8, 0JH60M9, 0JH63M6, 0JH63M7, 0JH63M8, 0JH63M9, 0JH70M6, 0JH70M7, 0JH70M8, 0JH70M9, 0JH73M6, 0JH73M7, 0JH73M8, 0JH73M9, 0JH80M6, 0JH80M7, 0JH80M8, 0JH80M9, 0JH83M6, 0JH83M7, 0JH83M8, 0JH83M9||Surgical, subcutaneous tissue and fascia, insertion, stimulator generator, code by body part, approach, number of arrays and whether rechargeable or not|
|0JPT0MZ, 0JPT3MZ||Surgical, subcutaneous tissue and fascia, removal, subcutaneous tissue and fascia, trunk, stimulator generator, code by approach (there aren’t ICD-10-PCS codes for removal of stimulator generator from other body parts)|
|Type of Service||Surgical|
|Place of Service||Inpatient/Outpatient|
Electrical Nerve Stimulation, Spinal
Spinal Cord Stimulation
Stimulation, Electrical, Spinal Cord
|03/31/96||Add to Surgery section||New policy|
|04/01/98||Replace policy||Policy cross-referenced to No.
|
L8685
|
Implt nrostm pls gen sng rec
|
HCPCS
|
Centers for Medicare and Medicaid Services (CMS). National Coverage Determination for Electrical Nerve Stimulators (160.7). Available online at: http://www.cms.hhs.gov. Last accessed November, 2011. |CPT||63650||Percutaneous implantation of neurostimulator electrode array; epidural|
|63655||Laminectomy for implantation of neurostimulator electrode plate/paddle; epidural|
|63661||Removal of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63662||Removal of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy (new code 1/1/10)|
|63663||Revision including replacement, when performed, of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63664||Revision including replacement, when performed, of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy, including fluoroscopy, when performed (new code 1/1/10)|
|63685||Insertion or replacement of spinal neurostimulator pulse generator or receiver, direct or inductive coupling|
|63688||Revision or removal of implanted spinal neurostimulator pulse generator or receiver|
|95970, 95971, 95972, 95973||Neurostimulator programming and analysis code range|
|ICD-9 Procedure||03.93||Insertion or replacement of spinal neurostimulator|
|03.94||Removal of spinal neurostimulator lead(s)|
|86.05||Incision with removal of foreign body or device from skin and subcutaneous tissue (used to report removal of a neurostimulator pulse generator)|
|86.94||Insertion or replacement of single array neurostimulator pulse generator, not specified as rechargeable|
|86.95||Insertion or replacement of dual array neurostimulator pulse generator, not specified as rechargeable|
|86.97||Insertion or replacement of single array rechargeable neurostimulator pulse generator (new code effective 10/1/05)|
|86.98||Insertion or replacement of dual array rechargeable neurostimulator pulse generation (new code effective 10/1/05)|
|ICD-9 Diagnosis||See “Pain” in ICD-9 diagnosis index|
|HCPCS||L8680||Implantable neurostimulator electrode, each (new code effective 1/1/06)|
|L8685||Implantable neurostimulator pulse generator, single array, rechargeable, includes extension (new code effective 1/1/06)|
|L8686||Implantable neurostimulator pulse generator, single array, nonrechargeable, includes extension (new code effective 1/1/06)|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension (new code effective 1/1/06)|
|L8688||Implantable neurostimulator pulse generator, dual array, nonrechargeable, includes extension (new code effective 1/1/06)|
|ICD-10-CM (effective 10/1/14)||This list is a representative list of severe and chronic pain of the trunk and limbs diagnosis codes.|
|G56.40 -G56.42||Causalgia of upper limb code range|
|G57.70 -G57.72||Causalgia of lower limb code range|
|G89.21 -G89.8||Chronic pain, not elsewhere classified, code range|
|G89.4||Chronic pain syndrome|
|G90.50 -G90.59||Complex regional pain syndrome I (CRPS I), code range|
|M25.50 -M25.579||Pain in joint, code range|
|M54.10 -M54.18||Radiculopathy, code range|
|M54.30 -M54.32||Sciatica, code range|
|M54.40 -M54.42||Lumbago with sciatica, code range|
|M54.5||Low back pain|
|M54.6||Pain in thoracic spine|
|M54.81, M54.89||Other dorsalgia codes|
|M79.60 -M79.676||Pain in limb, hand, foot, fingers and toes code range|
|ICD-10-PCS (effective 10/1/14)||ICD-10-PCS codes are only used for inpatient services.|
|Surgical, central nervous system, insertion, spinal canal, neurostimulator lead, code by approach|
|00HV0MZ, 00HV3MZ, 00HV4MZ||Surgical, central nervous system, insertion, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, removal, spinal canal, neurostimulator lead, code by approach|
|00PV0MZ, 00PV3MZ, 00PV4MZ||Surgical, central nervous system, removal, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, revision, spinal canal, neurostimulator lead, code by approach|
|00WV0MZ, 00WV3MZ, 00WV4MZ||Surgical, central nervous system, revision, spinal cord, neurostimulator lead, code by approach|
|0JH60M6, 0JH60M7, 0JH60M8, 0JH60M9, 0JH63M6, 0JH63M7, 0JH63M8, 0JH63M9, 0JH70M6, 0JH70M7, 0JH70M8, 0JH70M9, 0JH73M6, 0JH73M7, 0JH73M8, 0JH73M9, 0JH80M6, 0JH80M7, 0JH80M8, 0JH80M9, 0JH83M6, 0JH83M7, 0JH83M8, 0JH83M9||Surgical, subcutaneous tissue and fascia, insertion, stimulator generator, code by body part, approach, number of arrays and whether rechargeable or not|
|0JPT0MZ, 0JPT3MZ||Surgical, subcutaneous tissue and fascia, removal, subcutaneous tissue and fascia, trunk, stimulator generator, code by approach (there aren’t ICD-10-PCS codes for removal of stimulator generator from other body parts)|
|Type of Service||Surgical|
|Place of Service||Inpatient/Outpatient|
Electrical Nerve Stimulation, Spinal
Spinal Cord Stimulation
Stimulation, Electrical, Spinal Cord
|03/31/96||Add to Surgery section||New policy|
|04/01/98||Replace policy||Policy cross-referenced to No.
|
95973
|
Analyze neurostim complex
|
HCPCS
|
Centers for Medicare and Medicaid Services (CMS). National Coverage Determination for Electrical Nerve Stimulators (160.7). Available online at: http://www.cms.hhs.gov. Last accessed November, 2011. |CPT||63650||Percutaneous implantation of neurostimulator electrode array; epidural|
|63655||Laminectomy for implantation of neurostimulator electrode plate/paddle; epidural|
|63661||Removal of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63662||Removal of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy (new code 1/1/10)|
|63663||Revision including replacement, when performed, of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63664||Revision including replacement, when performed, of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy, including fluoroscopy, when performed (new code 1/1/10)|
|63685||Insertion or replacement of spinal neurostimulator pulse generator or receiver, direct or inductive coupling|
|63688||Revision or removal of implanted spinal neurostimulator pulse generator or receiver|
|95970, 95971, 95972, 95973||Neurostimulator programming and analysis code range|
|ICD-9 Procedure||03.93||Insertion or replacement of spinal neurostimulator|
|03.94||Removal of spinal neurostimulator lead(s)|
|86.05||Incision with removal of foreign body or device from skin and subcutaneous tissue (used to report removal of a neurostimulator pulse generator)|
|86.94||Insertion or replacement of single array neurostimulator pulse generator, not specified as rechargeable|
|86.95||Insertion or replacement of dual array neurostimulator pulse generator, not specified as rechargeable|
|86.97||Insertion or replacement of single array rechargeable neurostimulator pulse generator (new code effective 10/1/05)|
|86.98||Insertion or replacement of dual array rechargeable neurostimulator pulse generation (new code effective 10/1/05)|
|ICD-9 Diagnosis||See “Pain” in ICD-9 diagnosis index|
|HCPCS||L8680||Implantable neurostimulator electrode, each (new code effective 1/1/06)|
|L8685||Implantable neurostimulator pulse generator, single array, rechargeable, includes extension (new code effective 1/1/06)|
|L8686||Implantable neurostimulator pulse generator, single array, nonrechargeable, includes extension (new code effective 1/1/06)|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension (new code effective 1/1/06)|
|L8688||Implantable neurostimulator pulse generator, dual array, nonrechargeable, includes extension (new code effective 1/1/06)|
|ICD-10-CM (effective 10/1/14)||This list is a representative list of severe and chronic pain of the trunk and limbs diagnosis codes.|
|G56.40 -G56.42||Causalgia of upper limb code range|
|G57.70 -G57.72||Causalgia of lower limb code range|
|G89.21 -G89.8||Chronic pain, not elsewhere classified, code range|
|G89.4||Chronic pain syndrome|
|G90.50 -G90.59||Complex regional pain syndrome I (CRPS I), code range|
|M25.50 -M25.579||Pain in joint, code range|
|M54.10 -M54.18||Radiculopathy, code range|
|M54.30 -M54.32||Sciatica, code range|
|M54.40 -M54.42||Lumbago with sciatica, code range|
|M54.5||Low back pain|
|M54.6||Pain in thoracic spine|
|M54.81, M54.89||Other dorsalgia codes|
|M79.60 -M79.676||Pain in limb, hand, foot, fingers and toes code range|
|ICD-10-PCS (effective 10/1/14)||ICD-10-PCS codes are only used for inpatient services.|
|Surgical, central nervous system, insertion, spinal canal, neurostimulator lead, code by approach|
|00HV0MZ, 00HV3MZ, 00HV4MZ||Surgical, central nervous system, insertion, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, removal, spinal canal, neurostimulator lead, code by approach|
|00PV0MZ, 00PV3MZ, 00PV4MZ||Surgical, central nervous system, removal, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, revision, spinal canal, neurostimulator lead, code by approach|
|00WV0MZ, 00WV3MZ, 00WV4MZ||Surgical, central nervous system, revision, spinal cord, neurostimulator lead, code by approach|
|0JH60M6, 0JH60M7, 0JH60M8, 0JH60M9, 0JH63M6, 0JH63M7, 0JH63M8, 0JH63M9, 0JH70M6, 0JH70M7, 0JH70M8, 0JH70M9, 0JH73M6, 0JH73M7, 0JH73M8, 0JH73M9, 0JH80M6, 0JH80M7, 0JH80M8, 0JH80M9, 0JH83M6, 0JH83M7, 0JH83M8, 0JH83M9||Surgical, subcutaneous tissue and fascia, insertion, stimulator generator, code by body part, approach, number of arrays and whether rechargeable or not|
|0JPT0MZ, 0JPT3MZ||Surgical, subcutaneous tissue and fascia, removal, subcutaneous tissue and fascia, trunk, stimulator generator, code by approach (there aren’t ICD-10-PCS codes for removal of stimulator generator from other body parts)|
|Type of Service||Surgical|
|Place of Service||Inpatient/Outpatient|
Electrical Nerve Stimulation, Spinal
Spinal Cord Stimulation
Stimulation, Electrical, Spinal Cord
|03/31/96||Add to Surgery section||New policy|
|04/01/98||Replace policy||Policy cross-referenced to No.
|
63650
|
PR PRQ IMPLTJ NSTIM ELECTRODE ARRAY EPIDURAL
|
HCPCS
|
National Coverage Determination for Electrical Nerve Stimulators (160.7). Available online at: http://www.cms.hhs.gov. Last accessed November, 2011. |CPT||63650||Percutaneous implantation of neurostimulator electrode array; epidural|
|63655||Laminectomy for implantation of neurostimulator electrode plate/paddle; epidural|
|63661||Removal of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63662||Removal of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy (new code 1/1/10)|
|63663||Revision including replacement, when performed, of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63664||Revision including replacement, when performed, of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy, including fluoroscopy, when performed (new code 1/1/10)|
|63685||Insertion or replacement of spinal neurostimulator pulse generator or receiver, direct or inductive coupling|
|63688||Revision or removal of implanted spinal neurostimulator pulse generator or receiver|
|95970, 95971, 95972, 95973||Neurostimulator programming and analysis code range|
|ICD-9 Procedure||03.93||Insertion or replacement of spinal neurostimulator|
|03.94||Removal of spinal neurostimulator lead(s)|
|86.05||Incision with removal of foreign body or device from skin and subcutaneous tissue (used to report removal of a neurostimulator pulse generator)|
|86.94||Insertion or replacement of single array neurostimulator pulse generator, not specified as rechargeable|
|86.95||Insertion or replacement of dual array neurostimulator pulse generator, not specified as rechargeable|
|86.97||Insertion or replacement of single array rechargeable neurostimulator pulse generator (new code effective 10/1/05)|
|86.98||Insertion or replacement of dual array rechargeable neurostimulator pulse generation (new code effective 10/1/05)|
|ICD-9 Diagnosis||See “Pain” in ICD-9 diagnosis index|
|HCPCS||L8680||Implantable neurostimulator electrode, each (new code effective 1/1/06)|
|L8685||Implantable neurostimulator pulse generator, single array, rechargeable, includes extension (new code effective 1/1/06)|
|L8686||Implantable neurostimulator pulse generator, single array, nonrechargeable, includes extension (new code effective 1/1/06)|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension (new code effective 1/1/06)|
|L8688||Implantable neurostimulator pulse generator, dual array, nonrechargeable, includes extension (new code effective 1/1/06)|
|ICD-10-CM (effective 10/1/14)||This list is a representative list of severe and chronic pain of the trunk and limbs diagnosis codes.|
|G56.40 -G56.42||Causalgia of upper limb code range|
|G57.70 -G57.72||Causalgia of lower limb code range|
|G89.21 -G89.8||Chronic pain, not elsewhere classified, code range|
|G89.4||Chronic pain syndrome|
|G90.50 -G90.59||Complex regional pain syndrome I (CRPS I), code range|
|M25.50 -M25.579||Pain in joint, code range|
|M54.10 -M54.18||Radiculopathy, code range|
|M54.30 -M54.32||Sciatica, code range|
|M54.40 -M54.42||Lumbago with sciatica, code range|
|M54.5||Low back pain|
|M54.6||Pain in thoracic spine|
|M54.81, M54.89||Other dorsalgia codes|
|M79.60 -M79.676||Pain in limb, hand, foot, fingers and toes code range|
|ICD-10-PCS (effective 10/1/14)||ICD-10-PCS codes are only used for inpatient services.|
|Surgical, central nervous system, insertion, spinal canal, neurostimulator lead, code by approach|
|00HV0MZ, 00HV3MZ, 00HV4MZ||Surgical, central nervous system, insertion, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, removal, spinal canal, neurostimulator lead, code by approach|
|00PV0MZ, 00PV3MZ, 00PV4MZ||Surgical, central nervous system, removal, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, revision, spinal canal, neurostimulator lead, code by approach|
|00WV0MZ, 00WV3MZ, 00WV4MZ||Surgical, central nervous system, revision, spinal cord, neurostimulator lead, code by approach|
|0JH60M6, 0JH60M7, 0JH60M8, 0JH60M9, 0JH63M6, 0JH63M7, 0JH63M8, 0JH63M9, 0JH70M6, 0JH70M7, 0JH70M8, 0JH70M9, 0JH73M6, 0JH73M7, 0JH73M8, 0JH73M9, 0JH80M6, 0JH80M7, 0JH80M8, 0JH80M9, 0JH83M6, 0JH83M7, 0JH83M8, 0JH83M9||Surgical, subcutaneous tissue and fascia, insertion, stimulator generator, code by body part, approach, number of arrays and whether rechargeable or not|
|0JPT0MZ, 0JPT3MZ||Surgical, subcutaneous tissue and fascia, removal, subcutaneous tissue and fascia, trunk, stimulator generator, code by approach (there aren’t ICD-10-PCS codes for removal of stimulator generator from other body parts)|
|Type of Service||Surgical|
|Place of Service||Inpatient/Outpatient|
Electrical Nerve Stimulation, Spinal
Spinal Cord Stimulation
Stimulation, Electrical, Spinal Cord
|03/31/96||Add to Surgery section||New policy|
|04/01/98||Replace policy||Policy cross-referenced to No. 7.01.63|
|07/10/98||Replace policy||Policy updated and revised|
|11/15/98||Coding update||1999 CPT coding release|
|04/29/03||Replace policy||Policy updated; new policy statement added, stating that spinal cord stimulation is investigational as a treatment of critical limb ischemia|
|11/9/04||Replace policy||Policy updated; no change to policy statement.
|
63661
|
Remove spine eltrd perq aray
|
HCPCS
|
National Coverage Determination for Electrical Nerve Stimulators (160.7). Available online at: http://www.cms.hhs.gov. Last accessed November, 2011. |CPT||63650||Percutaneous implantation of neurostimulator electrode array; epidural|
|63655||Laminectomy for implantation of neurostimulator electrode plate/paddle; epidural|
|63661||Removal of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63662||Removal of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy (new code 1/1/10)|
|63663||Revision including replacement, when performed, of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63664||Revision including replacement, when performed, of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy, including fluoroscopy, when performed (new code 1/1/10)|
|63685||Insertion or replacement of spinal neurostimulator pulse generator or receiver, direct or inductive coupling|
|63688||Revision or removal of implanted spinal neurostimulator pulse generator or receiver|
|95970, 95971, 95972, 95973||Neurostimulator programming and analysis code range|
|ICD-9 Procedure||03.93||Insertion or replacement of spinal neurostimulator|
|03.94||Removal of spinal neurostimulator lead(s)|
|86.05||Incision with removal of foreign body or device from skin and subcutaneous tissue (used to report removal of a neurostimulator pulse generator)|
|86.94||Insertion or replacement of single array neurostimulator pulse generator, not specified as rechargeable|
|86.95||Insertion or replacement of dual array neurostimulator pulse generator, not specified as rechargeable|
|86.97||Insertion or replacement of single array rechargeable neurostimulator pulse generator (new code effective 10/1/05)|
|86.98||Insertion or replacement of dual array rechargeable neurostimulator pulse generation (new code effective 10/1/05)|
|ICD-9 Diagnosis||See “Pain” in ICD-9 diagnosis index|
|HCPCS||L8680||Implantable neurostimulator electrode, each (new code effective 1/1/06)|
|L8685||Implantable neurostimulator pulse generator, single array, rechargeable, includes extension (new code effective 1/1/06)|
|L8686||Implantable neurostimulator pulse generator, single array, nonrechargeable, includes extension (new code effective 1/1/06)|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension (new code effective 1/1/06)|
|L8688||Implantable neurostimulator pulse generator, dual array, nonrechargeable, includes extension (new code effective 1/1/06)|
|ICD-10-CM (effective 10/1/14)||This list is a representative list of severe and chronic pain of the trunk and limbs diagnosis codes.|
|G56.40 -G56.42||Causalgia of upper limb code range|
|G57.70 -G57.72||Causalgia of lower limb code range|
|G89.21 -G89.8||Chronic pain, not elsewhere classified, code range|
|G89.4||Chronic pain syndrome|
|G90.50 -G90.59||Complex regional pain syndrome I (CRPS I), code range|
|M25.50 -M25.579||Pain in joint, code range|
|M54.10 -M54.18||Radiculopathy, code range|
|M54.30 -M54.32||Sciatica, code range|
|M54.40 -M54.42||Lumbago with sciatica, code range|
|M54.5||Low back pain|
|M54.6||Pain in thoracic spine|
|M54.81, M54.89||Other dorsalgia codes|
|M79.60 -M79.676||Pain in limb, hand, foot, fingers and toes code range|
|ICD-10-PCS (effective 10/1/14)||ICD-10-PCS codes are only used for inpatient services.|
|Surgical, central nervous system, insertion, spinal canal, neurostimulator lead, code by approach|
|00HV0MZ, 00HV3MZ, 00HV4MZ||Surgical, central nervous system, insertion, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, removal, spinal canal, neurostimulator lead, code by approach|
|00PV0MZ, 00PV3MZ, 00PV4MZ||Surgical, central nervous system, removal, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, revision, spinal canal, neurostimulator lead, code by approach|
|00WV0MZ, 00WV3MZ, 00WV4MZ||Surgical, central nervous system, revision, spinal cord, neurostimulator lead, code by approach|
|0JH60M6, 0JH60M7, 0JH60M8, 0JH60M9, 0JH63M6, 0JH63M7, 0JH63M8, 0JH63M9, 0JH70M6, 0JH70M7, 0JH70M8, 0JH70M9, 0JH73M6, 0JH73M7, 0JH73M8, 0JH73M9, 0JH80M6, 0JH80M7, 0JH80M8, 0JH80M9, 0JH83M6, 0JH83M7, 0JH83M8, 0JH83M9||Surgical, subcutaneous tissue and fascia, insertion, stimulator generator, code by body part, approach, number of arrays and whether rechargeable or not|
|0JPT0MZ, 0JPT3MZ||Surgical, subcutaneous tissue and fascia, removal, subcutaneous tissue and fascia, trunk, stimulator generator, code by approach (there aren’t ICD-10-PCS codes for removal of stimulator generator from other body parts)|
|Type of Service||Surgical|
|Place of Service||Inpatient/Outpatient|
Electrical Nerve Stimulation, Spinal
Spinal Cord Stimulation
Stimulation, Electrical, Spinal Cord
|03/31/96||Add to Surgery section||New policy|
|04/01/98||Replace policy||Policy cross-referenced to No. 7.01.63|
|07/10/98||Replace policy||Policy updated and revised|
|11/15/98||Coding update||1999 CPT coding release|
|04/29/03||Replace policy||Policy updated; new policy statement added, stating that spinal cord stimulation is investigational as a treatment of critical limb ischemia|
|11/9/04||Replace policy||Policy updated; no change to policy statement.
|
95972
|
PR ELEC ALYS IMPLT NPGT CPLX SP/PN PRGRMG
|
HCPCS
|
National Coverage Determination for Electrical Nerve Stimulators (160.7). Available online at: http://www.cms.hhs.gov. Last accessed November, 2011. |CPT||63650||Percutaneous implantation of neurostimulator electrode array; epidural|
|63655||Laminectomy for implantation of neurostimulator electrode plate/paddle; epidural|
|63661||Removal of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63662||Removal of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy (new code 1/1/10)|
|63663||Revision including replacement, when performed, of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63664||Revision including replacement, when performed, of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy, including fluoroscopy, when performed (new code 1/1/10)|
|63685||Insertion or replacement of spinal neurostimulator pulse generator or receiver, direct or inductive coupling|
|63688||Revision or removal of implanted spinal neurostimulator pulse generator or receiver|
|95970, 95971, 95972, 95973||Neurostimulator programming and analysis code range|
|ICD-9 Procedure||03.93||Insertion or replacement of spinal neurostimulator|
|03.94||Removal of spinal neurostimulator lead(s)|
|86.05||Incision with removal of foreign body or device from skin and subcutaneous tissue (used to report removal of a neurostimulator pulse generator)|
|86.94||Insertion or replacement of single array neurostimulator pulse generator, not specified as rechargeable|
|86.95||Insertion or replacement of dual array neurostimulator pulse generator, not specified as rechargeable|
|86.97||Insertion or replacement of single array rechargeable neurostimulator pulse generator (new code effective 10/1/05)|
|86.98||Insertion or replacement of dual array rechargeable neurostimulator pulse generation (new code effective 10/1/05)|
|ICD-9 Diagnosis||See “Pain” in ICD-9 diagnosis index|
|HCPCS||L8680||Implantable neurostimulator electrode, each (new code effective 1/1/06)|
|L8685||Implantable neurostimulator pulse generator, single array, rechargeable, includes extension (new code effective 1/1/06)|
|L8686||Implantable neurostimulator pulse generator, single array, nonrechargeable, includes extension (new code effective 1/1/06)|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension (new code effective 1/1/06)|
|L8688||Implantable neurostimulator pulse generator, dual array, nonrechargeable, includes extension (new code effective 1/1/06)|
|ICD-10-CM (effective 10/1/14)||This list is a representative list of severe and chronic pain of the trunk and limbs diagnosis codes.|
|G56.40 -G56.42||Causalgia of upper limb code range|
|G57.70 -G57.72||Causalgia of lower limb code range|
|G89.21 -G89.8||Chronic pain, not elsewhere classified, code range|
|G89.4||Chronic pain syndrome|
|G90.50 -G90.59||Complex regional pain syndrome I (CRPS I), code range|
|M25.50 -M25.579||Pain in joint, code range|
|M54.10 -M54.18||Radiculopathy, code range|
|M54.30 -M54.32||Sciatica, code range|
|M54.40 -M54.42||Lumbago with sciatica, code range|
|M54.5||Low back pain|
|M54.6||Pain in thoracic spine|
|M54.81, M54.89||Other dorsalgia codes|
|M79.60 -M79.676||Pain in limb, hand, foot, fingers and toes code range|
|ICD-10-PCS (effective 10/1/14)||ICD-10-PCS codes are only used for inpatient services.|
|Surgical, central nervous system, insertion, spinal canal, neurostimulator lead, code by approach|
|00HV0MZ, 00HV3MZ, 00HV4MZ||Surgical, central nervous system, insertion, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, removal, spinal canal, neurostimulator lead, code by approach|
|00PV0MZ, 00PV3MZ, 00PV4MZ||Surgical, central nervous system, removal, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, revision, spinal canal, neurostimulator lead, code by approach|
|00WV0MZ, 00WV3MZ, 00WV4MZ||Surgical, central nervous system, revision, spinal cord, neurostimulator lead, code by approach|
|0JH60M6, 0JH60M7, 0JH60M8, 0JH60M9, 0JH63M6, 0JH63M7, 0JH63M8, 0JH63M9, 0JH70M6, 0JH70M7, 0JH70M8, 0JH70M9, 0JH73M6, 0JH73M7, 0JH73M8, 0JH73M9, 0JH80M6, 0JH80M7, 0JH80M8, 0JH80M9, 0JH83M6, 0JH83M7, 0JH83M8, 0JH83M9||Surgical, subcutaneous tissue and fascia, insertion, stimulator generator, code by body part, approach, number of arrays and whether rechargeable or not|
|0JPT0MZ, 0JPT3MZ||Surgical, subcutaneous tissue and fascia, removal, subcutaneous tissue and fascia, trunk, stimulator generator, code by approach (there aren’t ICD-10-PCS codes for removal of stimulator generator from other body parts)|
|Type of Service||Surgical|
|Place of Service||Inpatient/Outpatient|
Electrical Nerve Stimulation, Spinal
Spinal Cord Stimulation
Stimulation, Electrical, Spinal Cord
|03/31/96||Add to Surgery section||New policy|
|04/01/98||Replace policy||Policy cross-referenced to No. 7.01.63|
|07/10/98||Replace policy||Policy updated and revised|
|11/15/98||Coding update||1999 CPT coding release|
|04/29/03||Replace policy||Policy updated; new policy statement added, stating that spinal cord stimulation is investigational as a treatment of critical limb ischemia|
|11/9/04||Replace policy||Policy updated; no change to policy statement.
|
L8688
|
Implt nrostm pls gen dua non
|
HCPCS
|
National Coverage Determination for Electrical Nerve Stimulators (160.7). Available online at: http://www.cms.hhs.gov. Last accessed November, 2011. |CPT||63650||Percutaneous implantation of neurostimulator electrode array; epidural|
|63655||Laminectomy for implantation of neurostimulator electrode plate/paddle; epidural|
|63661||Removal of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63662||Removal of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy (new code 1/1/10)|
|63663||Revision including replacement, when performed, of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63664||Revision including replacement, when performed, of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy, including fluoroscopy, when performed (new code 1/1/10)|
|63685||Insertion or replacement of spinal neurostimulator pulse generator or receiver, direct or inductive coupling|
|63688||Revision or removal of implanted spinal neurostimulator pulse generator or receiver|
|95970, 95971, 95972, 95973||Neurostimulator programming and analysis code range|
|ICD-9 Procedure||03.93||Insertion or replacement of spinal neurostimulator|
|03.94||Removal of spinal neurostimulator lead(s)|
|86.05||Incision with removal of foreign body or device from skin and subcutaneous tissue (used to report removal of a neurostimulator pulse generator)|
|86.94||Insertion or replacement of single array neurostimulator pulse generator, not specified as rechargeable|
|86.95||Insertion or replacement of dual array neurostimulator pulse generator, not specified as rechargeable|
|86.97||Insertion or replacement of single array rechargeable neurostimulator pulse generator (new code effective 10/1/05)|
|86.98||Insertion or replacement of dual array rechargeable neurostimulator pulse generation (new code effective 10/1/05)|
|ICD-9 Diagnosis||See “Pain” in ICD-9 diagnosis index|
|HCPCS||L8680||Implantable neurostimulator electrode, each (new code effective 1/1/06)|
|L8685||Implantable neurostimulator pulse generator, single array, rechargeable, includes extension (new code effective 1/1/06)|
|L8686||Implantable neurostimulator pulse generator, single array, nonrechargeable, includes extension (new code effective 1/1/06)|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension (new code effective 1/1/06)|
|L8688||Implantable neurostimulator pulse generator, dual array, nonrechargeable, includes extension (new code effective 1/1/06)|
|ICD-10-CM (effective 10/1/14)||This list is a representative list of severe and chronic pain of the trunk and limbs diagnosis codes.|
|G56.40 -G56.42||Causalgia of upper limb code range|
|G57.70 -G57.72||Causalgia of lower limb code range|
|G89.21 -G89.8||Chronic pain, not elsewhere classified, code range|
|G89.4||Chronic pain syndrome|
|G90.50 -G90.59||Complex regional pain syndrome I (CRPS I), code range|
|M25.50 -M25.579||Pain in joint, code range|
|M54.10 -M54.18||Radiculopathy, code range|
|M54.30 -M54.32||Sciatica, code range|
|M54.40 -M54.42||Lumbago with sciatica, code range|
|M54.5||Low back pain|
|M54.6||Pain in thoracic spine|
|M54.81, M54.89||Other dorsalgia codes|
|M79.60 -M79.676||Pain in limb, hand, foot, fingers and toes code range|
|ICD-10-PCS (effective 10/1/14)||ICD-10-PCS codes are only used for inpatient services.|
|Surgical, central nervous system, insertion, spinal canal, neurostimulator lead, code by approach|
|00HV0MZ, 00HV3MZ, 00HV4MZ||Surgical, central nervous system, insertion, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, removal, spinal canal, neurostimulator lead, code by approach|
|00PV0MZ, 00PV3MZ, 00PV4MZ||Surgical, central nervous system, removal, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, revision, spinal canal, neurostimulator lead, code by approach|
|00WV0MZ, 00WV3MZ, 00WV4MZ||Surgical, central nervous system, revision, spinal cord, neurostimulator lead, code by approach|
|0JH60M6, 0JH60M7, 0JH60M8, 0JH60M9, 0JH63M6, 0JH63M7, 0JH63M8, 0JH63M9, 0JH70M6, 0JH70M7, 0JH70M8, 0JH70M9, 0JH73M6, 0JH73M7, 0JH73M8, 0JH73M9, 0JH80M6, 0JH80M7, 0JH80M8, 0JH80M9, 0JH83M6, 0JH83M7, 0JH83M8, 0JH83M9||Surgical, subcutaneous tissue and fascia, insertion, stimulator generator, code by body part, approach, number of arrays and whether rechargeable or not|
|0JPT0MZ, 0JPT3MZ||Surgical, subcutaneous tissue and fascia, removal, subcutaneous tissue and fascia, trunk, stimulator generator, code by approach (there aren’t ICD-10-PCS codes for removal of stimulator generator from other body parts)|
|Type of Service||Surgical|
|Place of Service||Inpatient/Outpatient|
Electrical Nerve Stimulation, Spinal
Spinal Cord Stimulation
Stimulation, Electrical, Spinal Cord
|03/31/96||Add to Surgery section||New policy|
|04/01/98||Replace policy||Policy cross-referenced to No. 7.01.63|
|07/10/98||Replace policy||Policy updated and revised|
|11/15/98||Coding update||1999 CPT coding release|
|04/29/03||Replace policy||Policy updated; new policy statement added, stating that spinal cord stimulation is investigational as a treatment of critical limb ischemia|
|11/9/04||Replace policy||Policy updated; no change to policy statement.
|
1999
|
ANESTHESIOLOGY GROUP
|
CPT
|
National Coverage Determination for Electrical Nerve Stimulators (160.7). Available online at: http://www.cms.hhs.gov. Last accessed November, 2011. |CPT||63650||Percutaneous implantation of neurostimulator electrode array; epidural|
|63655||Laminectomy for implantation of neurostimulator electrode plate/paddle; epidural|
|63661||Removal of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63662||Removal of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy (new code 1/1/10)|
|63663||Revision including replacement, when performed, of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63664||Revision including replacement, when performed, of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy, including fluoroscopy, when performed (new code 1/1/10)|
|63685||Insertion or replacement of spinal neurostimulator pulse generator or receiver, direct or inductive coupling|
|63688||Revision or removal of implanted spinal neurostimulator pulse generator or receiver|
|95970, 95971, 95972, 95973||Neurostimulator programming and analysis code range|
|ICD-9 Procedure||03.93||Insertion or replacement of spinal neurostimulator|
|03.94||Removal of spinal neurostimulator lead(s)|
|86.05||Incision with removal of foreign body or device from skin and subcutaneous tissue (used to report removal of a neurostimulator pulse generator)|
|86.94||Insertion or replacement of single array neurostimulator pulse generator, not specified as rechargeable|
|86.95||Insertion or replacement of dual array neurostimulator pulse generator, not specified as rechargeable|
|86.97||Insertion or replacement of single array rechargeable neurostimulator pulse generator (new code effective 10/1/05)|
|86.98||Insertion or replacement of dual array rechargeable neurostimulator pulse generation (new code effective 10/1/05)|
|ICD-9 Diagnosis||See “Pain” in ICD-9 diagnosis index|
|HCPCS||L8680||Implantable neurostimulator electrode, each (new code effective 1/1/06)|
|L8685||Implantable neurostimulator pulse generator, single array, rechargeable, includes extension (new code effective 1/1/06)|
|L8686||Implantable neurostimulator pulse generator, single array, nonrechargeable, includes extension (new code effective 1/1/06)|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension (new code effective 1/1/06)|
|L8688||Implantable neurostimulator pulse generator, dual array, nonrechargeable, includes extension (new code effective 1/1/06)|
|ICD-10-CM (effective 10/1/14)||This list is a representative list of severe and chronic pain of the trunk and limbs diagnosis codes.|
|G56.40 -G56.42||Causalgia of upper limb code range|
|G57.70 -G57.72||Causalgia of lower limb code range|
|G89.21 -G89.8||Chronic pain, not elsewhere classified, code range|
|G89.4||Chronic pain syndrome|
|G90.50 -G90.59||Complex regional pain syndrome I (CRPS I), code range|
|M25.50 -M25.579||Pain in joint, code range|
|M54.10 -M54.18||Radiculopathy, code range|
|M54.30 -M54.32||Sciatica, code range|
|M54.40 -M54.42||Lumbago with sciatica, code range|
|M54.5||Low back pain|
|M54.6||Pain in thoracic spine|
|M54.81, M54.89||Other dorsalgia codes|
|M79.60 -M79.676||Pain in limb, hand, foot, fingers and toes code range|
|ICD-10-PCS (effective 10/1/14)||ICD-10-PCS codes are only used for inpatient services.|
|Surgical, central nervous system, insertion, spinal canal, neurostimulator lead, code by approach|
|00HV0MZ, 00HV3MZ, 00HV4MZ||Surgical, central nervous system, insertion, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, removal, spinal canal, neurostimulator lead, code by approach|
|00PV0MZ, 00PV3MZ, 00PV4MZ||Surgical, central nervous system, removal, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, revision, spinal canal, neurostimulator lead, code by approach|
|00WV0MZ, 00WV3MZ, 00WV4MZ||Surgical, central nervous system, revision, spinal cord, neurostimulator lead, code by approach|
|0JH60M6, 0JH60M7, 0JH60M8, 0JH60M9, 0JH63M6, 0JH63M7, 0JH63M8, 0JH63M9, 0JH70M6, 0JH70M7, 0JH70M8, 0JH70M9, 0JH73M6, 0JH73M7, 0JH73M8, 0JH73M9, 0JH80M6, 0JH80M7, 0JH80M8, 0JH80M9, 0JH83M6, 0JH83M7, 0JH83M8, 0JH83M9||Surgical, subcutaneous tissue and fascia, insertion, stimulator generator, code by body part, approach, number of arrays and whether rechargeable or not|
|0JPT0MZ, 0JPT3MZ||Surgical, subcutaneous tissue and fascia, removal, subcutaneous tissue and fascia, trunk, stimulator generator, code by approach (there aren’t ICD-10-PCS codes for removal of stimulator generator from other body parts)|
|Type of Service||Surgical|
|Place of Service||Inpatient/Outpatient|
Electrical Nerve Stimulation, Spinal
Spinal Cord Stimulation
Stimulation, Electrical, Spinal Cord
|03/31/96||Add to Surgery section||New policy|
|04/01/98||Replace policy||Policy cross-referenced to No. 7.01.63|
|07/10/98||Replace policy||Policy updated and revised|
|11/15/98||Coding update||1999 CPT coding release|
|04/29/03||Replace policy||Policy updated; new policy statement added, stating that spinal cord stimulation is investigational as a treatment of critical limb ischemia|
|11/9/04||Replace policy||Policy updated; no change to policy statement.
|
L8680
|
KIT NRSTM 40CM STIMLOC .
|
HCPCS
|
National Coverage Determination for Electrical Nerve Stimulators (160.7). Available online at: http://www.cms.hhs.gov. Last accessed November, 2011. |CPT||63650||Percutaneous implantation of neurostimulator electrode array; epidural|
|63655||Laminectomy for implantation of neurostimulator electrode plate/paddle; epidural|
|63661||Removal of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63662||Removal of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy (new code 1/1/10)|
|63663||Revision including replacement, when performed, of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63664||Revision including replacement, when performed, of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy, including fluoroscopy, when performed (new code 1/1/10)|
|63685||Insertion or replacement of spinal neurostimulator pulse generator or receiver, direct or inductive coupling|
|63688||Revision or removal of implanted spinal neurostimulator pulse generator or receiver|
|95970, 95971, 95972, 95973||Neurostimulator programming and analysis code range|
|ICD-9 Procedure||03.93||Insertion or replacement of spinal neurostimulator|
|03.94||Removal of spinal neurostimulator lead(s)|
|86.05||Incision with removal of foreign body or device from skin and subcutaneous tissue (used to report removal of a neurostimulator pulse generator)|
|86.94||Insertion or replacement of single array neurostimulator pulse generator, not specified as rechargeable|
|86.95||Insertion or replacement of dual array neurostimulator pulse generator, not specified as rechargeable|
|86.97||Insertion or replacement of single array rechargeable neurostimulator pulse generator (new code effective 10/1/05)|
|86.98||Insertion or replacement of dual array rechargeable neurostimulator pulse generation (new code effective 10/1/05)|
|ICD-9 Diagnosis||See “Pain” in ICD-9 diagnosis index|
|HCPCS||L8680||Implantable neurostimulator electrode, each (new code effective 1/1/06)|
|L8685||Implantable neurostimulator pulse generator, single array, rechargeable, includes extension (new code effective 1/1/06)|
|L8686||Implantable neurostimulator pulse generator, single array, nonrechargeable, includes extension (new code effective 1/1/06)|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension (new code effective 1/1/06)|
|L8688||Implantable neurostimulator pulse generator, dual array, nonrechargeable, includes extension (new code effective 1/1/06)|
|ICD-10-CM (effective 10/1/14)||This list is a representative list of severe and chronic pain of the trunk and limbs diagnosis codes.|
|G56.40 -G56.42||Causalgia of upper limb code range|
|G57.70 -G57.72||Causalgia of lower limb code range|
|G89.21 -G89.8||Chronic pain, not elsewhere classified, code range|
|G89.4||Chronic pain syndrome|
|G90.50 -G90.59||Complex regional pain syndrome I (CRPS I), code range|
|M25.50 -M25.579||Pain in joint, code range|
|M54.10 -M54.18||Radiculopathy, code range|
|M54.30 -M54.32||Sciatica, code range|
|M54.40 -M54.42||Lumbago with sciatica, code range|
|M54.5||Low back pain|
|M54.6||Pain in thoracic spine|
|M54.81, M54.89||Other dorsalgia codes|
|M79.60 -M79.676||Pain in limb, hand, foot, fingers and toes code range|
|ICD-10-PCS (effective 10/1/14)||ICD-10-PCS codes are only used for inpatient services.|
|Surgical, central nervous system, insertion, spinal canal, neurostimulator lead, code by approach|
|00HV0MZ, 00HV3MZ, 00HV4MZ||Surgical, central nervous system, insertion, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, removal, spinal canal, neurostimulator lead, code by approach|
|00PV0MZ, 00PV3MZ, 00PV4MZ||Surgical, central nervous system, removal, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, revision, spinal canal, neurostimulator lead, code by approach|
|00WV0MZ, 00WV3MZ, 00WV4MZ||Surgical, central nervous system, revision, spinal cord, neurostimulator lead, code by approach|
|0JH60M6, 0JH60M7, 0JH60M8, 0JH60M9, 0JH63M6, 0JH63M7, 0JH63M8, 0JH63M9, 0JH70M6, 0JH70M7, 0JH70M8, 0JH70M9, 0JH73M6, 0JH73M7, 0JH73M8, 0JH73M9, 0JH80M6, 0JH80M7, 0JH80M8, 0JH80M9, 0JH83M6, 0JH83M7, 0JH83M8, 0JH83M9||Surgical, subcutaneous tissue and fascia, insertion, stimulator generator, code by body part, approach, number of arrays and whether rechargeable or not|
|0JPT0MZ, 0JPT3MZ||Surgical, subcutaneous tissue and fascia, removal, subcutaneous tissue and fascia, trunk, stimulator generator, code by approach (there aren’t ICD-10-PCS codes for removal of stimulator generator from other body parts)|
|Type of Service||Surgical|
|Place of Service||Inpatient/Outpatient|
Electrical Nerve Stimulation, Spinal
Spinal Cord Stimulation
Stimulation, Electrical, Spinal Cord
|03/31/96||Add to Surgery section||New policy|
|04/01/98||Replace policy||Policy cross-referenced to No. 7.01.63|
|07/10/98||Replace policy||Policy updated and revised|
|11/15/98||Coding update||1999 CPT coding release|
|04/29/03||Replace policy||Policy updated; new policy statement added, stating that spinal cord stimulation is investigational as a treatment of critical limb ischemia|
|11/9/04||Replace policy||Policy updated; no change to policy statement.
|
63662
|
Remove spine eltrd plate
|
HCPCS
|
National Coverage Determination for Electrical Nerve Stimulators (160.7). Available online at: http://www.cms.hhs.gov. Last accessed November, 2011. |CPT||63650||Percutaneous implantation of neurostimulator electrode array; epidural|
|63655||Laminectomy for implantation of neurostimulator electrode plate/paddle; epidural|
|63661||Removal of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63662||Removal of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy (new code 1/1/10)|
|63663||Revision including replacement, when performed, of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63664||Revision including replacement, when performed, of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy, including fluoroscopy, when performed (new code 1/1/10)|
|63685||Insertion or replacement of spinal neurostimulator pulse generator or receiver, direct or inductive coupling|
|63688||Revision or removal of implanted spinal neurostimulator pulse generator or receiver|
|95970, 95971, 95972, 95973||Neurostimulator programming and analysis code range|
|ICD-9 Procedure||03.93||Insertion or replacement of spinal neurostimulator|
|03.94||Removal of spinal neurostimulator lead(s)|
|86.05||Incision with removal of foreign body or device from skin and subcutaneous tissue (used to report removal of a neurostimulator pulse generator)|
|86.94||Insertion or replacement of single array neurostimulator pulse generator, not specified as rechargeable|
|86.95||Insertion or replacement of dual array neurostimulator pulse generator, not specified as rechargeable|
|86.97||Insertion or replacement of single array rechargeable neurostimulator pulse generator (new code effective 10/1/05)|
|86.98||Insertion or replacement of dual array rechargeable neurostimulator pulse generation (new code effective 10/1/05)|
|ICD-9 Diagnosis||See “Pain” in ICD-9 diagnosis index|
|HCPCS||L8680||Implantable neurostimulator electrode, each (new code effective 1/1/06)|
|L8685||Implantable neurostimulator pulse generator, single array, rechargeable, includes extension (new code effective 1/1/06)|
|L8686||Implantable neurostimulator pulse generator, single array, nonrechargeable, includes extension (new code effective 1/1/06)|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension (new code effective 1/1/06)|
|L8688||Implantable neurostimulator pulse generator, dual array, nonrechargeable, includes extension (new code effective 1/1/06)|
|ICD-10-CM (effective 10/1/14)||This list is a representative list of severe and chronic pain of the trunk and limbs diagnosis codes.|
|G56.40 -G56.42||Causalgia of upper limb code range|
|G57.70 -G57.72||Causalgia of lower limb code range|
|G89.21 -G89.8||Chronic pain, not elsewhere classified, code range|
|G89.4||Chronic pain syndrome|
|G90.50 -G90.59||Complex regional pain syndrome I (CRPS I), code range|
|M25.50 -M25.579||Pain in joint, code range|
|M54.10 -M54.18||Radiculopathy, code range|
|M54.30 -M54.32||Sciatica, code range|
|M54.40 -M54.42||Lumbago with sciatica, code range|
|M54.5||Low back pain|
|M54.6||Pain in thoracic spine|
|M54.81, M54.89||Other dorsalgia codes|
|M79.60 -M79.676||Pain in limb, hand, foot, fingers and toes code range|
|ICD-10-PCS (effective 10/1/14)||ICD-10-PCS codes are only used for inpatient services.|
|Surgical, central nervous system, insertion, spinal canal, neurostimulator lead, code by approach|
|00HV0MZ, 00HV3MZ, 00HV4MZ||Surgical, central nervous system, insertion, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, removal, spinal canal, neurostimulator lead, code by approach|
|00PV0MZ, 00PV3MZ, 00PV4MZ||Surgical, central nervous system, removal, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, revision, spinal canal, neurostimulator lead, code by approach|
|00WV0MZ, 00WV3MZ, 00WV4MZ||Surgical, central nervous system, revision, spinal cord, neurostimulator lead, code by approach|
|0JH60M6, 0JH60M7, 0JH60M8, 0JH60M9, 0JH63M6, 0JH63M7, 0JH63M8, 0JH63M9, 0JH70M6, 0JH70M7, 0JH70M8, 0JH70M9, 0JH73M6, 0JH73M7, 0JH73M8, 0JH73M9, 0JH80M6, 0JH80M7, 0JH80M8, 0JH80M9, 0JH83M6, 0JH83M7, 0JH83M8, 0JH83M9||Surgical, subcutaneous tissue and fascia, insertion, stimulator generator, code by body part, approach, number of arrays and whether rechargeable or not|
|0JPT0MZ, 0JPT3MZ||Surgical, subcutaneous tissue and fascia, removal, subcutaneous tissue and fascia, trunk, stimulator generator, code by approach (there aren’t ICD-10-PCS codes for removal of stimulator generator from other body parts)|
|Type of Service||Surgical|
|Place of Service||Inpatient/Outpatient|
Electrical Nerve Stimulation, Spinal
Spinal Cord Stimulation
Stimulation, Electrical, Spinal Cord
|03/31/96||Add to Surgery section||New policy|
|04/01/98||Replace policy||Policy cross-referenced to No. 7.01.63|
|07/10/98||Replace policy||Policy updated and revised|
|11/15/98||Coding update||1999 CPT coding release|
|04/29/03||Replace policy||Policy updated; new policy statement added, stating that spinal cord stimulation is investigational as a treatment of critical limb ischemia|
|11/9/04||Replace policy||Policy updated; no change to policy statement.
|
L8687
|
KIT NEUROSTIMULATOR SENZA IPG STERILE LATEX FREE DISPOSABLE
|
HCPCS
|
National Coverage Determination for Electrical Nerve Stimulators (160.7). Available online at: http://www.cms.hhs.gov. Last accessed November, 2011. |CPT||63650||Percutaneous implantation of neurostimulator electrode array; epidural|
|63655||Laminectomy for implantation of neurostimulator electrode plate/paddle; epidural|
|63661||Removal of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63662||Removal of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy (new code 1/1/10)|
|63663||Revision including replacement, when performed, of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63664||Revision including replacement, when performed, of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy, including fluoroscopy, when performed (new code 1/1/10)|
|63685||Insertion or replacement of spinal neurostimulator pulse generator or receiver, direct or inductive coupling|
|63688||Revision or removal of implanted spinal neurostimulator pulse generator or receiver|
|95970, 95971, 95972, 95973||Neurostimulator programming and analysis code range|
|ICD-9 Procedure||03.93||Insertion or replacement of spinal neurostimulator|
|03.94||Removal of spinal neurostimulator lead(s)|
|86.05||Incision with removal of foreign body or device from skin and subcutaneous tissue (used to report removal of a neurostimulator pulse generator)|
|86.94||Insertion or replacement of single array neurostimulator pulse generator, not specified as rechargeable|
|86.95||Insertion or replacement of dual array neurostimulator pulse generator, not specified as rechargeable|
|86.97||Insertion or replacement of single array rechargeable neurostimulator pulse generator (new code effective 10/1/05)|
|86.98||Insertion or replacement of dual array rechargeable neurostimulator pulse generation (new code effective 10/1/05)|
|ICD-9 Diagnosis||See “Pain” in ICD-9 diagnosis index|
|HCPCS||L8680||Implantable neurostimulator electrode, each (new code effective 1/1/06)|
|L8685||Implantable neurostimulator pulse generator, single array, rechargeable, includes extension (new code effective 1/1/06)|
|L8686||Implantable neurostimulator pulse generator, single array, nonrechargeable, includes extension (new code effective 1/1/06)|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension (new code effective 1/1/06)|
|L8688||Implantable neurostimulator pulse generator, dual array, nonrechargeable, includes extension (new code effective 1/1/06)|
|ICD-10-CM (effective 10/1/14)||This list is a representative list of severe and chronic pain of the trunk and limbs diagnosis codes.|
|G56.40 -G56.42||Causalgia of upper limb code range|
|G57.70 -G57.72||Causalgia of lower limb code range|
|G89.21 -G89.8||Chronic pain, not elsewhere classified, code range|
|G89.4||Chronic pain syndrome|
|G90.50 -G90.59||Complex regional pain syndrome I (CRPS I), code range|
|M25.50 -M25.579||Pain in joint, code range|
|M54.10 -M54.18||Radiculopathy, code range|
|M54.30 -M54.32||Sciatica, code range|
|M54.40 -M54.42||Lumbago with sciatica, code range|
|M54.5||Low back pain|
|M54.6||Pain in thoracic spine|
|M54.81, M54.89||Other dorsalgia codes|
|M79.60 -M79.676||Pain in limb, hand, foot, fingers and toes code range|
|ICD-10-PCS (effective 10/1/14)||ICD-10-PCS codes are only used for inpatient services.|
|Surgical, central nervous system, insertion, spinal canal, neurostimulator lead, code by approach|
|00HV0MZ, 00HV3MZ, 00HV4MZ||Surgical, central nervous system, insertion, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, removal, spinal canal, neurostimulator lead, code by approach|
|00PV0MZ, 00PV3MZ, 00PV4MZ||Surgical, central nervous system, removal, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, revision, spinal canal, neurostimulator lead, code by approach|
|00WV0MZ, 00WV3MZ, 00WV4MZ||Surgical, central nervous system, revision, spinal cord, neurostimulator lead, code by approach|
|0JH60M6, 0JH60M7, 0JH60M8, 0JH60M9, 0JH63M6, 0JH63M7, 0JH63M8, 0JH63M9, 0JH70M6, 0JH70M7, 0JH70M8, 0JH70M9, 0JH73M6, 0JH73M7, 0JH73M8, 0JH73M9, 0JH80M6, 0JH80M7, 0JH80M8, 0JH80M9, 0JH83M6, 0JH83M7, 0JH83M8, 0JH83M9||Surgical, subcutaneous tissue and fascia, insertion, stimulator generator, code by body part, approach, number of arrays and whether rechargeable or not|
|0JPT0MZ, 0JPT3MZ||Surgical, subcutaneous tissue and fascia, removal, subcutaneous tissue and fascia, trunk, stimulator generator, code by approach (there aren’t ICD-10-PCS codes for removal of stimulator generator from other body parts)|
|Type of Service||Surgical|
|Place of Service||Inpatient/Outpatient|
Electrical Nerve Stimulation, Spinal
Spinal Cord Stimulation
Stimulation, Electrical, Spinal Cord
|03/31/96||Add to Surgery section||New policy|
|04/01/98||Replace policy||Policy cross-referenced to No. 7.01.63|
|07/10/98||Replace policy||Policy updated and revised|
|11/15/98||Coding update||1999 CPT coding release|
|04/29/03||Replace policy||Policy updated; new policy statement added, stating that spinal cord stimulation is investigational as a treatment of critical limb ischemia|
|11/9/04||Replace policy||Policy updated; no change to policy statement.
|
63663
|
Revise spine eltrd perq aray
|
HCPCS
|
National Coverage Determination for Electrical Nerve Stimulators (160.7). Available online at: http://www.cms.hhs.gov. Last accessed November, 2011. |CPT||63650||Percutaneous implantation of neurostimulator electrode array; epidural|
|63655||Laminectomy for implantation of neurostimulator electrode plate/paddle; epidural|
|63661||Removal of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63662||Removal of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy (new code 1/1/10)|
|63663||Revision including replacement, when performed, of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63664||Revision including replacement, when performed, of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy, including fluoroscopy, when performed (new code 1/1/10)|
|63685||Insertion or replacement of spinal neurostimulator pulse generator or receiver, direct or inductive coupling|
|63688||Revision or removal of implanted spinal neurostimulator pulse generator or receiver|
|95970, 95971, 95972, 95973||Neurostimulator programming and analysis code range|
|ICD-9 Procedure||03.93||Insertion or replacement of spinal neurostimulator|
|03.94||Removal of spinal neurostimulator lead(s)|
|86.05||Incision with removal of foreign body or device from skin and subcutaneous tissue (used to report removal of a neurostimulator pulse generator)|
|86.94||Insertion or replacement of single array neurostimulator pulse generator, not specified as rechargeable|
|86.95||Insertion or replacement of dual array neurostimulator pulse generator, not specified as rechargeable|
|86.97||Insertion or replacement of single array rechargeable neurostimulator pulse generator (new code effective 10/1/05)|
|86.98||Insertion or replacement of dual array rechargeable neurostimulator pulse generation (new code effective 10/1/05)|
|ICD-9 Diagnosis||See “Pain” in ICD-9 diagnosis index|
|HCPCS||L8680||Implantable neurostimulator electrode, each (new code effective 1/1/06)|
|L8685||Implantable neurostimulator pulse generator, single array, rechargeable, includes extension (new code effective 1/1/06)|
|L8686||Implantable neurostimulator pulse generator, single array, nonrechargeable, includes extension (new code effective 1/1/06)|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension (new code effective 1/1/06)|
|L8688||Implantable neurostimulator pulse generator, dual array, nonrechargeable, includes extension (new code effective 1/1/06)|
|ICD-10-CM (effective 10/1/14)||This list is a representative list of severe and chronic pain of the trunk and limbs diagnosis codes.|
|G56.40 -G56.42||Causalgia of upper limb code range|
|G57.70 -G57.72||Causalgia of lower limb code range|
|G89.21 -G89.8||Chronic pain, not elsewhere classified, code range|
|G89.4||Chronic pain syndrome|
|G90.50 -G90.59||Complex regional pain syndrome I (CRPS I), code range|
|M25.50 -M25.579||Pain in joint, code range|
|M54.10 -M54.18||Radiculopathy, code range|
|M54.30 -M54.32||Sciatica, code range|
|M54.40 -M54.42||Lumbago with sciatica, code range|
|M54.5||Low back pain|
|M54.6||Pain in thoracic spine|
|M54.81, M54.89||Other dorsalgia codes|
|M79.60 -M79.676||Pain in limb, hand, foot, fingers and toes code range|
|ICD-10-PCS (effective 10/1/14)||ICD-10-PCS codes are only used for inpatient services.|
|Surgical, central nervous system, insertion, spinal canal, neurostimulator lead, code by approach|
|00HV0MZ, 00HV3MZ, 00HV4MZ||Surgical, central nervous system, insertion, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, removal, spinal canal, neurostimulator lead, code by approach|
|00PV0MZ, 00PV3MZ, 00PV4MZ||Surgical, central nervous system, removal, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, revision, spinal canal, neurostimulator lead, code by approach|
|00WV0MZ, 00WV3MZ, 00WV4MZ||Surgical, central nervous system, revision, spinal cord, neurostimulator lead, code by approach|
|0JH60M6, 0JH60M7, 0JH60M8, 0JH60M9, 0JH63M6, 0JH63M7, 0JH63M8, 0JH63M9, 0JH70M6, 0JH70M7, 0JH70M8, 0JH70M9, 0JH73M6, 0JH73M7, 0JH73M8, 0JH73M9, 0JH80M6, 0JH80M7, 0JH80M8, 0JH80M9, 0JH83M6, 0JH83M7, 0JH83M8, 0JH83M9||Surgical, subcutaneous tissue and fascia, insertion, stimulator generator, code by body part, approach, number of arrays and whether rechargeable or not|
|0JPT0MZ, 0JPT3MZ||Surgical, subcutaneous tissue and fascia, removal, subcutaneous tissue and fascia, trunk, stimulator generator, code by approach (there aren’t ICD-10-PCS codes for removal of stimulator generator from other body parts)|
|Type of Service||Surgical|
|Place of Service||Inpatient/Outpatient|
Electrical Nerve Stimulation, Spinal
Spinal Cord Stimulation
Stimulation, Electrical, Spinal Cord
|03/31/96||Add to Surgery section||New policy|
|04/01/98||Replace policy||Policy cross-referenced to No. 7.01.63|
|07/10/98||Replace policy||Policy updated and revised|
|11/15/98||Coding update||1999 CPT coding release|
|04/29/03||Replace policy||Policy updated; new policy statement added, stating that spinal cord stimulation is investigational as a treatment of critical limb ischemia|
|11/9/04||Replace policy||Policy updated; no change to policy statement.
|
95970
|
PR ELEC ALYS IMPLT NPGT PHYS/QHP W/O PROGRAMMING
|
HCPCS
|
National Coverage Determination for Electrical Nerve Stimulators (160.7). Available online at: http://www.cms.hhs.gov. Last accessed November, 2011. |CPT||63650||Percutaneous implantation of neurostimulator electrode array; epidural|
|63655||Laminectomy for implantation of neurostimulator electrode plate/paddle; epidural|
|63661||Removal of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63662||Removal of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy (new code 1/1/10)|
|63663||Revision including replacement, when performed, of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63664||Revision including replacement, when performed, of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy, including fluoroscopy, when performed (new code 1/1/10)|
|63685||Insertion or replacement of spinal neurostimulator pulse generator or receiver, direct or inductive coupling|
|63688||Revision or removal of implanted spinal neurostimulator pulse generator or receiver|
|95970, 95971, 95972, 95973||Neurostimulator programming and analysis code range|
|ICD-9 Procedure||03.93||Insertion or replacement of spinal neurostimulator|
|03.94||Removal of spinal neurostimulator lead(s)|
|86.05||Incision with removal of foreign body or device from skin and subcutaneous tissue (used to report removal of a neurostimulator pulse generator)|
|86.94||Insertion or replacement of single array neurostimulator pulse generator, not specified as rechargeable|
|86.95||Insertion or replacement of dual array neurostimulator pulse generator, not specified as rechargeable|
|86.97||Insertion or replacement of single array rechargeable neurostimulator pulse generator (new code effective 10/1/05)|
|86.98||Insertion or replacement of dual array rechargeable neurostimulator pulse generation (new code effective 10/1/05)|
|ICD-9 Diagnosis||See “Pain” in ICD-9 diagnosis index|
|HCPCS||L8680||Implantable neurostimulator electrode, each (new code effective 1/1/06)|
|L8685||Implantable neurostimulator pulse generator, single array, rechargeable, includes extension (new code effective 1/1/06)|
|L8686||Implantable neurostimulator pulse generator, single array, nonrechargeable, includes extension (new code effective 1/1/06)|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension (new code effective 1/1/06)|
|L8688||Implantable neurostimulator pulse generator, dual array, nonrechargeable, includes extension (new code effective 1/1/06)|
|ICD-10-CM (effective 10/1/14)||This list is a representative list of severe and chronic pain of the trunk and limbs diagnosis codes.|
|G56.40 -G56.42||Causalgia of upper limb code range|
|G57.70 -G57.72||Causalgia of lower limb code range|
|G89.21 -G89.8||Chronic pain, not elsewhere classified, code range|
|G89.4||Chronic pain syndrome|
|G90.50 -G90.59||Complex regional pain syndrome I (CRPS I), code range|
|M25.50 -M25.579||Pain in joint, code range|
|M54.10 -M54.18||Radiculopathy, code range|
|M54.30 -M54.32||Sciatica, code range|
|M54.40 -M54.42||Lumbago with sciatica, code range|
|M54.5||Low back pain|
|M54.6||Pain in thoracic spine|
|M54.81, M54.89||Other dorsalgia codes|
|M79.60 -M79.676||Pain in limb, hand, foot, fingers and toes code range|
|ICD-10-PCS (effective 10/1/14)||ICD-10-PCS codes are only used for inpatient services.|
|Surgical, central nervous system, insertion, spinal canal, neurostimulator lead, code by approach|
|00HV0MZ, 00HV3MZ, 00HV4MZ||Surgical, central nervous system, insertion, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, removal, spinal canal, neurostimulator lead, code by approach|
|00PV0MZ, 00PV3MZ, 00PV4MZ||Surgical, central nervous system, removal, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, revision, spinal canal, neurostimulator lead, code by approach|
|00WV0MZ, 00WV3MZ, 00WV4MZ||Surgical, central nervous system, revision, spinal cord, neurostimulator lead, code by approach|
|0JH60M6, 0JH60M7, 0JH60M8, 0JH60M9, 0JH63M6, 0JH63M7, 0JH63M8, 0JH63M9, 0JH70M6, 0JH70M7, 0JH70M8, 0JH70M9, 0JH73M6, 0JH73M7, 0JH73M8, 0JH73M9, 0JH80M6, 0JH80M7, 0JH80M8, 0JH80M9, 0JH83M6, 0JH83M7, 0JH83M8, 0JH83M9||Surgical, subcutaneous tissue and fascia, insertion, stimulator generator, code by body part, approach, number of arrays and whether rechargeable or not|
|0JPT0MZ, 0JPT3MZ||Surgical, subcutaneous tissue and fascia, removal, subcutaneous tissue and fascia, trunk, stimulator generator, code by approach (there aren’t ICD-10-PCS codes for removal of stimulator generator from other body parts)|
|Type of Service||Surgical|
|Place of Service||Inpatient/Outpatient|
Electrical Nerve Stimulation, Spinal
Spinal Cord Stimulation
Stimulation, Electrical, Spinal Cord
|03/31/96||Add to Surgery section||New policy|
|04/01/98||Replace policy||Policy cross-referenced to No. 7.01.63|
|07/10/98||Replace policy||Policy updated and revised|
|11/15/98||Coding update||1999 CPT coding release|
|04/29/03||Replace policy||Policy updated; new policy statement added, stating that spinal cord stimulation is investigational as a treatment of critical limb ischemia|
|11/9/04||Replace policy||Policy updated; no change to policy statement.
|
63688
|
Rev/rmv imp sp npg/r dtch cn
|
HCPCS
|
National Coverage Determination for Electrical Nerve Stimulators (160.7). Available online at: http://www.cms.hhs.gov. Last accessed November, 2011. |CPT||63650||Percutaneous implantation of neurostimulator electrode array; epidural|
|63655||Laminectomy for implantation of neurostimulator electrode plate/paddle; epidural|
|63661||Removal of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63662||Removal of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy (new code 1/1/10)|
|63663||Revision including replacement, when performed, of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63664||Revision including replacement, when performed, of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy, including fluoroscopy, when performed (new code 1/1/10)|
|63685||Insertion or replacement of spinal neurostimulator pulse generator or receiver, direct or inductive coupling|
|63688||Revision or removal of implanted spinal neurostimulator pulse generator or receiver|
|95970, 95971, 95972, 95973||Neurostimulator programming and analysis code range|
|ICD-9 Procedure||03.93||Insertion or replacement of spinal neurostimulator|
|03.94||Removal of spinal neurostimulator lead(s)|
|86.05||Incision with removal of foreign body or device from skin and subcutaneous tissue (used to report removal of a neurostimulator pulse generator)|
|86.94||Insertion or replacement of single array neurostimulator pulse generator, not specified as rechargeable|
|86.95||Insertion or replacement of dual array neurostimulator pulse generator, not specified as rechargeable|
|86.97||Insertion or replacement of single array rechargeable neurostimulator pulse generator (new code effective 10/1/05)|
|86.98||Insertion or replacement of dual array rechargeable neurostimulator pulse generation (new code effective 10/1/05)|
|ICD-9 Diagnosis||See “Pain” in ICD-9 diagnosis index|
|HCPCS||L8680||Implantable neurostimulator electrode, each (new code effective 1/1/06)|
|L8685||Implantable neurostimulator pulse generator, single array, rechargeable, includes extension (new code effective 1/1/06)|
|L8686||Implantable neurostimulator pulse generator, single array, nonrechargeable, includes extension (new code effective 1/1/06)|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension (new code effective 1/1/06)|
|L8688||Implantable neurostimulator pulse generator, dual array, nonrechargeable, includes extension (new code effective 1/1/06)|
|ICD-10-CM (effective 10/1/14)||This list is a representative list of severe and chronic pain of the trunk and limbs diagnosis codes.|
|G56.40 -G56.42||Causalgia of upper limb code range|
|G57.70 -G57.72||Causalgia of lower limb code range|
|G89.21 -G89.8||Chronic pain, not elsewhere classified, code range|
|G89.4||Chronic pain syndrome|
|G90.50 -G90.59||Complex regional pain syndrome I (CRPS I), code range|
|M25.50 -M25.579||Pain in joint, code range|
|M54.10 -M54.18||Radiculopathy, code range|
|M54.30 -M54.32||Sciatica, code range|
|M54.40 -M54.42||Lumbago with sciatica, code range|
|M54.5||Low back pain|
|M54.6||Pain in thoracic spine|
|M54.81, M54.89||Other dorsalgia codes|
|M79.60 -M79.676||Pain in limb, hand, foot, fingers and toes code range|
|ICD-10-PCS (effective 10/1/14)||ICD-10-PCS codes are only used for inpatient services.|
|Surgical, central nervous system, insertion, spinal canal, neurostimulator lead, code by approach|
|00HV0MZ, 00HV3MZ, 00HV4MZ||Surgical, central nervous system, insertion, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, removal, spinal canal, neurostimulator lead, code by approach|
|00PV0MZ, 00PV3MZ, 00PV4MZ||Surgical, central nervous system, removal, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, revision, spinal canal, neurostimulator lead, code by approach|
|00WV0MZ, 00WV3MZ, 00WV4MZ||Surgical, central nervous system, revision, spinal cord, neurostimulator lead, code by approach|
|0JH60M6, 0JH60M7, 0JH60M8, 0JH60M9, 0JH63M6, 0JH63M7, 0JH63M8, 0JH63M9, 0JH70M6, 0JH70M7, 0JH70M8, 0JH70M9, 0JH73M6, 0JH73M7, 0JH73M8, 0JH73M9, 0JH80M6, 0JH80M7, 0JH80M8, 0JH80M9, 0JH83M6, 0JH83M7, 0JH83M8, 0JH83M9||Surgical, subcutaneous tissue and fascia, insertion, stimulator generator, code by body part, approach, number of arrays and whether rechargeable or not|
|0JPT0MZ, 0JPT3MZ||Surgical, subcutaneous tissue and fascia, removal, subcutaneous tissue and fascia, trunk, stimulator generator, code by approach (there aren’t ICD-10-PCS codes for removal of stimulator generator from other body parts)|
|Type of Service||Surgical|
|Place of Service||Inpatient/Outpatient|
Electrical Nerve Stimulation, Spinal
Spinal Cord Stimulation
Stimulation, Electrical, Spinal Cord
|03/31/96||Add to Surgery section||New policy|
|04/01/98||Replace policy||Policy cross-referenced to No. 7.01.63|
|07/10/98||Replace policy||Policy updated and revised|
|11/15/98||Coding update||1999 CPT coding release|
|04/29/03||Replace policy||Policy updated; new policy statement added, stating that spinal cord stimulation is investigational as a treatment of critical limb ischemia|
|11/9/04||Replace policy||Policy updated; no change to policy statement.
|
63685
|
PR INSJ/RPLCMT SPINAL NPG/RCVR POCKET CRTJ&CONNJ
|
HCPCS
|
National Coverage Determination for Electrical Nerve Stimulators (160.7). Available online at: http://www.cms.hhs.gov. Last accessed November, 2011. |CPT||63650||Percutaneous implantation of neurostimulator electrode array; epidural|
|63655||Laminectomy for implantation of neurostimulator electrode plate/paddle; epidural|
|63661||Removal of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63662||Removal of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy (new code 1/1/10)|
|63663||Revision including replacement, when performed, of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63664||Revision including replacement, when performed, of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy, including fluoroscopy, when performed (new code 1/1/10)|
|63685||Insertion or replacement of spinal neurostimulator pulse generator or receiver, direct or inductive coupling|
|63688||Revision or removal of implanted spinal neurostimulator pulse generator or receiver|
|95970, 95971, 95972, 95973||Neurostimulator programming and analysis code range|
|ICD-9 Procedure||03.93||Insertion or replacement of spinal neurostimulator|
|03.94||Removal of spinal neurostimulator lead(s)|
|86.05||Incision with removal of foreign body or device from skin and subcutaneous tissue (used to report removal of a neurostimulator pulse generator)|
|86.94||Insertion or replacement of single array neurostimulator pulse generator, not specified as rechargeable|
|86.95||Insertion or replacement of dual array neurostimulator pulse generator, not specified as rechargeable|
|86.97||Insertion or replacement of single array rechargeable neurostimulator pulse generator (new code effective 10/1/05)|
|86.98||Insertion or replacement of dual array rechargeable neurostimulator pulse generation (new code effective 10/1/05)|
|ICD-9 Diagnosis||See “Pain” in ICD-9 diagnosis index|
|HCPCS||L8680||Implantable neurostimulator electrode, each (new code effective 1/1/06)|
|L8685||Implantable neurostimulator pulse generator, single array, rechargeable, includes extension (new code effective 1/1/06)|
|L8686||Implantable neurostimulator pulse generator, single array, nonrechargeable, includes extension (new code effective 1/1/06)|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension (new code effective 1/1/06)|
|L8688||Implantable neurostimulator pulse generator, dual array, nonrechargeable, includes extension (new code effective 1/1/06)|
|ICD-10-CM (effective 10/1/14)||This list is a representative list of severe and chronic pain of the trunk and limbs diagnosis codes.|
|G56.40 -G56.42||Causalgia of upper limb code range|
|G57.70 -G57.72||Causalgia of lower limb code range|
|G89.21 -G89.8||Chronic pain, not elsewhere classified, code range|
|G89.4||Chronic pain syndrome|
|G90.50 -G90.59||Complex regional pain syndrome I (CRPS I), code range|
|M25.50 -M25.579||Pain in joint, code range|
|M54.10 -M54.18||Radiculopathy, code range|
|M54.30 -M54.32||Sciatica, code range|
|M54.40 -M54.42||Lumbago with sciatica, code range|
|M54.5||Low back pain|
|M54.6||Pain in thoracic spine|
|M54.81, M54.89||Other dorsalgia codes|
|M79.60 -M79.676||Pain in limb, hand, foot, fingers and toes code range|
|ICD-10-PCS (effective 10/1/14)||ICD-10-PCS codes are only used for inpatient services.|
|Surgical, central nervous system, insertion, spinal canal, neurostimulator lead, code by approach|
|00HV0MZ, 00HV3MZ, 00HV4MZ||Surgical, central nervous system, insertion, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, removal, spinal canal, neurostimulator lead, code by approach|
|00PV0MZ, 00PV3MZ, 00PV4MZ||Surgical, central nervous system, removal, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, revision, spinal canal, neurostimulator lead, code by approach|
|00WV0MZ, 00WV3MZ, 00WV4MZ||Surgical, central nervous system, revision, spinal cord, neurostimulator lead, code by approach|
|0JH60M6, 0JH60M7, 0JH60M8, 0JH60M9, 0JH63M6, 0JH63M7, 0JH63M8, 0JH63M9, 0JH70M6, 0JH70M7, 0JH70M8, 0JH70M9, 0JH73M6, 0JH73M7, 0JH73M8, 0JH73M9, 0JH80M6, 0JH80M7, 0JH80M8, 0JH80M9, 0JH83M6, 0JH83M7, 0JH83M8, 0JH83M9||Surgical, subcutaneous tissue and fascia, insertion, stimulator generator, code by body part, approach, number of arrays and whether rechargeable or not|
|0JPT0MZ, 0JPT3MZ||Surgical, subcutaneous tissue and fascia, removal, subcutaneous tissue and fascia, trunk, stimulator generator, code by approach (there aren’t ICD-10-PCS codes for removal of stimulator generator from other body parts)|
|Type of Service||Surgical|
|Place of Service||Inpatient/Outpatient|
Electrical Nerve Stimulation, Spinal
Spinal Cord Stimulation
Stimulation, Electrical, Spinal Cord
|03/31/96||Add to Surgery section||New policy|
|04/01/98||Replace policy||Policy cross-referenced to No. 7.01.63|
|07/10/98||Replace policy||Policy updated and revised|
|11/15/98||Coding update||1999 CPT coding release|
|04/29/03||Replace policy||Policy updated; new policy statement added, stating that spinal cord stimulation is investigational as a treatment of critical limb ischemia|
|11/9/04||Replace policy||Policy updated; no change to policy statement.
|
63655
|
PR LAM IMPLTJ NSTIM ELTRDS PLATE/PADDLE EDRL
|
HCPCS
|
National Coverage Determination for Electrical Nerve Stimulators (160.7). Available online at: http://www.cms.hhs.gov. Last accessed November, 2011. |CPT||63650||Percutaneous implantation of neurostimulator electrode array; epidural|
|63655||Laminectomy for implantation of neurostimulator electrode plate/paddle; epidural|
|63661||Removal of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63662||Removal of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy (new code 1/1/10)|
|63663||Revision including replacement, when performed, of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63664||Revision including replacement, when performed, of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy, including fluoroscopy, when performed (new code 1/1/10)|
|63685||Insertion or replacement of spinal neurostimulator pulse generator or receiver, direct or inductive coupling|
|63688||Revision or removal of implanted spinal neurostimulator pulse generator or receiver|
|95970, 95971, 95972, 95973||Neurostimulator programming and analysis code range|
|ICD-9 Procedure||03.93||Insertion or replacement of spinal neurostimulator|
|03.94||Removal of spinal neurostimulator lead(s)|
|86.05||Incision with removal of foreign body or device from skin and subcutaneous tissue (used to report removal of a neurostimulator pulse generator)|
|86.94||Insertion or replacement of single array neurostimulator pulse generator, not specified as rechargeable|
|86.95||Insertion or replacement of dual array neurostimulator pulse generator, not specified as rechargeable|
|86.97||Insertion or replacement of single array rechargeable neurostimulator pulse generator (new code effective 10/1/05)|
|86.98||Insertion or replacement of dual array rechargeable neurostimulator pulse generation (new code effective 10/1/05)|
|ICD-9 Diagnosis||See “Pain” in ICD-9 diagnosis index|
|HCPCS||L8680||Implantable neurostimulator electrode, each (new code effective 1/1/06)|
|L8685||Implantable neurostimulator pulse generator, single array, rechargeable, includes extension (new code effective 1/1/06)|
|L8686||Implantable neurostimulator pulse generator, single array, nonrechargeable, includes extension (new code effective 1/1/06)|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension (new code effective 1/1/06)|
|L8688||Implantable neurostimulator pulse generator, dual array, nonrechargeable, includes extension (new code effective 1/1/06)|
|ICD-10-CM (effective 10/1/14)||This list is a representative list of severe and chronic pain of the trunk and limbs diagnosis codes.|
|G56.40 -G56.42||Causalgia of upper limb code range|
|G57.70 -G57.72||Causalgia of lower limb code range|
|G89.21 -G89.8||Chronic pain, not elsewhere classified, code range|
|G89.4||Chronic pain syndrome|
|G90.50 -G90.59||Complex regional pain syndrome I (CRPS I), code range|
|M25.50 -M25.579||Pain in joint, code range|
|M54.10 -M54.18||Radiculopathy, code range|
|M54.30 -M54.32||Sciatica, code range|
|M54.40 -M54.42||Lumbago with sciatica, code range|
|M54.5||Low back pain|
|M54.6||Pain in thoracic spine|
|M54.81, M54.89||Other dorsalgia codes|
|M79.60 -M79.676||Pain in limb, hand, foot, fingers and toes code range|
|ICD-10-PCS (effective 10/1/14)||ICD-10-PCS codes are only used for inpatient services.|
|Surgical, central nervous system, insertion, spinal canal, neurostimulator lead, code by approach|
|00HV0MZ, 00HV3MZ, 00HV4MZ||Surgical, central nervous system, insertion, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, removal, spinal canal, neurostimulator lead, code by approach|
|00PV0MZ, 00PV3MZ, 00PV4MZ||Surgical, central nervous system, removal, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, revision, spinal canal, neurostimulator lead, code by approach|
|00WV0MZ, 00WV3MZ, 00WV4MZ||Surgical, central nervous system, revision, spinal cord, neurostimulator lead, code by approach|
|0JH60M6, 0JH60M7, 0JH60M8, 0JH60M9, 0JH63M6, 0JH63M7, 0JH63M8, 0JH63M9, 0JH70M6, 0JH70M7, 0JH70M8, 0JH70M9, 0JH73M6, 0JH73M7, 0JH73M8, 0JH73M9, 0JH80M6, 0JH80M7, 0JH80M8, 0JH80M9, 0JH83M6, 0JH83M7, 0JH83M8, 0JH83M9||Surgical, subcutaneous tissue and fascia, insertion, stimulator generator, code by body part, approach, number of arrays and whether rechargeable or not|
|0JPT0MZ, 0JPT3MZ||Surgical, subcutaneous tissue and fascia, removal, subcutaneous tissue and fascia, trunk, stimulator generator, code by approach (there aren’t ICD-10-PCS codes for removal of stimulator generator from other body parts)|
|Type of Service||Surgical|
|Place of Service||Inpatient/Outpatient|
Electrical Nerve Stimulation, Spinal
Spinal Cord Stimulation
Stimulation, Electrical, Spinal Cord
|03/31/96||Add to Surgery section||New policy|
|04/01/98||Replace policy||Policy cross-referenced to No. 7.01.63|
|07/10/98||Replace policy||Policy updated and revised|
|11/15/98||Coding update||1999 CPT coding release|
|04/29/03||Replace policy||Policy updated; new policy statement added, stating that spinal cord stimulation is investigational as a treatment of critical limb ischemia|
|11/9/04||Replace policy||Policy updated; no change to policy statement.
|
95971
|
PR ELEC ALYS IMPLT NPGT SMPL SP/PN NPGT PRGRMG
|
HCPCS
|
National Coverage Determination for Electrical Nerve Stimulators (160.7). Available online at: http://www.cms.hhs.gov. Last accessed November, 2011. |CPT||63650||Percutaneous implantation of neurostimulator electrode array; epidural|
|63655||Laminectomy for implantation of neurostimulator electrode plate/paddle; epidural|
|63661||Removal of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63662||Removal of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy (new code 1/1/10)|
|63663||Revision including replacement, when performed, of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63664||Revision including replacement, when performed, of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy, including fluoroscopy, when performed (new code 1/1/10)|
|63685||Insertion or replacement of spinal neurostimulator pulse generator or receiver, direct or inductive coupling|
|63688||Revision or removal of implanted spinal neurostimulator pulse generator or receiver|
|95970, 95971, 95972, 95973||Neurostimulator programming and analysis code range|
|ICD-9 Procedure||03.93||Insertion or replacement of spinal neurostimulator|
|03.94||Removal of spinal neurostimulator lead(s)|
|86.05||Incision with removal of foreign body or device from skin and subcutaneous tissue (used to report removal of a neurostimulator pulse generator)|
|86.94||Insertion or replacement of single array neurostimulator pulse generator, not specified as rechargeable|
|86.95||Insertion or replacement of dual array neurostimulator pulse generator, not specified as rechargeable|
|86.97||Insertion or replacement of single array rechargeable neurostimulator pulse generator (new code effective 10/1/05)|
|86.98||Insertion or replacement of dual array rechargeable neurostimulator pulse generation (new code effective 10/1/05)|
|ICD-9 Diagnosis||See “Pain” in ICD-9 diagnosis index|
|HCPCS||L8680||Implantable neurostimulator electrode, each (new code effective 1/1/06)|
|L8685||Implantable neurostimulator pulse generator, single array, rechargeable, includes extension (new code effective 1/1/06)|
|L8686||Implantable neurostimulator pulse generator, single array, nonrechargeable, includes extension (new code effective 1/1/06)|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension (new code effective 1/1/06)|
|L8688||Implantable neurostimulator pulse generator, dual array, nonrechargeable, includes extension (new code effective 1/1/06)|
|ICD-10-CM (effective 10/1/14)||This list is a representative list of severe and chronic pain of the trunk and limbs diagnosis codes.|
|G56.40 -G56.42||Causalgia of upper limb code range|
|G57.70 -G57.72||Causalgia of lower limb code range|
|G89.21 -G89.8||Chronic pain, not elsewhere classified, code range|
|G89.4||Chronic pain syndrome|
|G90.50 -G90.59||Complex regional pain syndrome I (CRPS I), code range|
|M25.50 -M25.579||Pain in joint, code range|
|M54.10 -M54.18||Radiculopathy, code range|
|M54.30 -M54.32||Sciatica, code range|
|M54.40 -M54.42||Lumbago with sciatica, code range|
|M54.5||Low back pain|
|M54.6||Pain in thoracic spine|
|M54.81, M54.89||Other dorsalgia codes|
|M79.60 -M79.676||Pain in limb, hand, foot, fingers and toes code range|
|ICD-10-PCS (effective 10/1/14)||ICD-10-PCS codes are only used for inpatient services.|
|Surgical, central nervous system, insertion, spinal canal, neurostimulator lead, code by approach|
|00HV0MZ, 00HV3MZ, 00HV4MZ||Surgical, central nervous system, insertion, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, removal, spinal canal, neurostimulator lead, code by approach|
|00PV0MZ, 00PV3MZ, 00PV4MZ||Surgical, central nervous system, removal, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, revision, spinal canal, neurostimulator lead, code by approach|
|00WV0MZ, 00WV3MZ, 00WV4MZ||Surgical, central nervous system, revision, spinal cord, neurostimulator lead, code by approach|
|0JH60M6, 0JH60M7, 0JH60M8, 0JH60M9, 0JH63M6, 0JH63M7, 0JH63M8, 0JH63M9, 0JH70M6, 0JH70M7, 0JH70M8, 0JH70M9, 0JH73M6, 0JH73M7, 0JH73M8, 0JH73M9, 0JH80M6, 0JH80M7, 0JH80M8, 0JH80M9, 0JH83M6, 0JH83M7, 0JH83M8, 0JH83M9||Surgical, subcutaneous tissue and fascia, insertion, stimulator generator, code by body part, approach, number of arrays and whether rechargeable or not|
|0JPT0MZ, 0JPT3MZ||Surgical, subcutaneous tissue and fascia, removal, subcutaneous tissue and fascia, trunk, stimulator generator, code by approach (there aren’t ICD-10-PCS codes for removal of stimulator generator from other body parts)|
|Type of Service||Surgical|
|Place of Service||Inpatient/Outpatient|
Electrical Nerve Stimulation, Spinal
Spinal Cord Stimulation
Stimulation, Electrical, Spinal Cord
|03/31/96||Add to Surgery section||New policy|
|04/01/98||Replace policy||Policy cross-referenced to No. 7.01.63|
|07/10/98||Replace policy||Policy updated and revised|
|11/15/98||Coding update||1999 CPT coding release|
|04/29/03||Replace policy||Policy updated; new policy statement added, stating that spinal cord stimulation is investigational as a treatment of critical limb ischemia|
|11/9/04||Replace policy||Policy updated; no change to policy statement.
|
L8686
|
Implt nrostm pls gen sng non
|
HCPCS
|
National Coverage Determination for Electrical Nerve Stimulators (160.7). Available online at: http://www.cms.hhs.gov. Last accessed November, 2011. |CPT||63650||Percutaneous implantation of neurostimulator electrode array; epidural|
|63655||Laminectomy for implantation of neurostimulator electrode plate/paddle; epidural|
|63661||Removal of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63662||Removal of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy (new code 1/1/10)|
|63663||Revision including replacement, when performed, of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63664||Revision including replacement, when performed, of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy, including fluoroscopy, when performed (new code 1/1/10)|
|63685||Insertion or replacement of spinal neurostimulator pulse generator or receiver, direct or inductive coupling|
|63688||Revision or removal of implanted spinal neurostimulator pulse generator or receiver|
|95970, 95971, 95972, 95973||Neurostimulator programming and analysis code range|
|ICD-9 Procedure||03.93||Insertion or replacement of spinal neurostimulator|
|03.94||Removal of spinal neurostimulator lead(s)|
|86.05||Incision with removal of foreign body or device from skin and subcutaneous tissue (used to report removal of a neurostimulator pulse generator)|
|86.94||Insertion or replacement of single array neurostimulator pulse generator, not specified as rechargeable|
|86.95||Insertion or replacement of dual array neurostimulator pulse generator, not specified as rechargeable|
|86.97||Insertion or replacement of single array rechargeable neurostimulator pulse generator (new code effective 10/1/05)|
|86.98||Insertion or replacement of dual array rechargeable neurostimulator pulse generation (new code effective 10/1/05)|
|ICD-9 Diagnosis||See “Pain” in ICD-9 diagnosis index|
|HCPCS||L8680||Implantable neurostimulator electrode, each (new code effective 1/1/06)|
|L8685||Implantable neurostimulator pulse generator, single array, rechargeable, includes extension (new code effective 1/1/06)|
|L8686||Implantable neurostimulator pulse generator, single array, nonrechargeable, includes extension (new code effective 1/1/06)|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension (new code effective 1/1/06)|
|L8688||Implantable neurostimulator pulse generator, dual array, nonrechargeable, includes extension (new code effective 1/1/06)|
|ICD-10-CM (effective 10/1/14)||This list is a representative list of severe and chronic pain of the trunk and limbs diagnosis codes.|
|G56.40 -G56.42||Causalgia of upper limb code range|
|G57.70 -G57.72||Causalgia of lower limb code range|
|G89.21 -G89.8||Chronic pain, not elsewhere classified, code range|
|G89.4||Chronic pain syndrome|
|G90.50 -G90.59||Complex regional pain syndrome I (CRPS I), code range|
|M25.50 -M25.579||Pain in joint, code range|
|M54.10 -M54.18||Radiculopathy, code range|
|M54.30 -M54.32||Sciatica, code range|
|M54.40 -M54.42||Lumbago with sciatica, code range|
|M54.5||Low back pain|
|M54.6||Pain in thoracic spine|
|M54.81, M54.89||Other dorsalgia codes|
|M79.60 -M79.676||Pain in limb, hand, foot, fingers and toes code range|
|ICD-10-PCS (effective 10/1/14)||ICD-10-PCS codes are only used for inpatient services.|
|Surgical, central nervous system, insertion, spinal canal, neurostimulator lead, code by approach|
|00HV0MZ, 00HV3MZ, 00HV4MZ||Surgical, central nervous system, insertion, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, removal, spinal canal, neurostimulator lead, code by approach|
|00PV0MZ, 00PV3MZ, 00PV4MZ||Surgical, central nervous system, removal, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, revision, spinal canal, neurostimulator lead, code by approach|
|00WV0MZ, 00WV3MZ, 00WV4MZ||Surgical, central nervous system, revision, spinal cord, neurostimulator lead, code by approach|
|0JH60M6, 0JH60M7, 0JH60M8, 0JH60M9, 0JH63M6, 0JH63M7, 0JH63M8, 0JH63M9, 0JH70M6, 0JH70M7, 0JH70M8, 0JH70M9, 0JH73M6, 0JH73M7, 0JH73M8, 0JH73M9, 0JH80M6, 0JH80M7, 0JH80M8, 0JH80M9, 0JH83M6, 0JH83M7, 0JH83M8, 0JH83M9||Surgical, subcutaneous tissue and fascia, insertion, stimulator generator, code by body part, approach, number of arrays and whether rechargeable or not|
|0JPT0MZ, 0JPT3MZ||Surgical, subcutaneous tissue and fascia, removal, subcutaneous tissue and fascia, trunk, stimulator generator, code by approach (there aren’t ICD-10-PCS codes for removal of stimulator generator from other body parts)|
|Type of Service||Surgical|
|Place of Service||Inpatient/Outpatient|
Electrical Nerve Stimulation, Spinal
Spinal Cord Stimulation
Stimulation, Electrical, Spinal Cord
|03/31/96||Add to Surgery section||New policy|
|04/01/98||Replace policy||Policy cross-referenced to No. 7.01.63|
|07/10/98||Replace policy||Policy updated and revised|
|11/15/98||Coding update||1999 CPT coding release|
|04/29/03||Replace policy||Policy updated; new policy statement added, stating that spinal cord stimulation is investigational as a treatment of critical limb ischemia|
|11/9/04||Replace policy||Policy updated; no change to policy statement.
|
63664
|
Revise spine eltrd plate
|
HCPCS
|
National Coverage Determination for Electrical Nerve Stimulators (160.7). Available online at: http://www.cms.hhs.gov. Last accessed November, 2011. |CPT||63650||Percutaneous implantation of neurostimulator electrode array; epidural|
|63655||Laminectomy for implantation of neurostimulator electrode plate/paddle; epidural|
|63661||Removal of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63662||Removal of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy (new code 1/1/10)|
|63663||Revision including replacement, when performed, of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63664||Revision including replacement, when performed, of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy, including fluoroscopy, when performed (new code 1/1/10)|
|63685||Insertion or replacement of spinal neurostimulator pulse generator or receiver, direct or inductive coupling|
|63688||Revision or removal of implanted spinal neurostimulator pulse generator or receiver|
|95970, 95971, 95972, 95973||Neurostimulator programming and analysis code range|
|ICD-9 Procedure||03.93||Insertion or replacement of spinal neurostimulator|
|03.94||Removal of spinal neurostimulator lead(s)|
|86.05||Incision with removal of foreign body or device from skin and subcutaneous tissue (used to report removal of a neurostimulator pulse generator)|
|86.94||Insertion or replacement of single array neurostimulator pulse generator, not specified as rechargeable|
|86.95||Insertion or replacement of dual array neurostimulator pulse generator, not specified as rechargeable|
|86.97||Insertion or replacement of single array rechargeable neurostimulator pulse generator (new code effective 10/1/05)|
|86.98||Insertion or replacement of dual array rechargeable neurostimulator pulse generation (new code effective 10/1/05)|
|ICD-9 Diagnosis||See “Pain” in ICD-9 diagnosis index|
|HCPCS||L8680||Implantable neurostimulator electrode, each (new code effective 1/1/06)|
|L8685||Implantable neurostimulator pulse generator, single array, rechargeable, includes extension (new code effective 1/1/06)|
|L8686||Implantable neurostimulator pulse generator, single array, nonrechargeable, includes extension (new code effective 1/1/06)|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension (new code effective 1/1/06)|
|L8688||Implantable neurostimulator pulse generator, dual array, nonrechargeable, includes extension (new code effective 1/1/06)|
|ICD-10-CM (effective 10/1/14)||This list is a representative list of severe and chronic pain of the trunk and limbs diagnosis codes.|
|G56.40 -G56.42||Causalgia of upper limb code range|
|G57.70 -G57.72||Causalgia of lower limb code range|
|G89.21 -G89.8||Chronic pain, not elsewhere classified, code range|
|G89.4||Chronic pain syndrome|
|G90.50 -G90.59||Complex regional pain syndrome I (CRPS I), code range|
|M25.50 -M25.579||Pain in joint, code range|
|M54.10 -M54.18||Radiculopathy, code range|
|M54.30 -M54.32||Sciatica, code range|
|M54.40 -M54.42||Lumbago with sciatica, code range|
|M54.5||Low back pain|
|M54.6||Pain in thoracic spine|
|M54.81, M54.89||Other dorsalgia codes|
|M79.60 -M79.676||Pain in limb, hand, foot, fingers and toes code range|
|ICD-10-PCS (effective 10/1/14)||ICD-10-PCS codes are only used for inpatient services.|
|Surgical, central nervous system, insertion, spinal canal, neurostimulator lead, code by approach|
|00HV0MZ, 00HV3MZ, 00HV4MZ||Surgical, central nervous system, insertion, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, removal, spinal canal, neurostimulator lead, code by approach|
|00PV0MZ, 00PV3MZ, 00PV4MZ||Surgical, central nervous system, removal, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, revision, spinal canal, neurostimulator lead, code by approach|
|00WV0MZ, 00WV3MZ, 00WV4MZ||Surgical, central nervous system, revision, spinal cord, neurostimulator lead, code by approach|
|0JH60M6, 0JH60M7, 0JH60M8, 0JH60M9, 0JH63M6, 0JH63M7, 0JH63M8, 0JH63M9, 0JH70M6, 0JH70M7, 0JH70M8, 0JH70M9, 0JH73M6, 0JH73M7, 0JH73M8, 0JH73M9, 0JH80M6, 0JH80M7, 0JH80M8, 0JH80M9, 0JH83M6, 0JH83M7, 0JH83M8, 0JH83M9||Surgical, subcutaneous tissue and fascia, insertion, stimulator generator, code by body part, approach, number of arrays and whether rechargeable or not|
|0JPT0MZ, 0JPT3MZ||Surgical, subcutaneous tissue and fascia, removal, subcutaneous tissue and fascia, trunk, stimulator generator, code by approach (there aren’t ICD-10-PCS codes for removal of stimulator generator from other body parts)|
|Type of Service||Surgical|
|Place of Service||Inpatient/Outpatient|
Electrical Nerve Stimulation, Spinal
Spinal Cord Stimulation
Stimulation, Electrical, Spinal Cord
|03/31/96||Add to Surgery section||New policy|
|04/01/98||Replace policy||Policy cross-referenced to No. 7.01.63|
|07/10/98||Replace policy||Policy updated and revised|
|11/15/98||Coding update||1999 CPT coding release|
|04/29/03||Replace policy||Policy updated; new policy statement added, stating that spinal cord stimulation is investigational as a treatment of critical limb ischemia|
|11/9/04||Replace policy||Policy updated; no change to policy statement.
|
L8685
|
Implt nrostm pls gen sng rec
|
HCPCS
|
National Coverage Determination for Electrical Nerve Stimulators (160.7). Available online at: http://www.cms.hhs.gov. Last accessed November, 2011. |CPT||63650||Percutaneous implantation of neurostimulator electrode array; epidural|
|63655||Laminectomy for implantation of neurostimulator electrode plate/paddle; epidural|
|63661||Removal of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63662||Removal of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy (new code 1/1/10)|
|63663||Revision including replacement, when performed, of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63664||Revision including replacement, when performed, of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy, including fluoroscopy, when performed (new code 1/1/10)|
|63685||Insertion or replacement of spinal neurostimulator pulse generator or receiver, direct or inductive coupling|
|63688||Revision or removal of implanted spinal neurostimulator pulse generator or receiver|
|95970, 95971, 95972, 95973||Neurostimulator programming and analysis code range|
|ICD-9 Procedure||03.93||Insertion or replacement of spinal neurostimulator|
|03.94||Removal of spinal neurostimulator lead(s)|
|86.05||Incision with removal of foreign body or device from skin and subcutaneous tissue (used to report removal of a neurostimulator pulse generator)|
|86.94||Insertion or replacement of single array neurostimulator pulse generator, not specified as rechargeable|
|86.95||Insertion or replacement of dual array neurostimulator pulse generator, not specified as rechargeable|
|86.97||Insertion or replacement of single array rechargeable neurostimulator pulse generator (new code effective 10/1/05)|
|86.98||Insertion or replacement of dual array rechargeable neurostimulator pulse generation (new code effective 10/1/05)|
|ICD-9 Diagnosis||See “Pain” in ICD-9 diagnosis index|
|HCPCS||L8680||Implantable neurostimulator electrode, each (new code effective 1/1/06)|
|L8685||Implantable neurostimulator pulse generator, single array, rechargeable, includes extension (new code effective 1/1/06)|
|L8686||Implantable neurostimulator pulse generator, single array, nonrechargeable, includes extension (new code effective 1/1/06)|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension (new code effective 1/1/06)|
|L8688||Implantable neurostimulator pulse generator, dual array, nonrechargeable, includes extension (new code effective 1/1/06)|
|ICD-10-CM (effective 10/1/14)||This list is a representative list of severe and chronic pain of the trunk and limbs diagnosis codes.|
|G56.40 -G56.42||Causalgia of upper limb code range|
|G57.70 -G57.72||Causalgia of lower limb code range|
|G89.21 -G89.8||Chronic pain, not elsewhere classified, code range|
|G89.4||Chronic pain syndrome|
|G90.50 -G90.59||Complex regional pain syndrome I (CRPS I), code range|
|M25.50 -M25.579||Pain in joint, code range|
|M54.10 -M54.18||Radiculopathy, code range|
|M54.30 -M54.32||Sciatica, code range|
|M54.40 -M54.42||Lumbago with sciatica, code range|
|M54.5||Low back pain|
|M54.6||Pain in thoracic spine|
|M54.81, M54.89||Other dorsalgia codes|
|M79.60 -M79.676||Pain in limb, hand, foot, fingers and toes code range|
|ICD-10-PCS (effective 10/1/14)||ICD-10-PCS codes are only used for inpatient services.|
|Surgical, central nervous system, insertion, spinal canal, neurostimulator lead, code by approach|
|00HV0MZ, 00HV3MZ, 00HV4MZ||Surgical, central nervous system, insertion, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, removal, spinal canal, neurostimulator lead, code by approach|
|00PV0MZ, 00PV3MZ, 00PV4MZ||Surgical, central nervous system, removal, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, revision, spinal canal, neurostimulator lead, code by approach|
|00WV0MZ, 00WV3MZ, 00WV4MZ||Surgical, central nervous system, revision, spinal cord, neurostimulator lead, code by approach|
|0JH60M6, 0JH60M7, 0JH60M8, 0JH60M9, 0JH63M6, 0JH63M7, 0JH63M8, 0JH63M9, 0JH70M6, 0JH70M7, 0JH70M8, 0JH70M9, 0JH73M6, 0JH73M7, 0JH73M8, 0JH73M9, 0JH80M6, 0JH80M7, 0JH80M8, 0JH80M9, 0JH83M6, 0JH83M7, 0JH83M8, 0JH83M9||Surgical, subcutaneous tissue and fascia, insertion, stimulator generator, code by body part, approach, number of arrays and whether rechargeable or not|
|0JPT0MZ, 0JPT3MZ||Surgical, subcutaneous tissue and fascia, removal, subcutaneous tissue and fascia, trunk, stimulator generator, code by approach (there aren’t ICD-10-PCS codes for removal of stimulator generator from other body parts)|
|Type of Service||Surgical|
|Place of Service||Inpatient/Outpatient|
Electrical Nerve Stimulation, Spinal
Spinal Cord Stimulation
Stimulation, Electrical, Spinal Cord
|03/31/96||Add to Surgery section||New policy|
|04/01/98||Replace policy||Policy cross-referenced to No. 7.01.63|
|07/10/98||Replace policy||Policy updated and revised|
|11/15/98||Coding update||1999 CPT coding release|
|04/29/03||Replace policy||Policy updated; new policy statement added, stating that spinal cord stimulation is investigational as a treatment of critical limb ischemia|
|11/9/04||Replace policy||Policy updated; no change to policy statement.
|
95973
|
Analyze neurostim complex
|
HCPCS
|
National Coverage Determination for Electrical Nerve Stimulators (160.7). Available online at: http://www.cms.hhs.gov. Last accessed November, 2011. |CPT||63650||Percutaneous implantation of neurostimulator electrode array; epidural|
|63655||Laminectomy for implantation of neurostimulator electrode plate/paddle; epidural|
|63661||Removal of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63662||Removal of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy (new code 1/1/10)|
|63663||Revision including replacement, when performed, of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63664||Revision including replacement, when performed, of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy, including fluoroscopy, when performed (new code 1/1/10)|
|63685||Insertion or replacement of spinal neurostimulator pulse generator or receiver, direct or inductive coupling|
|63688||Revision or removal of implanted spinal neurostimulator pulse generator or receiver|
|95970, 95971, 95972, 95973||Neurostimulator programming and analysis code range|
|ICD-9 Procedure||03.93||Insertion or replacement of spinal neurostimulator|
|03.94||Removal of spinal neurostimulator lead(s)|
|86.05||Incision with removal of foreign body or device from skin and subcutaneous tissue (used to report removal of a neurostimulator pulse generator)|
|86.94||Insertion or replacement of single array neurostimulator pulse generator, not specified as rechargeable|
|86.95||Insertion or replacement of dual array neurostimulator pulse generator, not specified as rechargeable|
|86.97||Insertion or replacement of single array rechargeable neurostimulator pulse generator (new code effective 10/1/05)|
|86.98||Insertion or replacement of dual array rechargeable neurostimulator pulse generation (new code effective 10/1/05)|
|ICD-9 Diagnosis||See “Pain” in ICD-9 diagnosis index|
|HCPCS||L8680||Implantable neurostimulator electrode, each (new code effective 1/1/06)|
|L8685||Implantable neurostimulator pulse generator, single array, rechargeable, includes extension (new code effective 1/1/06)|
|L8686||Implantable neurostimulator pulse generator, single array, nonrechargeable, includes extension (new code effective 1/1/06)|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension (new code effective 1/1/06)|
|L8688||Implantable neurostimulator pulse generator, dual array, nonrechargeable, includes extension (new code effective 1/1/06)|
|ICD-10-CM (effective 10/1/14)||This list is a representative list of severe and chronic pain of the trunk and limbs diagnosis codes.|
|G56.40 -G56.42||Causalgia of upper limb code range|
|G57.70 -G57.72||Causalgia of lower limb code range|
|G89.21 -G89.8||Chronic pain, not elsewhere classified, code range|
|G89.4||Chronic pain syndrome|
|G90.50 -G90.59||Complex regional pain syndrome I (CRPS I), code range|
|M25.50 -M25.579||Pain in joint, code range|
|M54.10 -M54.18||Radiculopathy, code range|
|M54.30 -M54.32||Sciatica, code range|
|M54.40 -M54.42||Lumbago with sciatica, code range|
|M54.5||Low back pain|
|M54.6||Pain in thoracic spine|
|M54.81, M54.89||Other dorsalgia codes|
|M79.60 -M79.676||Pain in limb, hand, foot, fingers and toes code range|
|ICD-10-PCS (effective 10/1/14)||ICD-10-PCS codes are only used for inpatient services.|
|Surgical, central nervous system, insertion, spinal canal, neurostimulator lead, code by approach|
|00HV0MZ, 00HV3MZ, 00HV4MZ||Surgical, central nervous system, insertion, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, removal, spinal canal, neurostimulator lead, code by approach|
|00PV0MZ, 00PV3MZ, 00PV4MZ||Surgical, central nervous system, removal, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, revision, spinal canal, neurostimulator lead, code by approach|
|00WV0MZ, 00WV3MZ, 00WV4MZ||Surgical, central nervous system, revision, spinal cord, neurostimulator lead, code by approach|
|0JH60M6, 0JH60M7, 0JH60M8, 0JH60M9, 0JH63M6, 0JH63M7, 0JH63M8, 0JH63M9, 0JH70M6, 0JH70M7, 0JH70M8, 0JH70M9, 0JH73M6, 0JH73M7, 0JH73M8, 0JH73M9, 0JH80M6, 0JH80M7, 0JH80M8, 0JH80M9, 0JH83M6, 0JH83M7, 0JH83M8, 0JH83M9||Surgical, subcutaneous tissue and fascia, insertion, stimulator generator, code by body part, approach, number of arrays and whether rechargeable or not|
|0JPT0MZ, 0JPT3MZ||Surgical, subcutaneous tissue and fascia, removal, subcutaneous tissue and fascia, trunk, stimulator generator, code by approach (there aren’t ICD-10-PCS codes for removal of stimulator generator from other body parts)|
|Type of Service||Surgical|
|Place of Service||Inpatient/Outpatient|
Electrical Nerve Stimulation, Spinal
Spinal Cord Stimulation
Stimulation, Electrical, Spinal Cord
|03/31/96||Add to Surgery section||New policy|
|04/01/98||Replace policy||Policy cross-referenced to No. 7.01.63|
|07/10/98||Replace policy||Policy updated and revised|
|11/15/98||Coding update||1999 CPT coding release|
|04/29/03||Replace policy||Policy updated; new policy statement added, stating that spinal cord stimulation is investigational as a treatment of critical limb ischemia|
|11/9/04||Replace policy||Policy updated; no change to policy statement.
|
63650
|
PR PRQ IMPLTJ NSTIM ELECTRODE ARRAY EPIDURAL
|
HCPCS
|
Available online at: http://www.cms.hhs.gov. Last accessed November, 2011. |CPT||63650||Percutaneous implantation of neurostimulator electrode array; epidural|
|63655||Laminectomy for implantation of neurostimulator electrode plate/paddle; epidural|
|63661||Removal of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63662||Removal of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy (new code 1/1/10)|
|63663||Revision including replacement, when performed, of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63664||Revision including replacement, when performed, of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy, including fluoroscopy, when performed (new code 1/1/10)|
|63685||Insertion or replacement of spinal neurostimulator pulse generator or receiver, direct or inductive coupling|
|63688||Revision or removal of implanted spinal neurostimulator pulse generator or receiver|
|95970, 95971, 95972, 95973||Neurostimulator programming and analysis code range|
|ICD-9 Procedure||03.93||Insertion or replacement of spinal neurostimulator|
|03.94||Removal of spinal neurostimulator lead(s)|
|86.05||Incision with removal of foreign body or device from skin and subcutaneous tissue (used to report removal of a neurostimulator pulse generator)|
|86.94||Insertion or replacement of single array neurostimulator pulse generator, not specified as rechargeable|
|86.95||Insertion or replacement of dual array neurostimulator pulse generator, not specified as rechargeable|
|86.97||Insertion or replacement of single array rechargeable neurostimulator pulse generator (new code effective 10/1/05)|
|86.98||Insertion or replacement of dual array rechargeable neurostimulator pulse generation (new code effective 10/1/05)|
|ICD-9 Diagnosis||See “Pain” in ICD-9 diagnosis index|
|HCPCS||L8680||Implantable neurostimulator electrode, each (new code effective 1/1/06)|
|L8685||Implantable neurostimulator pulse generator, single array, rechargeable, includes extension (new code effective 1/1/06)|
|L8686||Implantable neurostimulator pulse generator, single array, nonrechargeable, includes extension (new code effective 1/1/06)|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension (new code effective 1/1/06)|
|L8688||Implantable neurostimulator pulse generator, dual array, nonrechargeable, includes extension (new code effective 1/1/06)|
|ICD-10-CM (effective 10/1/14)||This list is a representative list of severe and chronic pain of the trunk and limbs diagnosis codes.|
|G56.40 -G56.42||Causalgia of upper limb code range|
|G57.70 -G57.72||Causalgia of lower limb code range|
|G89.21 -G89.8||Chronic pain, not elsewhere classified, code range|
|G89.4||Chronic pain syndrome|
|G90.50 -G90.59||Complex regional pain syndrome I (CRPS I), code range|
|M25.50 -M25.579||Pain in joint, code range|
|M54.10 -M54.18||Radiculopathy, code range|
|M54.30 -M54.32||Sciatica, code range|
|M54.40 -M54.42||Lumbago with sciatica, code range|
|M54.5||Low back pain|
|M54.6||Pain in thoracic spine|
|M54.81, M54.89||Other dorsalgia codes|
|M79.60 -M79.676||Pain in limb, hand, foot, fingers and toes code range|
|ICD-10-PCS (effective 10/1/14)||ICD-10-PCS codes are only used for inpatient services.|
|Surgical, central nervous system, insertion, spinal canal, neurostimulator lead, code by approach|
|00HV0MZ, 00HV3MZ, 00HV4MZ||Surgical, central nervous system, insertion, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, removal, spinal canal, neurostimulator lead, code by approach|
|00PV0MZ, 00PV3MZ, 00PV4MZ||Surgical, central nervous system, removal, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, revision, spinal canal, neurostimulator lead, code by approach|
|00WV0MZ, 00WV3MZ, 00WV4MZ||Surgical, central nervous system, revision, spinal cord, neurostimulator lead, code by approach|
|0JH60M6, 0JH60M7, 0JH60M8, 0JH60M9, 0JH63M6, 0JH63M7, 0JH63M8, 0JH63M9, 0JH70M6, 0JH70M7, 0JH70M8, 0JH70M9, 0JH73M6, 0JH73M7, 0JH73M8, 0JH73M9, 0JH80M6, 0JH80M7, 0JH80M8, 0JH80M9, 0JH83M6, 0JH83M7, 0JH83M8, 0JH83M9||Surgical, subcutaneous tissue and fascia, insertion, stimulator generator, code by body part, approach, number of arrays and whether rechargeable or not|
|0JPT0MZ, 0JPT3MZ||Surgical, subcutaneous tissue and fascia, removal, subcutaneous tissue and fascia, trunk, stimulator generator, code by approach (there aren’t ICD-10-PCS codes for removal of stimulator generator from other body parts)|
|Type of Service||Surgical|
|Place of Service||Inpatient/Outpatient|
Electrical Nerve Stimulation, Spinal
Spinal Cord Stimulation
Stimulation, Electrical, Spinal Cord
|03/31/96||Add to Surgery section||New policy|
|04/01/98||Replace policy||Policy cross-referenced to No. 7.01.63|
|07/10/98||Replace policy||Policy updated and revised|
|11/15/98||Coding update||1999 CPT coding release|
|04/29/03||Replace policy||Policy updated; new policy statement added, stating that spinal cord stimulation is investigational as a treatment of critical limb ischemia|
|11/9/04||Replace policy||Policy updated; no change to policy statement. Coding updated|
|08/17/05||Replace policy||Policy updated with literature search and coding updated; no change to policy statement|
|12/14/05||Replace policy – coding update only||Coding updated|
|12/12/06||Replace policy||Policy updated with literature search; no change to policy statement; reference numbers 7 – 9 added|
|03/13/08||Replace policy||Policy updated with literature search; references 10 – 13 added; no change to policy statements|
|01/08/09||Replace policy||Policy updated with literature search; references 14–25 added.
|
63661
|
Remove spine eltrd perq aray
|
HCPCS
|
Available online at: http://www.cms.hhs.gov. Last accessed November, 2011. |CPT||63650||Percutaneous implantation of neurostimulator electrode array; epidural|
|63655||Laminectomy for implantation of neurostimulator electrode plate/paddle; epidural|
|63661||Removal of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63662||Removal of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy (new code 1/1/10)|
|63663||Revision including replacement, when performed, of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63664||Revision including replacement, when performed, of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy, including fluoroscopy, when performed (new code 1/1/10)|
|63685||Insertion or replacement of spinal neurostimulator pulse generator or receiver, direct or inductive coupling|
|63688||Revision or removal of implanted spinal neurostimulator pulse generator or receiver|
|95970, 95971, 95972, 95973||Neurostimulator programming and analysis code range|
|ICD-9 Procedure||03.93||Insertion or replacement of spinal neurostimulator|
|03.94||Removal of spinal neurostimulator lead(s)|
|86.05||Incision with removal of foreign body or device from skin and subcutaneous tissue (used to report removal of a neurostimulator pulse generator)|
|86.94||Insertion or replacement of single array neurostimulator pulse generator, not specified as rechargeable|
|86.95||Insertion or replacement of dual array neurostimulator pulse generator, not specified as rechargeable|
|86.97||Insertion or replacement of single array rechargeable neurostimulator pulse generator (new code effective 10/1/05)|
|86.98||Insertion or replacement of dual array rechargeable neurostimulator pulse generation (new code effective 10/1/05)|
|ICD-9 Diagnosis||See “Pain” in ICD-9 diagnosis index|
|HCPCS||L8680||Implantable neurostimulator electrode, each (new code effective 1/1/06)|
|L8685||Implantable neurostimulator pulse generator, single array, rechargeable, includes extension (new code effective 1/1/06)|
|L8686||Implantable neurostimulator pulse generator, single array, nonrechargeable, includes extension (new code effective 1/1/06)|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension (new code effective 1/1/06)|
|L8688||Implantable neurostimulator pulse generator, dual array, nonrechargeable, includes extension (new code effective 1/1/06)|
|ICD-10-CM (effective 10/1/14)||This list is a representative list of severe and chronic pain of the trunk and limbs diagnosis codes.|
|G56.40 -G56.42||Causalgia of upper limb code range|
|G57.70 -G57.72||Causalgia of lower limb code range|
|G89.21 -G89.8||Chronic pain, not elsewhere classified, code range|
|G89.4||Chronic pain syndrome|
|G90.50 -G90.59||Complex regional pain syndrome I (CRPS I), code range|
|M25.50 -M25.579||Pain in joint, code range|
|M54.10 -M54.18||Radiculopathy, code range|
|M54.30 -M54.32||Sciatica, code range|
|M54.40 -M54.42||Lumbago with sciatica, code range|
|M54.5||Low back pain|
|M54.6||Pain in thoracic spine|
|M54.81, M54.89||Other dorsalgia codes|
|M79.60 -M79.676||Pain in limb, hand, foot, fingers and toes code range|
|ICD-10-PCS (effective 10/1/14)||ICD-10-PCS codes are only used for inpatient services.|
|Surgical, central nervous system, insertion, spinal canal, neurostimulator lead, code by approach|
|00HV0MZ, 00HV3MZ, 00HV4MZ||Surgical, central nervous system, insertion, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, removal, spinal canal, neurostimulator lead, code by approach|
|00PV0MZ, 00PV3MZ, 00PV4MZ||Surgical, central nervous system, removal, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, revision, spinal canal, neurostimulator lead, code by approach|
|00WV0MZ, 00WV3MZ, 00WV4MZ||Surgical, central nervous system, revision, spinal cord, neurostimulator lead, code by approach|
|0JH60M6, 0JH60M7, 0JH60M8, 0JH60M9, 0JH63M6, 0JH63M7, 0JH63M8, 0JH63M9, 0JH70M6, 0JH70M7, 0JH70M8, 0JH70M9, 0JH73M6, 0JH73M7, 0JH73M8, 0JH73M9, 0JH80M6, 0JH80M7, 0JH80M8, 0JH80M9, 0JH83M6, 0JH83M7, 0JH83M8, 0JH83M9||Surgical, subcutaneous tissue and fascia, insertion, stimulator generator, code by body part, approach, number of arrays and whether rechargeable or not|
|0JPT0MZ, 0JPT3MZ||Surgical, subcutaneous tissue and fascia, removal, subcutaneous tissue and fascia, trunk, stimulator generator, code by approach (there aren’t ICD-10-PCS codes for removal of stimulator generator from other body parts)|
|Type of Service||Surgical|
|Place of Service||Inpatient/Outpatient|
Electrical Nerve Stimulation, Spinal
Spinal Cord Stimulation
Stimulation, Electrical, Spinal Cord
|03/31/96||Add to Surgery section||New policy|
|04/01/98||Replace policy||Policy cross-referenced to No. 7.01.63|
|07/10/98||Replace policy||Policy updated and revised|
|11/15/98||Coding update||1999 CPT coding release|
|04/29/03||Replace policy||Policy updated; new policy statement added, stating that spinal cord stimulation is investigational as a treatment of critical limb ischemia|
|11/9/04||Replace policy||Policy updated; no change to policy statement. Coding updated|
|08/17/05||Replace policy||Policy updated with literature search and coding updated; no change to policy statement|
|12/14/05||Replace policy – coding update only||Coding updated|
|12/12/06||Replace policy||Policy updated with literature search; no change to policy statement; reference numbers 7 – 9 added|
|03/13/08||Replace policy||Policy updated with literature search; references 10 – 13 added; no change to policy statements|
|01/08/09||Replace policy||Policy updated with literature search; references 14–25 added.
|
95972
|
PR ELEC ALYS IMPLT NPGT CPLX SP/PN PRGRMG
|
HCPCS
|
Available online at: http://www.cms.hhs.gov. Last accessed November, 2011. |CPT||63650||Percutaneous implantation of neurostimulator electrode array; epidural|
|63655||Laminectomy for implantation of neurostimulator electrode plate/paddle; epidural|
|63661||Removal of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63662||Removal of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy (new code 1/1/10)|
|63663||Revision including replacement, when performed, of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63664||Revision including replacement, when performed, of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy, including fluoroscopy, when performed (new code 1/1/10)|
|63685||Insertion or replacement of spinal neurostimulator pulse generator or receiver, direct or inductive coupling|
|63688||Revision or removal of implanted spinal neurostimulator pulse generator or receiver|
|95970, 95971, 95972, 95973||Neurostimulator programming and analysis code range|
|ICD-9 Procedure||03.93||Insertion or replacement of spinal neurostimulator|
|03.94||Removal of spinal neurostimulator lead(s)|
|86.05||Incision with removal of foreign body or device from skin and subcutaneous tissue (used to report removal of a neurostimulator pulse generator)|
|86.94||Insertion or replacement of single array neurostimulator pulse generator, not specified as rechargeable|
|86.95||Insertion or replacement of dual array neurostimulator pulse generator, not specified as rechargeable|
|86.97||Insertion or replacement of single array rechargeable neurostimulator pulse generator (new code effective 10/1/05)|
|86.98||Insertion or replacement of dual array rechargeable neurostimulator pulse generation (new code effective 10/1/05)|
|ICD-9 Diagnosis||See “Pain” in ICD-9 diagnosis index|
|HCPCS||L8680||Implantable neurostimulator electrode, each (new code effective 1/1/06)|
|L8685||Implantable neurostimulator pulse generator, single array, rechargeable, includes extension (new code effective 1/1/06)|
|L8686||Implantable neurostimulator pulse generator, single array, nonrechargeable, includes extension (new code effective 1/1/06)|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension (new code effective 1/1/06)|
|L8688||Implantable neurostimulator pulse generator, dual array, nonrechargeable, includes extension (new code effective 1/1/06)|
|ICD-10-CM (effective 10/1/14)||This list is a representative list of severe and chronic pain of the trunk and limbs diagnosis codes.|
|G56.40 -G56.42||Causalgia of upper limb code range|
|G57.70 -G57.72||Causalgia of lower limb code range|
|G89.21 -G89.8||Chronic pain, not elsewhere classified, code range|
|G89.4||Chronic pain syndrome|
|G90.50 -G90.59||Complex regional pain syndrome I (CRPS I), code range|
|M25.50 -M25.579||Pain in joint, code range|
|M54.10 -M54.18||Radiculopathy, code range|
|M54.30 -M54.32||Sciatica, code range|
|M54.40 -M54.42||Lumbago with sciatica, code range|
|M54.5||Low back pain|
|M54.6||Pain in thoracic spine|
|M54.81, M54.89||Other dorsalgia codes|
|M79.60 -M79.676||Pain in limb, hand, foot, fingers and toes code range|
|ICD-10-PCS (effective 10/1/14)||ICD-10-PCS codes are only used for inpatient services.|
|Surgical, central nervous system, insertion, spinal canal, neurostimulator lead, code by approach|
|00HV0MZ, 00HV3MZ, 00HV4MZ||Surgical, central nervous system, insertion, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, removal, spinal canal, neurostimulator lead, code by approach|
|00PV0MZ, 00PV3MZ, 00PV4MZ||Surgical, central nervous system, removal, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, revision, spinal canal, neurostimulator lead, code by approach|
|00WV0MZ, 00WV3MZ, 00WV4MZ||Surgical, central nervous system, revision, spinal cord, neurostimulator lead, code by approach|
|0JH60M6, 0JH60M7, 0JH60M8, 0JH60M9, 0JH63M6, 0JH63M7, 0JH63M8, 0JH63M9, 0JH70M6, 0JH70M7, 0JH70M8, 0JH70M9, 0JH73M6, 0JH73M7, 0JH73M8, 0JH73M9, 0JH80M6, 0JH80M7, 0JH80M8, 0JH80M9, 0JH83M6, 0JH83M7, 0JH83M8, 0JH83M9||Surgical, subcutaneous tissue and fascia, insertion, stimulator generator, code by body part, approach, number of arrays and whether rechargeable or not|
|0JPT0MZ, 0JPT3MZ||Surgical, subcutaneous tissue and fascia, removal, subcutaneous tissue and fascia, trunk, stimulator generator, code by approach (there aren’t ICD-10-PCS codes for removal of stimulator generator from other body parts)|
|Type of Service||Surgical|
|Place of Service||Inpatient/Outpatient|
Electrical Nerve Stimulation, Spinal
Spinal Cord Stimulation
Stimulation, Electrical, Spinal Cord
|03/31/96||Add to Surgery section||New policy|
|04/01/98||Replace policy||Policy cross-referenced to No. 7.01.63|
|07/10/98||Replace policy||Policy updated and revised|
|11/15/98||Coding update||1999 CPT coding release|
|04/29/03||Replace policy||Policy updated; new policy statement added, stating that spinal cord stimulation is investigational as a treatment of critical limb ischemia|
|11/9/04||Replace policy||Policy updated; no change to policy statement. Coding updated|
|08/17/05||Replace policy||Policy updated with literature search and coding updated; no change to policy statement|
|12/14/05||Replace policy – coding update only||Coding updated|
|12/12/06||Replace policy||Policy updated with literature search; no change to policy statement; reference numbers 7 – 9 added|
|03/13/08||Replace policy||Policy updated with literature search; references 10 – 13 added; no change to policy statements|
|01/08/09||Replace policy||Policy updated with literature search; references 14–25 added.
|
L8688
|
Implt nrostm pls gen dua non
|
HCPCS
|
Available online at: http://www.cms.hhs.gov. Last accessed November, 2011. |CPT||63650||Percutaneous implantation of neurostimulator electrode array; epidural|
|63655||Laminectomy for implantation of neurostimulator electrode plate/paddle; epidural|
|63661||Removal of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63662||Removal of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy (new code 1/1/10)|
|63663||Revision including replacement, when performed, of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63664||Revision including replacement, when performed, of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy, including fluoroscopy, when performed (new code 1/1/10)|
|63685||Insertion or replacement of spinal neurostimulator pulse generator or receiver, direct or inductive coupling|
|63688||Revision or removal of implanted spinal neurostimulator pulse generator or receiver|
|95970, 95971, 95972, 95973||Neurostimulator programming and analysis code range|
|ICD-9 Procedure||03.93||Insertion or replacement of spinal neurostimulator|
|03.94||Removal of spinal neurostimulator lead(s)|
|86.05||Incision with removal of foreign body or device from skin and subcutaneous tissue (used to report removal of a neurostimulator pulse generator)|
|86.94||Insertion or replacement of single array neurostimulator pulse generator, not specified as rechargeable|
|86.95||Insertion or replacement of dual array neurostimulator pulse generator, not specified as rechargeable|
|86.97||Insertion or replacement of single array rechargeable neurostimulator pulse generator (new code effective 10/1/05)|
|86.98||Insertion or replacement of dual array rechargeable neurostimulator pulse generation (new code effective 10/1/05)|
|ICD-9 Diagnosis||See “Pain” in ICD-9 diagnosis index|
|HCPCS||L8680||Implantable neurostimulator electrode, each (new code effective 1/1/06)|
|L8685||Implantable neurostimulator pulse generator, single array, rechargeable, includes extension (new code effective 1/1/06)|
|L8686||Implantable neurostimulator pulse generator, single array, nonrechargeable, includes extension (new code effective 1/1/06)|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension (new code effective 1/1/06)|
|L8688||Implantable neurostimulator pulse generator, dual array, nonrechargeable, includes extension (new code effective 1/1/06)|
|ICD-10-CM (effective 10/1/14)||This list is a representative list of severe and chronic pain of the trunk and limbs diagnosis codes.|
|G56.40 -G56.42||Causalgia of upper limb code range|
|G57.70 -G57.72||Causalgia of lower limb code range|
|G89.21 -G89.8||Chronic pain, not elsewhere classified, code range|
|G89.4||Chronic pain syndrome|
|G90.50 -G90.59||Complex regional pain syndrome I (CRPS I), code range|
|M25.50 -M25.579||Pain in joint, code range|
|M54.10 -M54.18||Radiculopathy, code range|
|M54.30 -M54.32||Sciatica, code range|
|M54.40 -M54.42||Lumbago with sciatica, code range|
|M54.5||Low back pain|
|M54.6||Pain in thoracic spine|
|M54.81, M54.89||Other dorsalgia codes|
|M79.60 -M79.676||Pain in limb, hand, foot, fingers and toes code range|
|ICD-10-PCS (effective 10/1/14)||ICD-10-PCS codes are only used for inpatient services.|
|Surgical, central nervous system, insertion, spinal canal, neurostimulator lead, code by approach|
|00HV0MZ, 00HV3MZ, 00HV4MZ||Surgical, central nervous system, insertion, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, removal, spinal canal, neurostimulator lead, code by approach|
|00PV0MZ, 00PV3MZ, 00PV4MZ||Surgical, central nervous system, removal, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, revision, spinal canal, neurostimulator lead, code by approach|
|00WV0MZ, 00WV3MZ, 00WV4MZ||Surgical, central nervous system, revision, spinal cord, neurostimulator lead, code by approach|
|0JH60M6, 0JH60M7, 0JH60M8, 0JH60M9, 0JH63M6, 0JH63M7, 0JH63M8, 0JH63M9, 0JH70M6, 0JH70M7, 0JH70M8, 0JH70M9, 0JH73M6, 0JH73M7, 0JH73M8, 0JH73M9, 0JH80M6, 0JH80M7, 0JH80M8, 0JH80M9, 0JH83M6, 0JH83M7, 0JH83M8, 0JH83M9||Surgical, subcutaneous tissue and fascia, insertion, stimulator generator, code by body part, approach, number of arrays and whether rechargeable or not|
|0JPT0MZ, 0JPT3MZ||Surgical, subcutaneous tissue and fascia, removal, subcutaneous tissue and fascia, trunk, stimulator generator, code by approach (there aren’t ICD-10-PCS codes for removal of stimulator generator from other body parts)|
|Type of Service||Surgical|
|Place of Service||Inpatient/Outpatient|
Electrical Nerve Stimulation, Spinal
Spinal Cord Stimulation
Stimulation, Electrical, Spinal Cord
|03/31/96||Add to Surgery section||New policy|
|04/01/98||Replace policy||Policy cross-referenced to No. 7.01.63|
|07/10/98||Replace policy||Policy updated and revised|
|11/15/98||Coding update||1999 CPT coding release|
|04/29/03||Replace policy||Policy updated; new policy statement added, stating that spinal cord stimulation is investigational as a treatment of critical limb ischemia|
|11/9/04||Replace policy||Policy updated; no change to policy statement. Coding updated|
|08/17/05||Replace policy||Policy updated with literature search and coding updated; no change to policy statement|
|12/14/05||Replace policy – coding update only||Coding updated|
|12/12/06||Replace policy||Policy updated with literature search; no change to policy statement; reference numbers 7 – 9 added|
|03/13/08||Replace policy||Policy updated with literature search; references 10 – 13 added; no change to policy statements|
|01/08/09||Replace policy||Policy updated with literature search; references 14–25 added.
|
1999
|
ANESTHESIOLOGY GROUP
|
CPT
|
Available online at: http://www.cms.hhs.gov. Last accessed November, 2011. |CPT||63650||Percutaneous implantation of neurostimulator electrode array; epidural|
|63655||Laminectomy for implantation of neurostimulator electrode plate/paddle; epidural|
|63661||Removal of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63662||Removal of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy (new code 1/1/10)|
|63663||Revision including replacement, when performed, of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63664||Revision including replacement, when performed, of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy, including fluoroscopy, when performed (new code 1/1/10)|
|63685||Insertion or replacement of spinal neurostimulator pulse generator or receiver, direct or inductive coupling|
|63688||Revision or removal of implanted spinal neurostimulator pulse generator or receiver|
|95970, 95971, 95972, 95973||Neurostimulator programming and analysis code range|
|ICD-9 Procedure||03.93||Insertion or replacement of spinal neurostimulator|
|03.94||Removal of spinal neurostimulator lead(s)|
|86.05||Incision with removal of foreign body or device from skin and subcutaneous tissue (used to report removal of a neurostimulator pulse generator)|
|86.94||Insertion or replacement of single array neurostimulator pulse generator, not specified as rechargeable|
|86.95||Insertion or replacement of dual array neurostimulator pulse generator, not specified as rechargeable|
|86.97||Insertion or replacement of single array rechargeable neurostimulator pulse generator (new code effective 10/1/05)|
|86.98||Insertion or replacement of dual array rechargeable neurostimulator pulse generation (new code effective 10/1/05)|
|ICD-9 Diagnosis||See “Pain” in ICD-9 diagnosis index|
|HCPCS||L8680||Implantable neurostimulator electrode, each (new code effective 1/1/06)|
|L8685||Implantable neurostimulator pulse generator, single array, rechargeable, includes extension (new code effective 1/1/06)|
|L8686||Implantable neurostimulator pulse generator, single array, nonrechargeable, includes extension (new code effective 1/1/06)|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension (new code effective 1/1/06)|
|L8688||Implantable neurostimulator pulse generator, dual array, nonrechargeable, includes extension (new code effective 1/1/06)|
|ICD-10-CM (effective 10/1/14)||This list is a representative list of severe and chronic pain of the trunk and limbs diagnosis codes.|
|G56.40 -G56.42||Causalgia of upper limb code range|
|G57.70 -G57.72||Causalgia of lower limb code range|
|G89.21 -G89.8||Chronic pain, not elsewhere classified, code range|
|G89.4||Chronic pain syndrome|
|G90.50 -G90.59||Complex regional pain syndrome I (CRPS I), code range|
|M25.50 -M25.579||Pain in joint, code range|
|M54.10 -M54.18||Radiculopathy, code range|
|M54.30 -M54.32||Sciatica, code range|
|M54.40 -M54.42||Lumbago with sciatica, code range|
|M54.5||Low back pain|
|M54.6||Pain in thoracic spine|
|M54.81, M54.89||Other dorsalgia codes|
|M79.60 -M79.676||Pain in limb, hand, foot, fingers and toes code range|
|ICD-10-PCS (effective 10/1/14)||ICD-10-PCS codes are only used for inpatient services.|
|Surgical, central nervous system, insertion, spinal canal, neurostimulator lead, code by approach|
|00HV0MZ, 00HV3MZ, 00HV4MZ||Surgical, central nervous system, insertion, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, removal, spinal canal, neurostimulator lead, code by approach|
|00PV0MZ, 00PV3MZ, 00PV4MZ||Surgical, central nervous system, removal, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, revision, spinal canal, neurostimulator lead, code by approach|
|00WV0MZ, 00WV3MZ, 00WV4MZ||Surgical, central nervous system, revision, spinal cord, neurostimulator lead, code by approach|
|0JH60M6, 0JH60M7, 0JH60M8, 0JH60M9, 0JH63M6, 0JH63M7, 0JH63M8, 0JH63M9, 0JH70M6, 0JH70M7, 0JH70M8, 0JH70M9, 0JH73M6, 0JH73M7, 0JH73M8, 0JH73M9, 0JH80M6, 0JH80M7, 0JH80M8, 0JH80M9, 0JH83M6, 0JH83M7, 0JH83M8, 0JH83M9||Surgical, subcutaneous tissue and fascia, insertion, stimulator generator, code by body part, approach, number of arrays and whether rechargeable or not|
|0JPT0MZ, 0JPT3MZ||Surgical, subcutaneous tissue and fascia, removal, subcutaneous tissue and fascia, trunk, stimulator generator, code by approach (there aren’t ICD-10-PCS codes for removal of stimulator generator from other body parts)|
|Type of Service||Surgical|
|Place of Service||Inpatient/Outpatient|
Electrical Nerve Stimulation, Spinal
Spinal Cord Stimulation
Stimulation, Electrical, Spinal Cord
|03/31/96||Add to Surgery section||New policy|
|04/01/98||Replace policy||Policy cross-referenced to No. 7.01.63|
|07/10/98||Replace policy||Policy updated and revised|
|11/15/98||Coding update||1999 CPT coding release|
|04/29/03||Replace policy||Policy updated; new policy statement added, stating that spinal cord stimulation is investigational as a treatment of critical limb ischemia|
|11/9/04||Replace policy||Policy updated; no change to policy statement. Coding updated|
|08/17/05||Replace policy||Policy updated with literature search and coding updated; no change to policy statement|
|12/14/05||Replace policy – coding update only||Coding updated|
|12/12/06||Replace policy||Policy updated with literature search; no change to policy statement; reference numbers 7 – 9 added|
|03/13/08||Replace policy||Policy updated with literature search; references 10 – 13 added; no change to policy statements|
|01/08/09||Replace policy||Policy updated with literature search; references 14–25 added.
|
L8680
|
KIT NRSTM 40CM STIMLOC .
|
HCPCS
|
Available online at: http://www.cms.hhs.gov. Last accessed November, 2011. |CPT||63650||Percutaneous implantation of neurostimulator electrode array; epidural|
|63655||Laminectomy for implantation of neurostimulator electrode plate/paddle; epidural|
|63661||Removal of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63662||Removal of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy (new code 1/1/10)|
|63663||Revision including replacement, when performed, of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63664||Revision including replacement, when performed, of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy, including fluoroscopy, when performed (new code 1/1/10)|
|63685||Insertion or replacement of spinal neurostimulator pulse generator or receiver, direct or inductive coupling|
|63688||Revision or removal of implanted spinal neurostimulator pulse generator or receiver|
|95970, 95971, 95972, 95973||Neurostimulator programming and analysis code range|
|ICD-9 Procedure||03.93||Insertion or replacement of spinal neurostimulator|
|03.94||Removal of spinal neurostimulator lead(s)|
|86.05||Incision with removal of foreign body or device from skin and subcutaneous tissue (used to report removal of a neurostimulator pulse generator)|
|86.94||Insertion or replacement of single array neurostimulator pulse generator, not specified as rechargeable|
|86.95||Insertion or replacement of dual array neurostimulator pulse generator, not specified as rechargeable|
|86.97||Insertion or replacement of single array rechargeable neurostimulator pulse generator (new code effective 10/1/05)|
|86.98||Insertion or replacement of dual array rechargeable neurostimulator pulse generation (new code effective 10/1/05)|
|ICD-9 Diagnosis||See “Pain” in ICD-9 diagnosis index|
|HCPCS||L8680||Implantable neurostimulator electrode, each (new code effective 1/1/06)|
|L8685||Implantable neurostimulator pulse generator, single array, rechargeable, includes extension (new code effective 1/1/06)|
|L8686||Implantable neurostimulator pulse generator, single array, nonrechargeable, includes extension (new code effective 1/1/06)|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension (new code effective 1/1/06)|
|L8688||Implantable neurostimulator pulse generator, dual array, nonrechargeable, includes extension (new code effective 1/1/06)|
|ICD-10-CM (effective 10/1/14)||This list is a representative list of severe and chronic pain of the trunk and limbs diagnosis codes.|
|G56.40 -G56.42||Causalgia of upper limb code range|
|G57.70 -G57.72||Causalgia of lower limb code range|
|G89.21 -G89.8||Chronic pain, not elsewhere classified, code range|
|G89.4||Chronic pain syndrome|
|G90.50 -G90.59||Complex regional pain syndrome I (CRPS I), code range|
|M25.50 -M25.579||Pain in joint, code range|
|M54.10 -M54.18||Radiculopathy, code range|
|M54.30 -M54.32||Sciatica, code range|
|M54.40 -M54.42||Lumbago with sciatica, code range|
|M54.5||Low back pain|
|M54.6||Pain in thoracic spine|
|M54.81, M54.89||Other dorsalgia codes|
|M79.60 -M79.676||Pain in limb, hand, foot, fingers and toes code range|
|ICD-10-PCS (effective 10/1/14)||ICD-10-PCS codes are only used for inpatient services.|
|Surgical, central nervous system, insertion, spinal canal, neurostimulator lead, code by approach|
|00HV0MZ, 00HV3MZ, 00HV4MZ||Surgical, central nervous system, insertion, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, removal, spinal canal, neurostimulator lead, code by approach|
|00PV0MZ, 00PV3MZ, 00PV4MZ||Surgical, central nervous system, removal, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, revision, spinal canal, neurostimulator lead, code by approach|
|00WV0MZ, 00WV3MZ, 00WV4MZ||Surgical, central nervous system, revision, spinal cord, neurostimulator lead, code by approach|
|0JH60M6, 0JH60M7, 0JH60M8, 0JH60M9, 0JH63M6, 0JH63M7, 0JH63M8, 0JH63M9, 0JH70M6, 0JH70M7, 0JH70M8, 0JH70M9, 0JH73M6, 0JH73M7, 0JH73M8, 0JH73M9, 0JH80M6, 0JH80M7, 0JH80M8, 0JH80M9, 0JH83M6, 0JH83M7, 0JH83M8, 0JH83M9||Surgical, subcutaneous tissue and fascia, insertion, stimulator generator, code by body part, approach, number of arrays and whether rechargeable or not|
|0JPT0MZ, 0JPT3MZ||Surgical, subcutaneous tissue and fascia, removal, subcutaneous tissue and fascia, trunk, stimulator generator, code by approach (there aren’t ICD-10-PCS codes for removal of stimulator generator from other body parts)|
|Type of Service||Surgical|
|Place of Service||Inpatient/Outpatient|
Electrical Nerve Stimulation, Spinal
Spinal Cord Stimulation
Stimulation, Electrical, Spinal Cord
|03/31/96||Add to Surgery section||New policy|
|04/01/98||Replace policy||Policy cross-referenced to No. 7.01.63|
|07/10/98||Replace policy||Policy updated and revised|
|11/15/98||Coding update||1999 CPT coding release|
|04/29/03||Replace policy||Policy updated; new policy statement added, stating that spinal cord stimulation is investigational as a treatment of critical limb ischemia|
|11/9/04||Replace policy||Policy updated; no change to policy statement. Coding updated|
|08/17/05||Replace policy||Policy updated with literature search and coding updated; no change to policy statement|
|12/14/05||Replace policy – coding update only||Coding updated|
|12/12/06||Replace policy||Policy updated with literature search; no change to policy statement; reference numbers 7 – 9 added|
|03/13/08||Replace policy||Policy updated with literature search; references 10 – 13 added; no change to policy statements|
|01/08/09||Replace policy||Policy updated with literature search; references 14–25 added.
|
63662
|
Remove spine eltrd plate
|
HCPCS
|
Available online at: http://www.cms.hhs.gov. Last accessed November, 2011. |CPT||63650||Percutaneous implantation of neurostimulator electrode array; epidural|
|63655||Laminectomy for implantation of neurostimulator electrode plate/paddle; epidural|
|63661||Removal of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63662||Removal of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy (new code 1/1/10)|
|63663||Revision including replacement, when performed, of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63664||Revision including replacement, when performed, of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy, including fluoroscopy, when performed (new code 1/1/10)|
|63685||Insertion or replacement of spinal neurostimulator pulse generator or receiver, direct or inductive coupling|
|63688||Revision or removal of implanted spinal neurostimulator pulse generator or receiver|
|95970, 95971, 95972, 95973||Neurostimulator programming and analysis code range|
|ICD-9 Procedure||03.93||Insertion or replacement of spinal neurostimulator|
|03.94||Removal of spinal neurostimulator lead(s)|
|86.05||Incision with removal of foreign body or device from skin and subcutaneous tissue (used to report removal of a neurostimulator pulse generator)|
|86.94||Insertion or replacement of single array neurostimulator pulse generator, not specified as rechargeable|
|86.95||Insertion or replacement of dual array neurostimulator pulse generator, not specified as rechargeable|
|86.97||Insertion or replacement of single array rechargeable neurostimulator pulse generator (new code effective 10/1/05)|
|86.98||Insertion or replacement of dual array rechargeable neurostimulator pulse generation (new code effective 10/1/05)|
|ICD-9 Diagnosis||See “Pain” in ICD-9 diagnosis index|
|HCPCS||L8680||Implantable neurostimulator electrode, each (new code effective 1/1/06)|
|L8685||Implantable neurostimulator pulse generator, single array, rechargeable, includes extension (new code effective 1/1/06)|
|L8686||Implantable neurostimulator pulse generator, single array, nonrechargeable, includes extension (new code effective 1/1/06)|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension (new code effective 1/1/06)|
|L8688||Implantable neurostimulator pulse generator, dual array, nonrechargeable, includes extension (new code effective 1/1/06)|
|ICD-10-CM (effective 10/1/14)||This list is a representative list of severe and chronic pain of the trunk and limbs diagnosis codes.|
|G56.40 -G56.42||Causalgia of upper limb code range|
|G57.70 -G57.72||Causalgia of lower limb code range|
|G89.21 -G89.8||Chronic pain, not elsewhere classified, code range|
|G89.4||Chronic pain syndrome|
|G90.50 -G90.59||Complex regional pain syndrome I (CRPS I), code range|
|M25.50 -M25.579||Pain in joint, code range|
|M54.10 -M54.18||Radiculopathy, code range|
|M54.30 -M54.32||Sciatica, code range|
|M54.40 -M54.42||Lumbago with sciatica, code range|
|M54.5||Low back pain|
|M54.6||Pain in thoracic spine|
|M54.81, M54.89||Other dorsalgia codes|
|M79.60 -M79.676||Pain in limb, hand, foot, fingers and toes code range|
|ICD-10-PCS (effective 10/1/14)||ICD-10-PCS codes are only used for inpatient services.|
|Surgical, central nervous system, insertion, spinal canal, neurostimulator lead, code by approach|
|00HV0MZ, 00HV3MZ, 00HV4MZ||Surgical, central nervous system, insertion, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, removal, spinal canal, neurostimulator lead, code by approach|
|00PV0MZ, 00PV3MZ, 00PV4MZ||Surgical, central nervous system, removal, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, revision, spinal canal, neurostimulator lead, code by approach|
|00WV0MZ, 00WV3MZ, 00WV4MZ||Surgical, central nervous system, revision, spinal cord, neurostimulator lead, code by approach|
|0JH60M6, 0JH60M7, 0JH60M8, 0JH60M9, 0JH63M6, 0JH63M7, 0JH63M8, 0JH63M9, 0JH70M6, 0JH70M7, 0JH70M8, 0JH70M9, 0JH73M6, 0JH73M7, 0JH73M8, 0JH73M9, 0JH80M6, 0JH80M7, 0JH80M8, 0JH80M9, 0JH83M6, 0JH83M7, 0JH83M8, 0JH83M9||Surgical, subcutaneous tissue and fascia, insertion, stimulator generator, code by body part, approach, number of arrays and whether rechargeable or not|
|0JPT0MZ, 0JPT3MZ||Surgical, subcutaneous tissue and fascia, removal, subcutaneous tissue and fascia, trunk, stimulator generator, code by approach (there aren’t ICD-10-PCS codes for removal of stimulator generator from other body parts)|
|Type of Service||Surgical|
|Place of Service||Inpatient/Outpatient|
Electrical Nerve Stimulation, Spinal
Spinal Cord Stimulation
Stimulation, Electrical, Spinal Cord
|03/31/96||Add to Surgery section||New policy|
|04/01/98||Replace policy||Policy cross-referenced to No. 7.01.63|
|07/10/98||Replace policy||Policy updated and revised|
|11/15/98||Coding update||1999 CPT coding release|
|04/29/03||Replace policy||Policy updated; new policy statement added, stating that spinal cord stimulation is investigational as a treatment of critical limb ischemia|
|11/9/04||Replace policy||Policy updated; no change to policy statement. Coding updated|
|08/17/05||Replace policy||Policy updated with literature search and coding updated; no change to policy statement|
|12/14/05||Replace policy – coding update only||Coding updated|
|12/12/06||Replace policy||Policy updated with literature search; no change to policy statement; reference numbers 7 – 9 added|
|03/13/08||Replace policy||Policy updated with literature search; references 10 – 13 added; no change to policy statements|
|01/08/09||Replace policy||Policy updated with literature search; references 14–25 added.
|
L8687
|
KIT NEUROSTIMULATOR SENZA IPG STERILE LATEX FREE DISPOSABLE
|
HCPCS
|
Available online at: http://www.cms.hhs.gov. Last accessed November, 2011. |CPT||63650||Percutaneous implantation of neurostimulator electrode array; epidural|
|63655||Laminectomy for implantation of neurostimulator electrode plate/paddle; epidural|
|63661||Removal of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63662||Removal of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy (new code 1/1/10)|
|63663||Revision including replacement, when performed, of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63664||Revision including replacement, when performed, of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy, including fluoroscopy, when performed (new code 1/1/10)|
|63685||Insertion or replacement of spinal neurostimulator pulse generator or receiver, direct or inductive coupling|
|63688||Revision or removal of implanted spinal neurostimulator pulse generator or receiver|
|95970, 95971, 95972, 95973||Neurostimulator programming and analysis code range|
|ICD-9 Procedure||03.93||Insertion or replacement of spinal neurostimulator|
|03.94||Removal of spinal neurostimulator lead(s)|
|86.05||Incision with removal of foreign body or device from skin and subcutaneous tissue (used to report removal of a neurostimulator pulse generator)|
|86.94||Insertion or replacement of single array neurostimulator pulse generator, not specified as rechargeable|
|86.95||Insertion or replacement of dual array neurostimulator pulse generator, not specified as rechargeable|
|86.97||Insertion or replacement of single array rechargeable neurostimulator pulse generator (new code effective 10/1/05)|
|86.98||Insertion or replacement of dual array rechargeable neurostimulator pulse generation (new code effective 10/1/05)|
|ICD-9 Diagnosis||See “Pain” in ICD-9 diagnosis index|
|HCPCS||L8680||Implantable neurostimulator electrode, each (new code effective 1/1/06)|
|L8685||Implantable neurostimulator pulse generator, single array, rechargeable, includes extension (new code effective 1/1/06)|
|L8686||Implantable neurostimulator pulse generator, single array, nonrechargeable, includes extension (new code effective 1/1/06)|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension (new code effective 1/1/06)|
|L8688||Implantable neurostimulator pulse generator, dual array, nonrechargeable, includes extension (new code effective 1/1/06)|
|ICD-10-CM (effective 10/1/14)||This list is a representative list of severe and chronic pain of the trunk and limbs diagnosis codes.|
|G56.40 -G56.42||Causalgia of upper limb code range|
|G57.70 -G57.72||Causalgia of lower limb code range|
|G89.21 -G89.8||Chronic pain, not elsewhere classified, code range|
|G89.4||Chronic pain syndrome|
|G90.50 -G90.59||Complex regional pain syndrome I (CRPS I), code range|
|M25.50 -M25.579||Pain in joint, code range|
|M54.10 -M54.18||Radiculopathy, code range|
|M54.30 -M54.32||Sciatica, code range|
|M54.40 -M54.42||Lumbago with sciatica, code range|
|M54.5||Low back pain|
|M54.6||Pain in thoracic spine|
|M54.81, M54.89||Other dorsalgia codes|
|M79.60 -M79.676||Pain in limb, hand, foot, fingers and toes code range|
|ICD-10-PCS (effective 10/1/14)||ICD-10-PCS codes are only used for inpatient services.|
|Surgical, central nervous system, insertion, spinal canal, neurostimulator lead, code by approach|
|00HV0MZ, 00HV3MZ, 00HV4MZ||Surgical, central nervous system, insertion, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, removal, spinal canal, neurostimulator lead, code by approach|
|00PV0MZ, 00PV3MZ, 00PV4MZ||Surgical, central nervous system, removal, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, revision, spinal canal, neurostimulator lead, code by approach|
|00WV0MZ, 00WV3MZ, 00WV4MZ||Surgical, central nervous system, revision, spinal cord, neurostimulator lead, code by approach|
|0JH60M6, 0JH60M7, 0JH60M8, 0JH60M9, 0JH63M6, 0JH63M7, 0JH63M8, 0JH63M9, 0JH70M6, 0JH70M7, 0JH70M8, 0JH70M9, 0JH73M6, 0JH73M7, 0JH73M8, 0JH73M9, 0JH80M6, 0JH80M7, 0JH80M8, 0JH80M9, 0JH83M6, 0JH83M7, 0JH83M8, 0JH83M9||Surgical, subcutaneous tissue and fascia, insertion, stimulator generator, code by body part, approach, number of arrays and whether rechargeable or not|
|0JPT0MZ, 0JPT3MZ||Surgical, subcutaneous tissue and fascia, removal, subcutaneous tissue and fascia, trunk, stimulator generator, code by approach (there aren’t ICD-10-PCS codes for removal of stimulator generator from other body parts)|
|Type of Service||Surgical|
|Place of Service||Inpatient/Outpatient|
Electrical Nerve Stimulation, Spinal
Spinal Cord Stimulation
Stimulation, Electrical, Spinal Cord
|03/31/96||Add to Surgery section||New policy|
|04/01/98||Replace policy||Policy cross-referenced to No. 7.01.63|
|07/10/98||Replace policy||Policy updated and revised|
|11/15/98||Coding update||1999 CPT coding release|
|04/29/03||Replace policy||Policy updated; new policy statement added, stating that spinal cord stimulation is investigational as a treatment of critical limb ischemia|
|11/9/04||Replace policy||Policy updated; no change to policy statement. Coding updated|
|08/17/05||Replace policy||Policy updated with literature search and coding updated; no change to policy statement|
|12/14/05||Replace policy – coding update only||Coding updated|
|12/12/06||Replace policy||Policy updated with literature search; no change to policy statement; reference numbers 7 – 9 added|
|03/13/08||Replace policy||Policy updated with literature search; references 10 – 13 added; no change to policy statements|
|01/08/09||Replace policy||Policy updated with literature search; references 14–25 added.
|
63663
|
Revise spine eltrd perq aray
|
HCPCS
|
Available online at: http://www.cms.hhs.gov. Last accessed November, 2011. |CPT||63650||Percutaneous implantation of neurostimulator electrode array; epidural|
|63655||Laminectomy for implantation of neurostimulator electrode plate/paddle; epidural|
|63661||Removal of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63662||Removal of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy (new code 1/1/10)|
|63663||Revision including replacement, when performed, of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63664||Revision including replacement, when performed, of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy, including fluoroscopy, when performed (new code 1/1/10)|
|63685||Insertion or replacement of spinal neurostimulator pulse generator or receiver, direct or inductive coupling|
|63688||Revision or removal of implanted spinal neurostimulator pulse generator or receiver|
|95970, 95971, 95972, 95973||Neurostimulator programming and analysis code range|
|ICD-9 Procedure||03.93||Insertion or replacement of spinal neurostimulator|
|03.94||Removal of spinal neurostimulator lead(s)|
|86.05||Incision with removal of foreign body or device from skin and subcutaneous tissue (used to report removal of a neurostimulator pulse generator)|
|86.94||Insertion or replacement of single array neurostimulator pulse generator, not specified as rechargeable|
|86.95||Insertion or replacement of dual array neurostimulator pulse generator, not specified as rechargeable|
|86.97||Insertion or replacement of single array rechargeable neurostimulator pulse generator (new code effective 10/1/05)|
|86.98||Insertion or replacement of dual array rechargeable neurostimulator pulse generation (new code effective 10/1/05)|
|ICD-9 Diagnosis||See “Pain” in ICD-9 diagnosis index|
|HCPCS||L8680||Implantable neurostimulator electrode, each (new code effective 1/1/06)|
|L8685||Implantable neurostimulator pulse generator, single array, rechargeable, includes extension (new code effective 1/1/06)|
|L8686||Implantable neurostimulator pulse generator, single array, nonrechargeable, includes extension (new code effective 1/1/06)|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension (new code effective 1/1/06)|
|L8688||Implantable neurostimulator pulse generator, dual array, nonrechargeable, includes extension (new code effective 1/1/06)|
|ICD-10-CM (effective 10/1/14)||This list is a representative list of severe and chronic pain of the trunk and limbs diagnosis codes.|
|G56.40 -G56.42||Causalgia of upper limb code range|
|G57.70 -G57.72||Causalgia of lower limb code range|
|G89.21 -G89.8||Chronic pain, not elsewhere classified, code range|
|G89.4||Chronic pain syndrome|
|G90.50 -G90.59||Complex regional pain syndrome I (CRPS I), code range|
|M25.50 -M25.579||Pain in joint, code range|
|M54.10 -M54.18||Radiculopathy, code range|
|M54.30 -M54.32||Sciatica, code range|
|M54.40 -M54.42||Lumbago with sciatica, code range|
|M54.5||Low back pain|
|M54.6||Pain in thoracic spine|
|M54.81, M54.89||Other dorsalgia codes|
|M79.60 -M79.676||Pain in limb, hand, foot, fingers and toes code range|
|ICD-10-PCS (effective 10/1/14)||ICD-10-PCS codes are only used for inpatient services.|
|Surgical, central nervous system, insertion, spinal canal, neurostimulator lead, code by approach|
|00HV0MZ, 00HV3MZ, 00HV4MZ||Surgical, central nervous system, insertion, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, removal, spinal canal, neurostimulator lead, code by approach|
|00PV0MZ, 00PV3MZ, 00PV4MZ||Surgical, central nervous system, removal, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, revision, spinal canal, neurostimulator lead, code by approach|
|00WV0MZ, 00WV3MZ, 00WV4MZ||Surgical, central nervous system, revision, spinal cord, neurostimulator lead, code by approach|
|0JH60M6, 0JH60M7, 0JH60M8, 0JH60M9, 0JH63M6, 0JH63M7, 0JH63M8, 0JH63M9, 0JH70M6, 0JH70M7, 0JH70M8, 0JH70M9, 0JH73M6, 0JH73M7, 0JH73M8, 0JH73M9, 0JH80M6, 0JH80M7, 0JH80M8, 0JH80M9, 0JH83M6, 0JH83M7, 0JH83M8, 0JH83M9||Surgical, subcutaneous tissue and fascia, insertion, stimulator generator, code by body part, approach, number of arrays and whether rechargeable or not|
|0JPT0MZ, 0JPT3MZ||Surgical, subcutaneous tissue and fascia, removal, subcutaneous tissue and fascia, trunk, stimulator generator, code by approach (there aren’t ICD-10-PCS codes for removal of stimulator generator from other body parts)|
|Type of Service||Surgical|
|Place of Service||Inpatient/Outpatient|
Electrical Nerve Stimulation, Spinal
Spinal Cord Stimulation
Stimulation, Electrical, Spinal Cord
|03/31/96||Add to Surgery section||New policy|
|04/01/98||Replace policy||Policy cross-referenced to No. 7.01.63|
|07/10/98||Replace policy||Policy updated and revised|
|11/15/98||Coding update||1999 CPT coding release|
|04/29/03||Replace policy||Policy updated; new policy statement added, stating that spinal cord stimulation is investigational as a treatment of critical limb ischemia|
|11/9/04||Replace policy||Policy updated; no change to policy statement. Coding updated|
|08/17/05||Replace policy||Policy updated with literature search and coding updated; no change to policy statement|
|12/14/05||Replace policy – coding update only||Coding updated|
|12/12/06||Replace policy||Policy updated with literature search; no change to policy statement; reference numbers 7 – 9 added|
|03/13/08||Replace policy||Policy updated with literature search; references 10 – 13 added; no change to policy statements|
|01/08/09||Replace policy||Policy updated with literature search; references 14–25 added.
|
95970
|
PR ELEC ALYS IMPLT NPGT PHYS/QHP W/O PROGRAMMING
|
HCPCS
|
Available online at: http://www.cms.hhs.gov. Last accessed November, 2011. |CPT||63650||Percutaneous implantation of neurostimulator electrode array; epidural|
|63655||Laminectomy for implantation of neurostimulator electrode plate/paddle; epidural|
|63661||Removal of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63662||Removal of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy (new code 1/1/10)|
|63663||Revision including replacement, when performed, of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63664||Revision including replacement, when performed, of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy, including fluoroscopy, when performed (new code 1/1/10)|
|63685||Insertion or replacement of spinal neurostimulator pulse generator or receiver, direct or inductive coupling|
|63688||Revision or removal of implanted spinal neurostimulator pulse generator or receiver|
|95970, 95971, 95972, 95973||Neurostimulator programming and analysis code range|
|ICD-9 Procedure||03.93||Insertion or replacement of spinal neurostimulator|
|03.94||Removal of spinal neurostimulator lead(s)|
|86.05||Incision with removal of foreign body or device from skin and subcutaneous tissue (used to report removal of a neurostimulator pulse generator)|
|86.94||Insertion or replacement of single array neurostimulator pulse generator, not specified as rechargeable|
|86.95||Insertion or replacement of dual array neurostimulator pulse generator, not specified as rechargeable|
|86.97||Insertion or replacement of single array rechargeable neurostimulator pulse generator (new code effective 10/1/05)|
|86.98||Insertion or replacement of dual array rechargeable neurostimulator pulse generation (new code effective 10/1/05)|
|ICD-9 Diagnosis||See “Pain” in ICD-9 diagnosis index|
|HCPCS||L8680||Implantable neurostimulator electrode, each (new code effective 1/1/06)|
|L8685||Implantable neurostimulator pulse generator, single array, rechargeable, includes extension (new code effective 1/1/06)|
|L8686||Implantable neurostimulator pulse generator, single array, nonrechargeable, includes extension (new code effective 1/1/06)|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension (new code effective 1/1/06)|
|L8688||Implantable neurostimulator pulse generator, dual array, nonrechargeable, includes extension (new code effective 1/1/06)|
|ICD-10-CM (effective 10/1/14)||This list is a representative list of severe and chronic pain of the trunk and limbs diagnosis codes.|
|G56.40 -G56.42||Causalgia of upper limb code range|
|G57.70 -G57.72||Causalgia of lower limb code range|
|G89.21 -G89.8||Chronic pain, not elsewhere classified, code range|
|G89.4||Chronic pain syndrome|
|G90.50 -G90.59||Complex regional pain syndrome I (CRPS I), code range|
|M25.50 -M25.579||Pain in joint, code range|
|M54.10 -M54.18||Radiculopathy, code range|
|M54.30 -M54.32||Sciatica, code range|
|M54.40 -M54.42||Lumbago with sciatica, code range|
|M54.5||Low back pain|
|M54.6||Pain in thoracic spine|
|M54.81, M54.89||Other dorsalgia codes|
|M79.60 -M79.676||Pain in limb, hand, foot, fingers and toes code range|
|ICD-10-PCS (effective 10/1/14)||ICD-10-PCS codes are only used for inpatient services.|
|Surgical, central nervous system, insertion, spinal canal, neurostimulator lead, code by approach|
|00HV0MZ, 00HV3MZ, 00HV4MZ||Surgical, central nervous system, insertion, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, removal, spinal canal, neurostimulator lead, code by approach|
|00PV0MZ, 00PV3MZ, 00PV4MZ||Surgical, central nervous system, removal, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, revision, spinal canal, neurostimulator lead, code by approach|
|00WV0MZ, 00WV3MZ, 00WV4MZ||Surgical, central nervous system, revision, spinal cord, neurostimulator lead, code by approach|
|0JH60M6, 0JH60M7, 0JH60M8, 0JH60M9, 0JH63M6, 0JH63M7, 0JH63M8, 0JH63M9, 0JH70M6, 0JH70M7, 0JH70M8, 0JH70M9, 0JH73M6, 0JH73M7, 0JH73M8, 0JH73M9, 0JH80M6, 0JH80M7, 0JH80M8, 0JH80M9, 0JH83M6, 0JH83M7, 0JH83M8, 0JH83M9||Surgical, subcutaneous tissue and fascia, insertion, stimulator generator, code by body part, approach, number of arrays and whether rechargeable or not|
|0JPT0MZ, 0JPT3MZ||Surgical, subcutaneous tissue and fascia, removal, subcutaneous tissue and fascia, trunk, stimulator generator, code by approach (there aren’t ICD-10-PCS codes for removal of stimulator generator from other body parts)|
|Type of Service||Surgical|
|Place of Service||Inpatient/Outpatient|
Electrical Nerve Stimulation, Spinal
Spinal Cord Stimulation
Stimulation, Electrical, Spinal Cord
|03/31/96||Add to Surgery section||New policy|
|04/01/98||Replace policy||Policy cross-referenced to No. 7.01.63|
|07/10/98||Replace policy||Policy updated and revised|
|11/15/98||Coding update||1999 CPT coding release|
|04/29/03||Replace policy||Policy updated; new policy statement added, stating that spinal cord stimulation is investigational as a treatment of critical limb ischemia|
|11/9/04||Replace policy||Policy updated; no change to policy statement. Coding updated|
|08/17/05||Replace policy||Policy updated with literature search and coding updated; no change to policy statement|
|12/14/05||Replace policy – coding update only||Coding updated|
|12/12/06||Replace policy||Policy updated with literature search; no change to policy statement; reference numbers 7 – 9 added|
|03/13/08||Replace policy||Policy updated with literature search; references 10 – 13 added; no change to policy statements|
|01/08/09||Replace policy||Policy updated with literature search; references 14–25 added.
|
63688
|
Rev/rmv imp sp npg/r dtch cn
|
HCPCS
|
Available online at: http://www.cms.hhs.gov. Last accessed November, 2011. |CPT||63650||Percutaneous implantation of neurostimulator electrode array; epidural|
|63655||Laminectomy for implantation of neurostimulator electrode plate/paddle; epidural|
|63661||Removal of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63662||Removal of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy (new code 1/1/10)|
|63663||Revision including replacement, when performed, of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63664||Revision including replacement, when performed, of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy, including fluoroscopy, when performed (new code 1/1/10)|
|63685||Insertion or replacement of spinal neurostimulator pulse generator or receiver, direct or inductive coupling|
|63688||Revision or removal of implanted spinal neurostimulator pulse generator or receiver|
|95970, 95971, 95972, 95973||Neurostimulator programming and analysis code range|
|ICD-9 Procedure||03.93||Insertion or replacement of spinal neurostimulator|
|03.94||Removal of spinal neurostimulator lead(s)|
|86.05||Incision with removal of foreign body or device from skin and subcutaneous tissue (used to report removal of a neurostimulator pulse generator)|
|86.94||Insertion or replacement of single array neurostimulator pulse generator, not specified as rechargeable|
|86.95||Insertion or replacement of dual array neurostimulator pulse generator, not specified as rechargeable|
|86.97||Insertion or replacement of single array rechargeable neurostimulator pulse generator (new code effective 10/1/05)|
|86.98||Insertion or replacement of dual array rechargeable neurostimulator pulse generation (new code effective 10/1/05)|
|ICD-9 Diagnosis||See “Pain” in ICD-9 diagnosis index|
|HCPCS||L8680||Implantable neurostimulator electrode, each (new code effective 1/1/06)|
|L8685||Implantable neurostimulator pulse generator, single array, rechargeable, includes extension (new code effective 1/1/06)|
|L8686||Implantable neurostimulator pulse generator, single array, nonrechargeable, includes extension (new code effective 1/1/06)|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension (new code effective 1/1/06)|
|L8688||Implantable neurostimulator pulse generator, dual array, nonrechargeable, includes extension (new code effective 1/1/06)|
|ICD-10-CM (effective 10/1/14)||This list is a representative list of severe and chronic pain of the trunk and limbs diagnosis codes.|
|G56.40 -G56.42||Causalgia of upper limb code range|
|G57.70 -G57.72||Causalgia of lower limb code range|
|G89.21 -G89.8||Chronic pain, not elsewhere classified, code range|
|G89.4||Chronic pain syndrome|
|G90.50 -G90.59||Complex regional pain syndrome I (CRPS I), code range|
|M25.50 -M25.579||Pain in joint, code range|
|M54.10 -M54.18||Radiculopathy, code range|
|M54.30 -M54.32||Sciatica, code range|
|M54.40 -M54.42||Lumbago with sciatica, code range|
|M54.5||Low back pain|
|M54.6||Pain in thoracic spine|
|M54.81, M54.89||Other dorsalgia codes|
|M79.60 -M79.676||Pain in limb, hand, foot, fingers and toes code range|
|ICD-10-PCS (effective 10/1/14)||ICD-10-PCS codes are only used for inpatient services.|
|Surgical, central nervous system, insertion, spinal canal, neurostimulator lead, code by approach|
|00HV0MZ, 00HV3MZ, 00HV4MZ||Surgical, central nervous system, insertion, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, removal, spinal canal, neurostimulator lead, code by approach|
|00PV0MZ, 00PV3MZ, 00PV4MZ||Surgical, central nervous system, removal, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, revision, spinal canal, neurostimulator lead, code by approach|
|00WV0MZ, 00WV3MZ, 00WV4MZ||Surgical, central nervous system, revision, spinal cord, neurostimulator lead, code by approach|
|0JH60M6, 0JH60M7, 0JH60M8, 0JH60M9, 0JH63M6, 0JH63M7, 0JH63M8, 0JH63M9, 0JH70M6, 0JH70M7, 0JH70M8, 0JH70M9, 0JH73M6, 0JH73M7, 0JH73M8, 0JH73M9, 0JH80M6, 0JH80M7, 0JH80M8, 0JH80M9, 0JH83M6, 0JH83M7, 0JH83M8, 0JH83M9||Surgical, subcutaneous tissue and fascia, insertion, stimulator generator, code by body part, approach, number of arrays and whether rechargeable or not|
|0JPT0MZ, 0JPT3MZ||Surgical, subcutaneous tissue and fascia, removal, subcutaneous tissue and fascia, trunk, stimulator generator, code by approach (there aren’t ICD-10-PCS codes for removal of stimulator generator from other body parts)|
|Type of Service||Surgical|
|Place of Service||Inpatient/Outpatient|
Electrical Nerve Stimulation, Spinal
Spinal Cord Stimulation
Stimulation, Electrical, Spinal Cord
|03/31/96||Add to Surgery section||New policy|
|04/01/98||Replace policy||Policy cross-referenced to No. 7.01.63|
|07/10/98||Replace policy||Policy updated and revised|
|11/15/98||Coding update||1999 CPT coding release|
|04/29/03||Replace policy||Policy updated; new policy statement added, stating that spinal cord stimulation is investigational as a treatment of critical limb ischemia|
|11/9/04||Replace policy||Policy updated; no change to policy statement. Coding updated|
|08/17/05||Replace policy||Policy updated with literature search and coding updated; no change to policy statement|
|12/14/05||Replace policy – coding update only||Coding updated|
|12/12/06||Replace policy||Policy updated with literature search; no change to policy statement; reference numbers 7 – 9 added|
|03/13/08||Replace policy||Policy updated with literature search; references 10 – 13 added; no change to policy statements|
|01/08/09||Replace policy||Policy updated with literature search; references 14–25 added.
|
63685
|
PR INSJ/RPLCMT SPINAL NPG/RCVR POCKET CRTJ&CONNJ
|
HCPCS
|
Available online at: http://www.cms.hhs.gov. Last accessed November, 2011. |CPT||63650||Percutaneous implantation of neurostimulator electrode array; epidural|
|63655||Laminectomy for implantation of neurostimulator electrode plate/paddle; epidural|
|63661||Removal of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63662||Removal of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy (new code 1/1/10)|
|63663||Revision including replacement, when performed, of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63664||Revision including replacement, when performed, of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy, including fluoroscopy, when performed (new code 1/1/10)|
|63685||Insertion or replacement of spinal neurostimulator pulse generator or receiver, direct or inductive coupling|
|63688||Revision or removal of implanted spinal neurostimulator pulse generator or receiver|
|95970, 95971, 95972, 95973||Neurostimulator programming and analysis code range|
|ICD-9 Procedure||03.93||Insertion or replacement of spinal neurostimulator|
|03.94||Removal of spinal neurostimulator lead(s)|
|86.05||Incision with removal of foreign body or device from skin and subcutaneous tissue (used to report removal of a neurostimulator pulse generator)|
|86.94||Insertion or replacement of single array neurostimulator pulse generator, not specified as rechargeable|
|86.95||Insertion or replacement of dual array neurostimulator pulse generator, not specified as rechargeable|
|86.97||Insertion or replacement of single array rechargeable neurostimulator pulse generator (new code effective 10/1/05)|
|86.98||Insertion or replacement of dual array rechargeable neurostimulator pulse generation (new code effective 10/1/05)|
|ICD-9 Diagnosis||See “Pain” in ICD-9 diagnosis index|
|HCPCS||L8680||Implantable neurostimulator electrode, each (new code effective 1/1/06)|
|L8685||Implantable neurostimulator pulse generator, single array, rechargeable, includes extension (new code effective 1/1/06)|
|L8686||Implantable neurostimulator pulse generator, single array, nonrechargeable, includes extension (new code effective 1/1/06)|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension (new code effective 1/1/06)|
|L8688||Implantable neurostimulator pulse generator, dual array, nonrechargeable, includes extension (new code effective 1/1/06)|
|ICD-10-CM (effective 10/1/14)||This list is a representative list of severe and chronic pain of the trunk and limbs diagnosis codes.|
|G56.40 -G56.42||Causalgia of upper limb code range|
|G57.70 -G57.72||Causalgia of lower limb code range|
|G89.21 -G89.8||Chronic pain, not elsewhere classified, code range|
|G89.4||Chronic pain syndrome|
|G90.50 -G90.59||Complex regional pain syndrome I (CRPS I), code range|
|M25.50 -M25.579||Pain in joint, code range|
|M54.10 -M54.18||Radiculopathy, code range|
|M54.30 -M54.32||Sciatica, code range|
|M54.40 -M54.42||Lumbago with sciatica, code range|
|M54.5||Low back pain|
|M54.6||Pain in thoracic spine|
|M54.81, M54.89||Other dorsalgia codes|
|M79.60 -M79.676||Pain in limb, hand, foot, fingers and toes code range|
|ICD-10-PCS (effective 10/1/14)||ICD-10-PCS codes are only used for inpatient services.|
|Surgical, central nervous system, insertion, spinal canal, neurostimulator lead, code by approach|
|00HV0MZ, 00HV3MZ, 00HV4MZ||Surgical, central nervous system, insertion, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, removal, spinal canal, neurostimulator lead, code by approach|
|00PV0MZ, 00PV3MZ, 00PV4MZ||Surgical, central nervous system, removal, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, revision, spinal canal, neurostimulator lead, code by approach|
|00WV0MZ, 00WV3MZ, 00WV4MZ||Surgical, central nervous system, revision, spinal cord, neurostimulator lead, code by approach|
|0JH60M6, 0JH60M7, 0JH60M8, 0JH60M9, 0JH63M6, 0JH63M7, 0JH63M8, 0JH63M9, 0JH70M6, 0JH70M7, 0JH70M8, 0JH70M9, 0JH73M6, 0JH73M7, 0JH73M8, 0JH73M9, 0JH80M6, 0JH80M7, 0JH80M8, 0JH80M9, 0JH83M6, 0JH83M7, 0JH83M8, 0JH83M9||Surgical, subcutaneous tissue and fascia, insertion, stimulator generator, code by body part, approach, number of arrays and whether rechargeable or not|
|0JPT0MZ, 0JPT3MZ||Surgical, subcutaneous tissue and fascia, removal, subcutaneous tissue and fascia, trunk, stimulator generator, code by approach (there aren’t ICD-10-PCS codes for removal of stimulator generator from other body parts)|
|Type of Service||Surgical|
|Place of Service||Inpatient/Outpatient|
Electrical Nerve Stimulation, Spinal
Spinal Cord Stimulation
Stimulation, Electrical, Spinal Cord
|03/31/96||Add to Surgery section||New policy|
|04/01/98||Replace policy||Policy cross-referenced to No. 7.01.63|
|07/10/98||Replace policy||Policy updated and revised|
|11/15/98||Coding update||1999 CPT coding release|
|04/29/03||Replace policy||Policy updated; new policy statement added, stating that spinal cord stimulation is investigational as a treatment of critical limb ischemia|
|11/9/04||Replace policy||Policy updated; no change to policy statement. Coding updated|
|08/17/05||Replace policy||Policy updated with literature search and coding updated; no change to policy statement|
|12/14/05||Replace policy – coding update only||Coding updated|
|12/12/06||Replace policy||Policy updated with literature search; no change to policy statement; reference numbers 7 – 9 added|
|03/13/08||Replace policy||Policy updated with literature search; references 10 – 13 added; no change to policy statements|
|01/08/09||Replace policy||Policy updated with literature search; references 14–25 added.
|
63655
|
PR LAM IMPLTJ NSTIM ELTRDS PLATE/PADDLE EDRL
|
HCPCS
|
Available online at: http://www.cms.hhs.gov. Last accessed November, 2011. |CPT||63650||Percutaneous implantation of neurostimulator electrode array; epidural|
|63655||Laminectomy for implantation of neurostimulator electrode plate/paddle; epidural|
|63661||Removal of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63662||Removal of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy (new code 1/1/10)|
|63663||Revision including replacement, when performed, of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63664||Revision including replacement, when performed, of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy, including fluoroscopy, when performed (new code 1/1/10)|
|63685||Insertion or replacement of spinal neurostimulator pulse generator or receiver, direct or inductive coupling|
|63688||Revision or removal of implanted spinal neurostimulator pulse generator or receiver|
|95970, 95971, 95972, 95973||Neurostimulator programming and analysis code range|
|ICD-9 Procedure||03.93||Insertion or replacement of spinal neurostimulator|
|03.94||Removal of spinal neurostimulator lead(s)|
|86.05||Incision with removal of foreign body or device from skin and subcutaneous tissue (used to report removal of a neurostimulator pulse generator)|
|86.94||Insertion or replacement of single array neurostimulator pulse generator, not specified as rechargeable|
|86.95||Insertion or replacement of dual array neurostimulator pulse generator, not specified as rechargeable|
|86.97||Insertion or replacement of single array rechargeable neurostimulator pulse generator (new code effective 10/1/05)|
|86.98||Insertion or replacement of dual array rechargeable neurostimulator pulse generation (new code effective 10/1/05)|
|ICD-9 Diagnosis||See “Pain” in ICD-9 diagnosis index|
|HCPCS||L8680||Implantable neurostimulator electrode, each (new code effective 1/1/06)|
|L8685||Implantable neurostimulator pulse generator, single array, rechargeable, includes extension (new code effective 1/1/06)|
|L8686||Implantable neurostimulator pulse generator, single array, nonrechargeable, includes extension (new code effective 1/1/06)|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension (new code effective 1/1/06)|
|L8688||Implantable neurostimulator pulse generator, dual array, nonrechargeable, includes extension (new code effective 1/1/06)|
|ICD-10-CM (effective 10/1/14)||This list is a representative list of severe and chronic pain of the trunk and limbs diagnosis codes.|
|G56.40 -G56.42||Causalgia of upper limb code range|
|G57.70 -G57.72||Causalgia of lower limb code range|
|G89.21 -G89.8||Chronic pain, not elsewhere classified, code range|
|G89.4||Chronic pain syndrome|
|G90.50 -G90.59||Complex regional pain syndrome I (CRPS I), code range|
|M25.50 -M25.579||Pain in joint, code range|
|M54.10 -M54.18||Radiculopathy, code range|
|M54.30 -M54.32||Sciatica, code range|
|M54.40 -M54.42||Lumbago with sciatica, code range|
|M54.5||Low back pain|
|M54.6||Pain in thoracic spine|
|M54.81, M54.89||Other dorsalgia codes|
|M79.60 -M79.676||Pain in limb, hand, foot, fingers and toes code range|
|ICD-10-PCS (effective 10/1/14)||ICD-10-PCS codes are only used for inpatient services.|
|Surgical, central nervous system, insertion, spinal canal, neurostimulator lead, code by approach|
|00HV0MZ, 00HV3MZ, 00HV4MZ||Surgical, central nervous system, insertion, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, removal, spinal canal, neurostimulator lead, code by approach|
|00PV0MZ, 00PV3MZ, 00PV4MZ||Surgical, central nervous system, removal, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, revision, spinal canal, neurostimulator lead, code by approach|
|00WV0MZ, 00WV3MZ, 00WV4MZ||Surgical, central nervous system, revision, spinal cord, neurostimulator lead, code by approach|
|0JH60M6, 0JH60M7, 0JH60M8, 0JH60M9, 0JH63M6, 0JH63M7, 0JH63M8, 0JH63M9, 0JH70M6, 0JH70M7, 0JH70M8, 0JH70M9, 0JH73M6, 0JH73M7, 0JH73M8, 0JH73M9, 0JH80M6, 0JH80M7, 0JH80M8, 0JH80M9, 0JH83M6, 0JH83M7, 0JH83M8, 0JH83M9||Surgical, subcutaneous tissue and fascia, insertion, stimulator generator, code by body part, approach, number of arrays and whether rechargeable or not|
|0JPT0MZ, 0JPT3MZ||Surgical, subcutaneous tissue and fascia, removal, subcutaneous tissue and fascia, trunk, stimulator generator, code by approach (there aren’t ICD-10-PCS codes for removal of stimulator generator from other body parts)|
|Type of Service||Surgical|
|Place of Service||Inpatient/Outpatient|
Electrical Nerve Stimulation, Spinal
Spinal Cord Stimulation
Stimulation, Electrical, Spinal Cord
|03/31/96||Add to Surgery section||New policy|
|04/01/98||Replace policy||Policy cross-referenced to No. 7.01.63|
|07/10/98||Replace policy||Policy updated and revised|
|11/15/98||Coding update||1999 CPT coding release|
|04/29/03||Replace policy||Policy updated; new policy statement added, stating that spinal cord stimulation is investigational as a treatment of critical limb ischemia|
|11/9/04||Replace policy||Policy updated; no change to policy statement. Coding updated|
|08/17/05||Replace policy||Policy updated with literature search and coding updated; no change to policy statement|
|12/14/05||Replace policy – coding update only||Coding updated|
|12/12/06||Replace policy||Policy updated with literature search; no change to policy statement; reference numbers 7 – 9 added|
|03/13/08||Replace policy||Policy updated with literature search; references 10 – 13 added; no change to policy statements|
|01/08/09||Replace policy||Policy updated with literature search; references 14–25 added.
|
95971
|
PR ELEC ALYS IMPLT NPGT SMPL SP/PN NPGT PRGRMG
|
HCPCS
|
Available online at: http://www.cms.hhs.gov. Last accessed November, 2011. |CPT||63650||Percutaneous implantation of neurostimulator electrode array; epidural|
|63655||Laminectomy for implantation of neurostimulator electrode plate/paddle; epidural|
|63661||Removal of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63662||Removal of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy (new code 1/1/10)|
|63663||Revision including replacement, when performed, of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63664||Revision including replacement, when performed, of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy, including fluoroscopy, when performed (new code 1/1/10)|
|63685||Insertion or replacement of spinal neurostimulator pulse generator or receiver, direct or inductive coupling|
|63688||Revision or removal of implanted spinal neurostimulator pulse generator or receiver|
|95970, 95971, 95972, 95973||Neurostimulator programming and analysis code range|
|ICD-9 Procedure||03.93||Insertion or replacement of spinal neurostimulator|
|03.94||Removal of spinal neurostimulator lead(s)|
|86.05||Incision with removal of foreign body or device from skin and subcutaneous tissue (used to report removal of a neurostimulator pulse generator)|
|86.94||Insertion or replacement of single array neurostimulator pulse generator, not specified as rechargeable|
|86.95||Insertion or replacement of dual array neurostimulator pulse generator, not specified as rechargeable|
|86.97||Insertion or replacement of single array rechargeable neurostimulator pulse generator (new code effective 10/1/05)|
|86.98||Insertion or replacement of dual array rechargeable neurostimulator pulse generation (new code effective 10/1/05)|
|ICD-9 Diagnosis||See “Pain” in ICD-9 diagnosis index|
|HCPCS||L8680||Implantable neurostimulator electrode, each (new code effective 1/1/06)|
|L8685||Implantable neurostimulator pulse generator, single array, rechargeable, includes extension (new code effective 1/1/06)|
|L8686||Implantable neurostimulator pulse generator, single array, nonrechargeable, includes extension (new code effective 1/1/06)|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension (new code effective 1/1/06)|
|L8688||Implantable neurostimulator pulse generator, dual array, nonrechargeable, includes extension (new code effective 1/1/06)|
|ICD-10-CM (effective 10/1/14)||This list is a representative list of severe and chronic pain of the trunk and limbs diagnosis codes.|
|G56.40 -G56.42||Causalgia of upper limb code range|
|G57.70 -G57.72||Causalgia of lower limb code range|
|G89.21 -G89.8||Chronic pain, not elsewhere classified, code range|
|G89.4||Chronic pain syndrome|
|G90.50 -G90.59||Complex regional pain syndrome I (CRPS I), code range|
|M25.50 -M25.579||Pain in joint, code range|
|M54.10 -M54.18||Radiculopathy, code range|
|M54.30 -M54.32||Sciatica, code range|
|M54.40 -M54.42||Lumbago with sciatica, code range|
|M54.5||Low back pain|
|M54.6||Pain in thoracic spine|
|M54.81, M54.89||Other dorsalgia codes|
|M79.60 -M79.676||Pain in limb, hand, foot, fingers and toes code range|
|ICD-10-PCS (effective 10/1/14)||ICD-10-PCS codes are only used for inpatient services.|
|Surgical, central nervous system, insertion, spinal canal, neurostimulator lead, code by approach|
|00HV0MZ, 00HV3MZ, 00HV4MZ||Surgical, central nervous system, insertion, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, removal, spinal canal, neurostimulator lead, code by approach|
|00PV0MZ, 00PV3MZ, 00PV4MZ||Surgical, central nervous system, removal, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, revision, spinal canal, neurostimulator lead, code by approach|
|00WV0MZ, 00WV3MZ, 00WV4MZ||Surgical, central nervous system, revision, spinal cord, neurostimulator lead, code by approach|
|0JH60M6, 0JH60M7, 0JH60M8, 0JH60M9, 0JH63M6, 0JH63M7, 0JH63M8, 0JH63M9, 0JH70M6, 0JH70M7, 0JH70M8, 0JH70M9, 0JH73M6, 0JH73M7, 0JH73M8, 0JH73M9, 0JH80M6, 0JH80M7, 0JH80M8, 0JH80M9, 0JH83M6, 0JH83M7, 0JH83M8, 0JH83M9||Surgical, subcutaneous tissue and fascia, insertion, stimulator generator, code by body part, approach, number of arrays and whether rechargeable or not|
|0JPT0MZ, 0JPT3MZ||Surgical, subcutaneous tissue and fascia, removal, subcutaneous tissue and fascia, trunk, stimulator generator, code by approach (there aren’t ICD-10-PCS codes for removal of stimulator generator from other body parts)|
|Type of Service||Surgical|
|Place of Service||Inpatient/Outpatient|
Electrical Nerve Stimulation, Spinal
Spinal Cord Stimulation
Stimulation, Electrical, Spinal Cord
|03/31/96||Add to Surgery section||New policy|
|04/01/98||Replace policy||Policy cross-referenced to No. 7.01.63|
|07/10/98||Replace policy||Policy updated and revised|
|11/15/98||Coding update||1999 CPT coding release|
|04/29/03||Replace policy||Policy updated; new policy statement added, stating that spinal cord stimulation is investigational as a treatment of critical limb ischemia|
|11/9/04||Replace policy||Policy updated; no change to policy statement. Coding updated|
|08/17/05||Replace policy||Policy updated with literature search and coding updated; no change to policy statement|
|12/14/05||Replace policy – coding update only||Coding updated|
|12/12/06||Replace policy||Policy updated with literature search; no change to policy statement; reference numbers 7 – 9 added|
|03/13/08||Replace policy||Policy updated with literature search; references 10 – 13 added; no change to policy statements|
|01/08/09||Replace policy||Policy updated with literature search; references 14–25 added.
|
L8686
|
Implt nrostm pls gen sng non
|
HCPCS
|
Available online at: http://www.cms.hhs.gov. Last accessed November, 2011. |CPT||63650||Percutaneous implantation of neurostimulator electrode array; epidural|
|63655||Laminectomy for implantation of neurostimulator electrode plate/paddle; epidural|
|63661||Removal of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63662||Removal of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy (new code 1/1/10)|
|63663||Revision including replacement, when performed, of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63664||Revision including replacement, when performed, of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy, including fluoroscopy, when performed (new code 1/1/10)|
|63685||Insertion or replacement of spinal neurostimulator pulse generator or receiver, direct or inductive coupling|
|63688||Revision or removal of implanted spinal neurostimulator pulse generator or receiver|
|95970, 95971, 95972, 95973||Neurostimulator programming and analysis code range|
|ICD-9 Procedure||03.93||Insertion or replacement of spinal neurostimulator|
|03.94||Removal of spinal neurostimulator lead(s)|
|86.05||Incision with removal of foreign body or device from skin and subcutaneous tissue (used to report removal of a neurostimulator pulse generator)|
|86.94||Insertion or replacement of single array neurostimulator pulse generator, not specified as rechargeable|
|86.95||Insertion or replacement of dual array neurostimulator pulse generator, not specified as rechargeable|
|86.97||Insertion or replacement of single array rechargeable neurostimulator pulse generator (new code effective 10/1/05)|
|86.98||Insertion or replacement of dual array rechargeable neurostimulator pulse generation (new code effective 10/1/05)|
|ICD-9 Diagnosis||See “Pain” in ICD-9 diagnosis index|
|HCPCS||L8680||Implantable neurostimulator electrode, each (new code effective 1/1/06)|
|L8685||Implantable neurostimulator pulse generator, single array, rechargeable, includes extension (new code effective 1/1/06)|
|L8686||Implantable neurostimulator pulse generator, single array, nonrechargeable, includes extension (new code effective 1/1/06)|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension (new code effective 1/1/06)|
|L8688||Implantable neurostimulator pulse generator, dual array, nonrechargeable, includes extension (new code effective 1/1/06)|
|ICD-10-CM (effective 10/1/14)||This list is a representative list of severe and chronic pain of the trunk and limbs diagnosis codes.|
|G56.40 -G56.42||Causalgia of upper limb code range|
|G57.70 -G57.72||Causalgia of lower limb code range|
|G89.21 -G89.8||Chronic pain, not elsewhere classified, code range|
|G89.4||Chronic pain syndrome|
|G90.50 -G90.59||Complex regional pain syndrome I (CRPS I), code range|
|M25.50 -M25.579||Pain in joint, code range|
|M54.10 -M54.18||Radiculopathy, code range|
|M54.30 -M54.32||Sciatica, code range|
|M54.40 -M54.42||Lumbago with sciatica, code range|
|M54.5||Low back pain|
|M54.6||Pain in thoracic spine|
|M54.81, M54.89||Other dorsalgia codes|
|M79.60 -M79.676||Pain in limb, hand, foot, fingers and toes code range|
|ICD-10-PCS (effective 10/1/14)||ICD-10-PCS codes are only used for inpatient services.|
|Surgical, central nervous system, insertion, spinal canal, neurostimulator lead, code by approach|
|00HV0MZ, 00HV3MZ, 00HV4MZ||Surgical, central nervous system, insertion, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, removal, spinal canal, neurostimulator lead, code by approach|
|00PV0MZ, 00PV3MZ, 00PV4MZ||Surgical, central nervous system, removal, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, revision, spinal canal, neurostimulator lead, code by approach|
|00WV0MZ, 00WV3MZ, 00WV4MZ||Surgical, central nervous system, revision, spinal cord, neurostimulator lead, code by approach|
|0JH60M6, 0JH60M7, 0JH60M8, 0JH60M9, 0JH63M6, 0JH63M7, 0JH63M8, 0JH63M9, 0JH70M6, 0JH70M7, 0JH70M8, 0JH70M9, 0JH73M6, 0JH73M7, 0JH73M8, 0JH73M9, 0JH80M6, 0JH80M7, 0JH80M8, 0JH80M9, 0JH83M6, 0JH83M7, 0JH83M8, 0JH83M9||Surgical, subcutaneous tissue and fascia, insertion, stimulator generator, code by body part, approach, number of arrays and whether rechargeable or not|
|0JPT0MZ, 0JPT3MZ||Surgical, subcutaneous tissue and fascia, removal, subcutaneous tissue and fascia, trunk, stimulator generator, code by approach (there aren’t ICD-10-PCS codes for removal of stimulator generator from other body parts)|
|Type of Service||Surgical|
|Place of Service||Inpatient/Outpatient|
Electrical Nerve Stimulation, Spinal
Spinal Cord Stimulation
Stimulation, Electrical, Spinal Cord
|03/31/96||Add to Surgery section||New policy|
|04/01/98||Replace policy||Policy cross-referenced to No. 7.01.63|
|07/10/98||Replace policy||Policy updated and revised|
|11/15/98||Coding update||1999 CPT coding release|
|04/29/03||Replace policy||Policy updated; new policy statement added, stating that spinal cord stimulation is investigational as a treatment of critical limb ischemia|
|11/9/04||Replace policy||Policy updated; no change to policy statement. Coding updated|
|08/17/05||Replace policy||Policy updated with literature search and coding updated; no change to policy statement|
|12/14/05||Replace policy – coding update only||Coding updated|
|12/12/06||Replace policy||Policy updated with literature search; no change to policy statement; reference numbers 7 – 9 added|
|03/13/08||Replace policy||Policy updated with literature search; references 10 – 13 added; no change to policy statements|
|01/08/09||Replace policy||Policy updated with literature search; references 14–25 added.
|
63664
|
Revise spine eltrd plate
|
HCPCS
|
Available online at: http://www.cms.hhs.gov. Last accessed November, 2011. |CPT||63650||Percutaneous implantation of neurostimulator electrode array; epidural|
|63655||Laminectomy for implantation of neurostimulator electrode plate/paddle; epidural|
|63661||Removal of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63662||Removal of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy (new code 1/1/10)|
|63663||Revision including replacement, when performed, of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63664||Revision including replacement, when performed, of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy, including fluoroscopy, when performed (new code 1/1/10)|
|63685||Insertion or replacement of spinal neurostimulator pulse generator or receiver, direct or inductive coupling|
|63688||Revision or removal of implanted spinal neurostimulator pulse generator or receiver|
|95970, 95971, 95972, 95973||Neurostimulator programming and analysis code range|
|ICD-9 Procedure||03.93||Insertion or replacement of spinal neurostimulator|
|03.94||Removal of spinal neurostimulator lead(s)|
|86.05||Incision with removal of foreign body or device from skin and subcutaneous tissue (used to report removal of a neurostimulator pulse generator)|
|86.94||Insertion or replacement of single array neurostimulator pulse generator, not specified as rechargeable|
|86.95||Insertion or replacement of dual array neurostimulator pulse generator, not specified as rechargeable|
|86.97||Insertion or replacement of single array rechargeable neurostimulator pulse generator (new code effective 10/1/05)|
|86.98||Insertion or replacement of dual array rechargeable neurostimulator pulse generation (new code effective 10/1/05)|
|ICD-9 Diagnosis||See “Pain” in ICD-9 diagnosis index|
|HCPCS||L8680||Implantable neurostimulator electrode, each (new code effective 1/1/06)|
|L8685||Implantable neurostimulator pulse generator, single array, rechargeable, includes extension (new code effective 1/1/06)|
|L8686||Implantable neurostimulator pulse generator, single array, nonrechargeable, includes extension (new code effective 1/1/06)|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension (new code effective 1/1/06)|
|L8688||Implantable neurostimulator pulse generator, dual array, nonrechargeable, includes extension (new code effective 1/1/06)|
|ICD-10-CM (effective 10/1/14)||This list is a representative list of severe and chronic pain of the trunk and limbs diagnosis codes.|
|G56.40 -G56.42||Causalgia of upper limb code range|
|G57.70 -G57.72||Causalgia of lower limb code range|
|G89.21 -G89.8||Chronic pain, not elsewhere classified, code range|
|G89.4||Chronic pain syndrome|
|G90.50 -G90.59||Complex regional pain syndrome I (CRPS I), code range|
|M25.50 -M25.579||Pain in joint, code range|
|M54.10 -M54.18||Radiculopathy, code range|
|M54.30 -M54.32||Sciatica, code range|
|M54.40 -M54.42||Lumbago with sciatica, code range|
|M54.5||Low back pain|
|M54.6||Pain in thoracic spine|
|M54.81, M54.89||Other dorsalgia codes|
|M79.60 -M79.676||Pain in limb, hand, foot, fingers and toes code range|
|ICD-10-PCS (effective 10/1/14)||ICD-10-PCS codes are only used for inpatient services.|
|Surgical, central nervous system, insertion, spinal canal, neurostimulator lead, code by approach|
|00HV0MZ, 00HV3MZ, 00HV4MZ||Surgical, central nervous system, insertion, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, removal, spinal canal, neurostimulator lead, code by approach|
|00PV0MZ, 00PV3MZ, 00PV4MZ||Surgical, central nervous system, removal, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, revision, spinal canal, neurostimulator lead, code by approach|
|00WV0MZ, 00WV3MZ, 00WV4MZ||Surgical, central nervous system, revision, spinal cord, neurostimulator lead, code by approach|
|0JH60M6, 0JH60M7, 0JH60M8, 0JH60M9, 0JH63M6, 0JH63M7, 0JH63M8, 0JH63M9, 0JH70M6, 0JH70M7, 0JH70M8, 0JH70M9, 0JH73M6, 0JH73M7, 0JH73M8, 0JH73M9, 0JH80M6, 0JH80M7, 0JH80M8, 0JH80M9, 0JH83M6, 0JH83M7, 0JH83M8, 0JH83M9||Surgical, subcutaneous tissue and fascia, insertion, stimulator generator, code by body part, approach, number of arrays and whether rechargeable or not|
|0JPT0MZ, 0JPT3MZ||Surgical, subcutaneous tissue and fascia, removal, subcutaneous tissue and fascia, trunk, stimulator generator, code by approach (there aren’t ICD-10-PCS codes for removal of stimulator generator from other body parts)|
|Type of Service||Surgical|
|Place of Service||Inpatient/Outpatient|
Electrical Nerve Stimulation, Spinal
Spinal Cord Stimulation
Stimulation, Electrical, Spinal Cord
|03/31/96||Add to Surgery section||New policy|
|04/01/98||Replace policy||Policy cross-referenced to No. 7.01.63|
|07/10/98||Replace policy||Policy updated and revised|
|11/15/98||Coding update||1999 CPT coding release|
|04/29/03||Replace policy||Policy updated; new policy statement added, stating that spinal cord stimulation is investigational as a treatment of critical limb ischemia|
|11/9/04||Replace policy||Policy updated; no change to policy statement. Coding updated|
|08/17/05||Replace policy||Policy updated with literature search and coding updated; no change to policy statement|
|12/14/05||Replace policy – coding update only||Coding updated|
|12/12/06||Replace policy||Policy updated with literature search; no change to policy statement; reference numbers 7 – 9 added|
|03/13/08||Replace policy||Policy updated with literature search; references 10 – 13 added; no change to policy statements|
|01/08/09||Replace policy||Policy updated with literature search; references 14–25 added.
|
L8685
|
Implt nrostm pls gen sng rec
|
HCPCS
|
Available online at: http://www.cms.hhs.gov. Last accessed November, 2011. |CPT||63650||Percutaneous implantation of neurostimulator electrode array; epidural|
|63655||Laminectomy for implantation of neurostimulator electrode plate/paddle; epidural|
|63661||Removal of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63662||Removal of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy (new code 1/1/10)|
|63663||Revision including replacement, when performed, of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63664||Revision including replacement, when performed, of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy, including fluoroscopy, when performed (new code 1/1/10)|
|63685||Insertion or replacement of spinal neurostimulator pulse generator or receiver, direct or inductive coupling|
|63688||Revision or removal of implanted spinal neurostimulator pulse generator or receiver|
|95970, 95971, 95972, 95973||Neurostimulator programming and analysis code range|
|ICD-9 Procedure||03.93||Insertion or replacement of spinal neurostimulator|
|03.94||Removal of spinal neurostimulator lead(s)|
|86.05||Incision with removal of foreign body or device from skin and subcutaneous tissue (used to report removal of a neurostimulator pulse generator)|
|86.94||Insertion or replacement of single array neurostimulator pulse generator, not specified as rechargeable|
|86.95||Insertion or replacement of dual array neurostimulator pulse generator, not specified as rechargeable|
|86.97||Insertion or replacement of single array rechargeable neurostimulator pulse generator (new code effective 10/1/05)|
|86.98||Insertion or replacement of dual array rechargeable neurostimulator pulse generation (new code effective 10/1/05)|
|ICD-9 Diagnosis||See “Pain” in ICD-9 diagnosis index|
|HCPCS||L8680||Implantable neurostimulator electrode, each (new code effective 1/1/06)|
|L8685||Implantable neurostimulator pulse generator, single array, rechargeable, includes extension (new code effective 1/1/06)|
|L8686||Implantable neurostimulator pulse generator, single array, nonrechargeable, includes extension (new code effective 1/1/06)|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension (new code effective 1/1/06)|
|L8688||Implantable neurostimulator pulse generator, dual array, nonrechargeable, includes extension (new code effective 1/1/06)|
|ICD-10-CM (effective 10/1/14)||This list is a representative list of severe and chronic pain of the trunk and limbs diagnosis codes.|
|G56.40 -G56.42||Causalgia of upper limb code range|
|G57.70 -G57.72||Causalgia of lower limb code range|
|G89.21 -G89.8||Chronic pain, not elsewhere classified, code range|
|G89.4||Chronic pain syndrome|
|G90.50 -G90.59||Complex regional pain syndrome I (CRPS I), code range|
|M25.50 -M25.579||Pain in joint, code range|
|M54.10 -M54.18||Radiculopathy, code range|
|M54.30 -M54.32||Sciatica, code range|
|M54.40 -M54.42||Lumbago with sciatica, code range|
|M54.5||Low back pain|
|M54.6||Pain in thoracic spine|
|M54.81, M54.89||Other dorsalgia codes|
|M79.60 -M79.676||Pain in limb, hand, foot, fingers and toes code range|
|ICD-10-PCS (effective 10/1/14)||ICD-10-PCS codes are only used for inpatient services.|
|Surgical, central nervous system, insertion, spinal canal, neurostimulator lead, code by approach|
|00HV0MZ, 00HV3MZ, 00HV4MZ||Surgical, central nervous system, insertion, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, removal, spinal canal, neurostimulator lead, code by approach|
|00PV0MZ, 00PV3MZ, 00PV4MZ||Surgical, central nervous system, removal, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, revision, spinal canal, neurostimulator lead, code by approach|
|00WV0MZ, 00WV3MZ, 00WV4MZ||Surgical, central nervous system, revision, spinal cord, neurostimulator lead, code by approach|
|0JH60M6, 0JH60M7, 0JH60M8, 0JH60M9, 0JH63M6, 0JH63M7, 0JH63M8, 0JH63M9, 0JH70M6, 0JH70M7, 0JH70M8, 0JH70M9, 0JH73M6, 0JH73M7, 0JH73M8, 0JH73M9, 0JH80M6, 0JH80M7, 0JH80M8, 0JH80M9, 0JH83M6, 0JH83M7, 0JH83M8, 0JH83M9||Surgical, subcutaneous tissue and fascia, insertion, stimulator generator, code by body part, approach, number of arrays and whether rechargeable or not|
|0JPT0MZ, 0JPT3MZ||Surgical, subcutaneous tissue and fascia, removal, subcutaneous tissue and fascia, trunk, stimulator generator, code by approach (there aren’t ICD-10-PCS codes for removal of stimulator generator from other body parts)|
|Type of Service||Surgical|
|Place of Service||Inpatient/Outpatient|
Electrical Nerve Stimulation, Spinal
Spinal Cord Stimulation
Stimulation, Electrical, Spinal Cord
|03/31/96||Add to Surgery section||New policy|
|04/01/98||Replace policy||Policy cross-referenced to No. 7.01.63|
|07/10/98||Replace policy||Policy updated and revised|
|11/15/98||Coding update||1999 CPT coding release|
|04/29/03||Replace policy||Policy updated; new policy statement added, stating that spinal cord stimulation is investigational as a treatment of critical limb ischemia|
|11/9/04||Replace policy||Policy updated; no change to policy statement. Coding updated|
|08/17/05||Replace policy||Policy updated with literature search and coding updated; no change to policy statement|
|12/14/05||Replace policy – coding update only||Coding updated|
|12/12/06||Replace policy||Policy updated with literature search; no change to policy statement; reference numbers 7 – 9 added|
|03/13/08||Replace policy||Policy updated with literature search; references 10 – 13 added; no change to policy statements|
|01/08/09||Replace policy||Policy updated with literature search; references 14–25 added.
|
95973
|
Analyze neurostim complex
|
HCPCS
|
Available online at: http://www.cms.hhs.gov. Last accessed November, 2011. |CPT||63650||Percutaneous implantation of neurostimulator electrode array; epidural|
|63655||Laminectomy for implantation of neurostimulator electrode plate/paddle; epidural|
|63661||Removal of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63662||Removal of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy (new code 1/1/10)|
|63663||Revision including replacement, when performed, of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63664||Revision including replacement, when performed, of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy, including fluoroscopy, when performed (new code 1/1/10)|
|63685||Insertion or replacement of spinal neurostimulator pulse generator or receiver, direct or inductive coupling|
|63688||Revision or removal of implanted spinal neurostimulator pulse generator or receiver|
|95970, 95971, 95972, 95973||Neurostimulator programming and analysis code range|
|ICD-9 Procedure||03.93||Insertion or replacement of spinal neurostimulator|
|03.94||Removal of spinal neurostimulator lead(s)|
|86.05||Incision with removal of foreign body or device from skin and subcutaneous tissue (used to report removal of a neurostimulator pulse generator)|
|86.94||Insertion or replacement of single array neurostimulator pulse generator, not specified as rechargeable|
|86.95||Insertion or replacement of dual array neurostimulator pulse generator, not specified as rechargeable|
|86.97||Insertion or replacement of single array rechargeable neurostimulator pulse generator (new code effective 10/1/05)|
|86.98||Insertion or replacement of dual array rechargeable neurostimulator pulse generation (new code effective 10/1/05)|
|ICD-9 Diagnosis||See “Pain” in ICD-9 diagnosis index|
|HCPCS||L8680||Implantable neurostimulator electrode, each (new code effective 1/1/06)|
|L8685||Implantable neurostimulator pulse generator, single array, rechargeable, includes extension (new code effective 1/1/06)|
|L8686||Implantable neurostimulator pulse generator, single array, nonrechargeable, includes extension (new code effective 1/1/06)|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension (new code effective 1/1/06)|
|L8688||Implantable neurostimulator pulse generator, dual array, nonrechargeable, includes extension (new code effective 1/1/06)|
|ICD-10-CM (effective 10/1/14)||This list is a representative list of severe and chronic pain of the trunk and limbs diagnosis codes.|
|G56.40 -G56.42||Causalgia of upper limb code range|
|G57.70 -G57.72||Causalgia of lower limb code range|
|G89.21 -G89.8||Chronic pain, not elsewhere classified, code range|
|G89.4||Chronic pain syndrome|
|G90.50 -G90.59||Complex regional pain syndrome I (CRPS I), code range|
|M25.50 -M25.579||Pain in joint, code range|
|M54.10 -M54.18||Radiculopathy, code range|
|M54.30 -M54.32||Sciatica, code range|
|M54.40 -M54.42||Lumbago with sciatica, code range|
|M54.5||Low back pain|
|M54.6||Pain in thoracic spine|
|M54.81, M54.89||Other dorsalgia codes|
|M79.60 -M79.676||Pain in limb, hand, foot, fingers and toes code range|
|ICD-10-PCS (effective 10/1/14)||ICD-10-PCS codes are only used for inpatient services.|
|Surgical, central nervous system, insertion, spinal canal, neurostimulator lead, code by approach|
|00HV0MZ, 00HV3MZ, 00HV4MZ||Surgical, central nervous system, insertion, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, removal, spinal canal, neurostimulator lead, code by approach|
|00PV0MZ, 00PV3MZ, 00PV4MZ||Surgical, central nervous system, removal, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, revision, spinal canal, neurostimulator lead, code by approach|
|00WV0MZ, 00WV3MZ, 00WV4MZ||Surgical, central nervous system, revision, spinal cord, neurostimulator lead, code by approach|
|0JH60M6, 0JH60M7, 0JH60M8, 0JH60M9, 0JH63M6, 0JH63M7, 0JH63M8, 0JH63M9, 0JH70M6, 0JH70M7, 0JH70M8, 0JH70M9, 0JH73M6, 0JH73M7, 0JH73M8, 0JH73M9, 0JH80M6, 0JH80M7, 0JH80M8, 0JH80M9, 0JH83M6, 0JH83M7, 0JH83M8, 0JH83M9||Surgical, subcutaneous tissue and fascia, insertion, stimulator generator, code by body part, approach, number of arrays and whether rechargeable or not|
|0JPT0MZ, 0JPT3MZ||Surgical, subcutaneous tissue and fascia, removal, subcutaneous tissue and fascia, trunk, stimulator generator, code by approach (there aren’t ICD-10-PCS codes for removal of stimulator generator from other body parts)|
|Type of Service||Surgical|
|Place of Service||Inpatient/Outpatient|
Electrical Nerve Stimulation, Spinal
Spinal Cord Stimulation
Stimulation, Electrical, Spinal Cord
|03/31/96||Add to Surgery section||New policy|
|04/01/98||Replace policy||Policy cross-referenced to No. 7.01.63|
|07/10/98||Replace policy||Policy updated and revised|
|11/15/98||Coding update||1999 CPT coding release|
|04/29/03||Replace policy||Policy updated; new policy statement added, stating that spinal cord stimulation is investigational as a treatment of critical limb ischemia|
|11/9/04||Replace policy||Policy updated; no change to policy statement. Coding updated|
|08/17/05||Replace policy||Policy updated with literature search and coding updated; no change to policy statement|
|12/14/05||Replace policy – coding update only||Coding updated|
|12/12/06||Replace policy||Policy updated with literature search; no change to policy statement; reference numbers 7 – 9 added|
|03/13/08||Replace policy||Policy updated with literature search; references 10 – 13 added; no change to policy statements|
|01/08/09||Replace policy||Policy updated with literature search; references 14–25 added.
|
63650
|
PR PRQ IMPLTJ NSTIM ELECTRODE ARRAY EPIDURAL
|
HCPCS
|
Last accessed November, 2011. |CPT||63650||Percutaneous implantation of neurostimulator electrode array; epidural|
|63655||Laminectomy for implantation of neurostimulator electrode plate/paddle; epidural|
|63661||Removal of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63662||Removal of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy (new code 1/1/10)|
|63663||Revision including replacement, when performed, of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63664||Revision including replacement, when performed, of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy, including fluoroscopy, when performed (new code 1/1/10)|
|63685||Insertion or replacement of spinal neurostimulator pulse generator or receiver, direct or inductive coupling|
|63688||Revision or removal of implanted spinal neurostimulator pulse generator or receiver|
|95970, 95971, 95972, 95973||Neurostimulator programming and analysis code range|
|ICD-9 Procedure||03.93||Insertion or replacement of spinal neurostimulator|
|03.94||Removal of spinal neurostimulator lead(s)|
|86.05||Incision with removal of foreign body or device from skin and subcutaneous tissue (used to report removal of a neurostimulator pulse generator)|
|86.94||Insertion or replacement of single array neurostimulator pulse generator, not specified as rechargeable|
|86.95||Insertion or replacement of dual array neurostimulator pulse generator, not specified as rechargeable|
|86.97||Insertion or replacement of single array rechargeable neurostimulator pulse generator (new code effective 10/1/05)|
|86.98||Insertion or replacement of dual array rechargeable neurostimulator pulse generation (new code effective 10/1/05)|
|ICD-9 Diagnosis||See “Pain” in ICD-9 diagnosis index|
|HCPCS||L8680||Implantable neurostimulator electrode, each (new code effective 1/1/06)|
|L8685||Implantable neurostimulator pulse generator, single array, rechargeable, includes extension (new code effective 1/1/06)|
|L8686||Implantable neurostimulator pulse generator, single array, nonrechargeable, includes extension (new code effective 1/1/06)|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension (new code effective 1/1/06)|
|L8688||Implantable neurostimulator pulse generator, dual array, nonrechargeable, includes extension (new code effective 1/1/06)|
|ICD-10-CM (effective 10/1/14)||This list is a representative list of severe and chronic pain of the trunk and limbs diagnosis codes.|
|G56.40 -G56.42||Causalgia of upper limb code range|
|G57.70 -G57.72||Causalgia of lower limb code range|
|G89.21 -G89.8||Chronic pain, not elsewhere classified, code range|
|G89.4||Chronic pain syndrome|
|G90.50 -G90.59||Complex regional pain syndrome I (CRPS I), code range|
|M25.50 -M25.579||Pain in joint, code range|
|M54.10 -M54.18||Radiculopathy, code range|
|M54.30 -M54.32||Sciatica, code range|
|M54.40 -M54.42||Lumbago with sciatica, code range|
|M54.5||Low back pain|
|M54.6||Pain in thoracic spine|
|M54.81, M54.89||Other dorsalgia codes|
|M79.60 -M79.676||Pain in limb, hand, foot, fingers and toes code range|
|ICD-10-PCS (effective 10/1/14)||ICD-10-PCS codes are only used for inpatient services.|
|Surgical, central nervous system, insertion, spinal canal, neurostimulator lead, code by approach|
|00HV0MZ, 00HV3MZ, 00HV4MZ||Surgical, central nervous system, insertion, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, removal, spinal canal, neurostimulator lead, code by approach|
|00PV0MZ, 00PV3MZ, 00PV4MZ||Surgical, central nervous system, removal, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, revision, spinal canal, neurostimulator lead, code by approach|
|00WV0MZ, 00WV3MZ, 00WV4MZ||Surgical, central nervous system, revision, spinal cord, neurostimulator lead, code by approach|
|0JH60M6, 0JH60M7, 0JH60M8, 0JH60M9, 0JH63M6, 0JH63M7, 0JH63M8, 0JH63M9, 0JH70M6, 0JH70M7, 0JH70M8, 0JH70M9, 0JH73M6, 0JH73M7, 0JH73M8, 0JH73M9, 0JH80M6, 0JH80M7, 0JH80M8, 0JH80M9, 0JH83M6, 0JH83M7, 0JH83M8, 0JH83M9||Surgical, subcutaneous tissue and fascia, insertion, stimulator generator, code by body part, approach, number of arrays and whether rechargeable or not|
|0JPT0MZ, 0JPT3MZ||Surgical, subcutaneous tissue and fascia, removal, subcutaneous tissue and fascia, trunk, stimulator generator, code by approach (there aren’t ICD-10-PCS codes for removal of stimulator generator from other body parts)|
|Type of Service||Surgical|
|Place of Service||Inpatient/Outpatient|
Electrical Nerve Stimulation, Spinal
Spinal Cord Stimulation
Stimulation, Electrical, Spinal Cord
|03/31/96||Add to Surgery section||New policy|
|04/01/98||Replace policy||Policy cross-referenced to No. 7.01.63|
|07/10/98||Replace policy||Policy updated and revised|
|11/15/98||Coding update||1999 CPT coding release|
|04/29/03||Replace policy||Policy updated; new policy statement added, stating that spinal cord stimulation is investigational as a treatment of critical limb ischemia|
|11/9/04||Replace policy||Policy updated; no change to policy statement. Coding updated|
|08/17/05||Replace policy||Policy updated with literature search and coding updated; no change to policy statement|
|12/14/05||Replace policy – coding update only||Coding updated|
|12/12/06||Replace policy||Policy updated with literature search; no change to policy statement; reference numbers 7 – 9 added|
|03/13/08||Replace policy||Policy updated with literature search; references 10 – 13 added; no change to policy statements|
|01/08/09||Replace policy||Policy updated with literature search; references 14–25 added. Use in refractory angina added as investigational indication.|
|01/14/10||Replace policy||Policy updated with literature search; reference numbers 26-29 added; no change to policy statements|
|01/13/11||Replace policy||Policy updated with literature search.
|
63661
|
Remove spine eltrd perq aray
|
HCPCS
|
Last accessed November, 2011. |CPT||63650||Percutaneous implantation of neurostimulator electrode array; epidural|
|63655||Laminectomy for implantation of neurostimulator electrode plate/paddle; epidural|
|63661||Removal of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63662||Removal of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy (new code 1/1/10)|
|63663||Revision including replacement, when performed, of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63664||Revision including replacement, when performed, of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy, including fluoroscopy, when performed (new code 1/1/10)|
|63685||Insertion or replacement of spinal neurostimulator pulse generator or receiver, direct or inductive coupling|
|63688||Revision or removal of implanted spinal neurostimulator pulse generator or receiver|
|95970, 95971, 95972, 95973||Neurostimulator programming and analysis code range|
|ICD-9 Procedure||03.93||Insertion or replacement of spinal neurostimulator|
|03.94||Removal of spinal neurostimulator lead(s)|
|86.05||Incision with removal of foreign body or device from skin and subcutaneous tissue (used to report removal of a neurostimulator pulse generator)|
|86.94||Insertion or replacement of single array neurostimulator pulse generator, not specified as rechargeable|
|86.95||Insertion or replacement of dual array neurostimulator pulse generator, not specified as rechargeable|
|86.97||Insertion or replacement of single array rechargeable neurostimulator pulse generator (new code effective 10/1/05)|
|86.98||Insertion or replacement of dual array rechargeable neurostimulator pulse generation (new code effective 10/1/05)|
|ICD-9 Diagnosis||See “Pain” in ICD-9 diagnosis index|
|HCPCS||L8680||Implantable neurostimulator electrode, each (new code effective 1/1/06)|
|L8685||Implantable neurostimulator pulse generator, single array, rechargeable, includes extension (new code effective 1/1/06)|
|L8686||Implantable neurostimulator pulse generator, single array, nonrechargeable, includes extension (new code effective 1/1/06)|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension (new code effective 1/1/06)|
|L8688||Implantable neurostimulator pulse generator, dual array, nonrechargeable, includes extension (new code effective 1/1/06)|
|ICD-10-CM (effective 10/1/14)||This list is a representative list of severe and chronic pain of the trunk and limbs diagnosis codes.|
|G56.40 -G56.42||Causalgia of upper limb code range|
|G57.70 -G57.72||Causalgia of lower limb code range|
|G89.21 -G89.8||Chronic pain, not elsewhere classified, code range|
|G89.4||Chronic pain syndrome|
|G90.50 -G90.59||Complex regional pain syndrome I (CRPS I), code range|
|M25.50 -M25.579||Pain in joint, code range|
|M54.10 -M54.18||Radiculopathy, code range|
|M54.30 -M54.32||Sciatica, code range|
|M54.40 -M54.42||Lumbago with sciatica, code range|
|M54.5||Low back pain|
|M54.6||Pain in thoracic spine|
|M54.81, M54.89||Other dorsalgia codes|
|M79.60 -M79.676||Pain in limb, hand, foot, fingers and toes code range|
|ICD-10-PCS (effective 10/1/14)||ICD-10-PCS codes are only used for inpatient services.|
|Surgical, central nervous system, insertion, spinal canal, neurostimulator lead, code by approach|
|00HV0MZ, 00HV3MZ, 00HV4MZ||Surgical, central nervous system, insertion, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, removal, spinal canal, neurostimulator lead, code by approach|
|00PV0MZ, 00PV3MZ, 00PV4MZ||Surgical, central nervous system, removal, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, revision, spinal canal, neurostimulator lead, code by approach|
|00WV0MZ, 00WV3MZ, 00WV4MZ||Surgical, central nervous system, revision, spinal cord, neurostimulator lead, code by approach|
|0JH60M6, 0JH60M7, 0JH60M8, 0JH60M9, 0JH63M6, 0JH63M7, 0JH63M8, 0JH63M9, 0JH70M6, 0JH70M7, 0JH70M8, 0JH70M9, 0JH73M6, 0JH73M7, 0JH73M8, 0JH73M9, 0JH80M6, 0JH80M7, 0JH80M8, 0JH80M9, 0JH83M6, 0JH83M7, 0JH83M8, 0JH83M9||Surgical, subcutaneous tissue and fascia, insertion, stimulator generator, code by body part, approach, number of arrays and whether rechargeable or not|
|0JPT0MZ, 0JPT3MZ||Surgical, subcutaneous tissue and fascia, removal, subcutaneous tissue and fascia, trunk, stimulator generator, code by approach (there aren’t ICD-10-PCS codes for removal of stimulator generator from other body parts)|
|Type of Service||Surgical|
|Place of Service||Inpatient/Outpatient|
Electrical Nerve Stimulation, Spinal
Spinal Cord Stimulation
Stimulation, Electrical, Spinal Cord
|03/31/96||Add to Surgery section||New policy|
|04/01/98||Replace policy||Policy cross-referenced to No. 7.01.63|
|07/10/98||Replace policy||Policy updated and revised|
|11/15/98||Coding update||1999 CPT coding release|
|04/29/03||Replace policy||Policy updated; new policy statement added, stating that spinal cord stimulation is investigational as a treatment of critical limb ischemia|
|11/9/04||Replace policy||Policy updated; no change to policy statement. Coding updated|
|08/17/05||Replace policy||Policy updated with literature search and coding updated; no change to policy statement|
|12/14/05||Replace policy – coding update only||Coding updated|
|12/12/06||Replace policy||Policy updated with literature search; no change to policy statement; reference numbers 7 – 9 added|
|03/13/08||Replace policy||Policy updated with literature search; references 10 – 13 added; no change to policy statements|
|01/08/09||Replace policy||Policy updated with literature search; references 14–25 added. Use in refractory angina added as investigational indication.|
|01/14/10||Replace policy||Policy updated with literature search; reference numbers 26-29 added; no change to policy statements|
|01/13/11||Replace policy||Policy updated with literature search.
|
95972
|
PR ELEC ALYS IMPLT NPGT CPLX SP/PN PRGRMG
|
HCPCS
|
Last accessed November, 2011. |CPT||63650||Percutaneous implantation of neurostimulator electrode array; epidural|
|63655||Laminectomy for implantation of neurostimulator electrode plate/paddle; epidural|
|63661||Removal of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63662||Removal of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy (new code 1/1/10)|
|63663||Revision including replacement, when performed, of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63664||Revision including replacement, when performed, of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy, including fluoroscopy, when performed (new code 1/1/10)|
|63685||Insertion or replacement of spinal neurostimulator pulse generator or receiver, direct or inductive coupling|
|63688||Revision or removal of implanted spinal neurostimulator pulse generator or receiver|
|95970, 95971, 95972, 95973||Neurostimulator programming and analysis code range|
|ICD-9 Procedure||03.93||Insertion or replacement of spinal neurostimulator|
|03.94||Removal of spinal neurostimulator lead(s)|
|86.05||Incision with removal of foreign body or device from skin and subcutaneous tissue (used to report removal of a neurostimulator pulse generator)|
|86.94||Insertion or replacement of single array neurostimulator pulse generator, not specified as rechargeable|
|86.95||Insertion or replacement of dual array neurostimulator pulse generator, not specified as rechargeable|
|86.97||Insertion or replacement of single array rechargeable neurostimulator pulse generator (new code effective 10/1/05)|
|86.98||Insertion or replacement of dual array rechargeable neurostimulator pulse generation (new code effective 10/1/05)|
|ICD-9 Diagnosis||See “Pain” in ICD-9 diagnosis index|
|HCPCS||L8680||Implantable neurostimulator electrode, each (new code effective 1/1/06)|
|L8685||Implantable neurostimulator pulse generator, single array, rechargeable, includes extension (new code effective 1/1/06)|
|L8686||Implantable neurostimulator pulse generator, single array, nonrechargeable, includes extension (new code effective 1/1/06)|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension (new code effective 1/1/06)|
|L8688||Implantable neurostimulator pulse generator, dual array, nonrechargeable, includes extension (new code effective 1/1/06)|
|ICD-10-CM (effective 10/1/14)||This list is a representative list of severe and chronic pain of the trunk and limbs diagnosis codes.|
|G56.40 -G56.42||Causalgia of upper limb code range|
|G57.70 -G57.72||Causalgia of lower limb code range|
|G89.21 -G89.8||Chronic pain, not elsewhere classified, code range|
|G89.4||Chronic pain syndrome|
|G90.50 -G90.59||Complex regional pain syndrome I (CRPS I), code range|
|M25.50 -M25.579||Pain in joint, code range|
|M54.10 -M54.18||Radiculopathy, code range|
|M54.30 -M54.32||Sciatica, code range|
|M54.40 -M54.42||Lumbago with sciatica, code range|
|M54.5||Low back pain|
|M54.6||Pain in thoracic spine|
|M54.81, M54.89||Other dorsalgia codes|
|M79.60 -M79.676||Pain in limb, hand, foot, fingers and toes code range|
|ICD-10-PCS (effective 10/1/14)||ICD-10-PCS codes are only used for inpatient services.|
|Surgical, central nervous system, insertion, spinal canal, neurostimulator lead, code by approach|
|00HV0MZ, 00HV3MZ, 00HV4MZ||Surgical, central nervous system, insertion, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, removal, spinal canal, neurostimulator lead, code by approach|
|00PV0MZ, 00PV3MZ, 00PV4MZ||Surgical, central nervous system, removal, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, revision, spinal canal, neurostimulator lead, code by approach|
|00WV0MZ, 00WV3MZ, 00WV4MZ||Surgical, central nervous system, revision, spinal cord, neurostimulator lead, code by approach|
|0JH60M6, 0JH60M7, 0JH60M8, 0JH60M9, 0JH63M6, 0JH63M7, 0JH63M8, 0JH63M9, 0JH70M6, 0JH70M7, 0JH70M8, 0JH70M9, 0JH73M6, 0JH73M7, 0JH73M8, 0JH73M9, 0JH80M6, 0JH80M7, 0JH80M8, 0JH80M9, 0JH83M6, 0JH83M7, 0JH83M8, 0JH83M9||Surgical, subcutaneous tissue and fascia, insertion, stimulator generator, code by body part, approach, number of arrays and whether rechargeable or not|
|0JPT0MZ, 0JPT3MZ||Surgical, subcutaneous tissue and fascia, removal, subcutaneous tissue and fascia, trunk, stimulator generator, code by approach (there aren’t ICD-10-PCS codes for removal of stimulator generator from other body parts)|
|Type of Service||Surgical|
|Place of Service||Inpatient/Outpatient|
Electrical Nerve Stimulation, Spinal
Spinal Cord Stimulation
Stimulation, Electrical, Spinal Cord
|03/31/96||Add to Surgery section||New policy|
|04/01/98||Replace policy||Policy cross-referenced to No. 7.01.63|
|07/10/98||Replace policy||Policy updated and revised|
|11/15/98||Coding update||1999 CPT coding release|
|04/29/03||Replace policy||Policy updated; new policy statement added, stating that spinal cord stimulation is investigational as a treatment of critical limb ischemia|
|11/9/04||Replace policy||Policy updated; no change to policy statement. Coding updated|
|08/17/05||Replace policy||Policy updated with literature search and coding updated; no change to policy statement|
|12/14/05||Replace policy – coding update only||Coding updated|
|12/12/06||Replace policy||Policy updated with literature search; no change to policy statement; reference numbers 7 – 9 added|
|03/13/08||Replace policy||Policy updated with literature search; references 10 – 13 added; no change to policy statements|
|01/08/09||Replace policy||Policy updated with literature search; references 14–25 added. Use in refractory angina added as investigational indication.|
|01/14/10||Replace policy||Policy updated with literature search; reference numbers 26-29 added; no change to policy statements|
|01/13/11||Replace policy||Policy updated with literature search.
|
L8688
|
Implt nrostm pls gen dua non
|
HCPCS
|
Last accessed November, 2011. |CPT||63650||Percutaneous implantation of neurostimulator electrode array; epidural|
|63655||Laminectomy for implantation of neurostimulator electrode plate/paddle; epidural|
|63661||Removal of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63662||Removal of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy (new code 1/1/10)|
|63663||Revision including replacement, when performed, of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63664||Revision including replacement, when performed, of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy, including fluoroscopy, when performed (new code 1/1/10)|
|63685||Insertion or replacement of spinal neurostimulator pulse generator or receiver, direct or inductive coupling|
|63688||Revision or removal of implanted spinal neurostimulator pulse generator or receiver|
|95970, 95971, 95972, 95973||Neurostimulator programming and analysis code range|
|ICD-9 Procedure||03.93||Insertion or replacement of spinal neurostimulator|
|03.94||Removal of spinal neurostimulator lead(s)|
|86.05||Incision with removal of foreign body or device from skin and subcutaneous tissue (used to report removal of a neurostimulator pulse generator)|
|86.94||Insertion or replacement of single array neurostimulator pulse generator, not specified as rechargeable|
|86.95||Insertion or replacement of dual array neurostimulator pulse generator, not specified as rechargeable|
|86.97||Insertion or replacement of single array rechargeable neurostimulator pulse generator (new code effective 10/1/05)|
|86.98||Insertion or replacement of dual array rechargeable neurostimulator pulse generation (new code effective 10/1/05)|
|ICD-9 Diagnosis||See “Pain” in ICD-9 diagnosis index|
|HCPCS||L8680||Implantable neurostimulator electrode, each (new code effective 1/1/06)|
|L8685||Implantable neurostimulator pulse generator, single array, rechargeable, includes extension (new code effective 1/1/06)|
|L8686||Implantable neurostimulator pulse generator, single array, nonrechargeable, includes extension (new code effective 1/1/06)|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension (new code effective 1/1/06)|
|L8688||Implantable neurostimulator pulse generator, dual array, nonrechargeable, includes extension (new code effective 1/1/06)|
|ICD-10-CM (effective 10/1/14)||This list is a representative list of severe and chronic pain of the trunk and limbs diagnosis codes.|
|G56.40 -G56.42||Causalgia of upper limb code range|
|G57.70 -G57.72||Causalgia of lower limb code range|
|G89.21 -G89.8||Chronic pain, not elsewhere classified, code range|
|G89.4||Chronic pain syndrome|
|G90.50 -G90.59||Complex regional pain syndrome I (CRPS I), code range|
|M25.50 -M25.579||Pain in joint, code range|
|M54.10 -M54.18||Radiculopathy, code range|
|M54.30 -M54.32||Sciatica, code range|
|M54.40 -M54.42||Lumbago with sciatica, code range|
|M54.5||Low back pain|
|M54.6||Pain in thoracic spine|
|M54.81, M54.89||Other dorsalgia codes|
|M79.60 -M79.676||Pain in limb, hand, foot, fingers and toes code range|
|ICD-10-PCS (effective 10/1/14)||ICD-10-PCS codes are only used for inpatient services.|
|Surgical, central nervous system, insertion, spinal canal, neurostimulator lead, code by approach|
|00HV0MZ, 00HV3MZ, 00HV4MZ||Surgical, central nervous system, insertion, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, removal, spinal canal, neurostimulator lead, code by approach|
|00PV0MZ, 00PV3MZ, 00PV4MZ||Surgical, central nervous system, removal, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, revision, spinal canal, neurostimulator lead, code by approach|
|00WV0MZ, 00WV3MZ, 00WV4MZ||Surgical, central nervous system, revision, spinal cord, neurostimulator lead, code by approach|
|0JH60M6, 0JH60M7, 0JH60M8, 0JH60M9, 0JH63M6, 0JH63M7, 0JH63M8, 0JH63M9, 0JH70M6, 0JH70M7, 0JH70M8, 0JH70M9, 0JH73M6, 0JH73M7, 0JH73M8, 0JH73M9, 0JH80M6, 0JH80M7, 0JH80M8, 0JH80M9, 0JH83M6, 0JH83M7, 0JH83M8, 0JH83M9||Surgical, subcutaneous tissue and fascia, insertion, stimulator generator, code by body part, approach, number of arrays and whether rechargeable or not|
|0JPT0MZ, 0JPT3MZ||Surgical, subcutaneous tissue and fascia, removal, subcutaneous tissue and fascia, trunk, stimulator generator, code by approach (there aren’t ICD-10-PCS codes for removal of stimulator generator from other body parts)|
|Type of Service||Surgical|
|Place of Service||Inpatient/Outpatient|
Electrical Nerve Stimulation, Spinal
Spinal Cord Stimulation
Stimulation, Electrical, Spinal Cord
|03/31/96||Add to Surgery section||New policy|
|04/01/98||Replace policy||Policy cross-referenced to No. 7.01.63|
|07/10/98||Replace policy||Policy updated and revised|
|11/15/98||Coding update||1999 CPT coding release|
|04/29/03||Replace policy||Policy updated; new policy statement added, stating that spinal cord stimulation is investigational as a treatment of critical limb ischemia|
|11/9/04||Replace policy||Policy updated; no change to policy statement. Coding updated|
|08/17/05||Replace policy||Policy updated with literature search and coding updated; no change to policy statement|
|12/14/05||Replace policy – coding update only||Coding updated|
|12/12/06||Replace policy||Policy updated with literature search; no change to policy statement; reference numbers 7 – 9 added|
|03/13/08||Replace policy||Policy updated with literature search; references 10 – 13 added; no change to policy statements|
|01/08/09||Replace policy||Policy updated with literature search; references 14–25 added. Use in refractory angina added as investigational indication.|
|01/14/10||Replace policy||Policy updated with literature search; reference numbers 26-29 added; no change to policy statements|
|01/13/11||Replace policy||Policy updated with literature search.
|
1999
|
ANESTHESIOLOGY GROUP
|
CPT
|
Last accessed November, 2011. |CPT||63650||Percutaneous implantation of neurostimulator electrode array; epidural|
|63655||Laminectomy for implantation of neurostimulator electrode plate/paddle; epidural|
|63661||Removal of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63662||Removal of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy (new code 1/1/10)|
|63663||Revision including replacement, when performed, of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63664||Revision including replacement, when performed, of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy, including fluoroscopy, when performed (new code 1/1/10)|
|63685||Insertion or replacement of spinal neurostimulator pulse generator or receiver, direct or inductive coupling|
|63688||Revision or removal of implanted spinal neurostimulator pulse generator or receiver|
|95970, 95971, 95972, 95973||Neurostimulator programming and analysis code range|
|ICD-9 Procedure||03.93||Insertion or replacement of spinal neurostimulator|
|03.94||Removal of spinal neurostimulator lead(s)|
|86.05||Incision with removal of foreign body or device from skin and subcutaneous tissue (used to report removal of a neurostimulator pulse generator)|
|86.94||Insertion or replacement of single array neurostimulator pulse generator, not specified as rechargeable|
|86.95||Insertion or replacement of dual array neurostimulator pulse generator, not specified as rechargeable|
|86.97||Insertion or replacement of single array rechargeable neurostimulator pulse generator (new code effective 10/1/05)|
|86.98||Insertion or replacement of dual array rechargeable neurostimulator pulse generation (new code effective 10/1/05)|
|ICD-9 Diagnosis||See “Pain” in ICD-9 diagnosis index|
|HCPCS||L8680||Implantable neurostimulator electrode, each (new code effective 1/1/06)|
|L8685||Implantable neurostimulator pulse generator, single array, rechargeable, includes extension (new code effective 1/1/06)|
|L8686||Implantable neurostimulator pulse generator, single array, nonrechargeable, includes extension (new code effective 1/1/06)|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension (new code effective 1/1/06)|
|L8688||Implantable neurostimulator pulse generator, dual array, nonrechargeable, includes extension (new code effective 1/1/06)|
|ICD-10-CM (effective 10/1/14)||This list is a representative list of severe and chronic pain of the trunk and limbs diagnosis codes.|
|G56.40 -G56.42||Causalgia of upper limb code range|
|G57.70 -G57.72||Causalgia of lower limb code range|
|G89.21 -G89.8||Chronic pain, not elsewhere classified, code range|
|G89.4||Chronic pain syndrome|
|G90.50 -G90.59||Complex regional pain syndrome I (CRPS I), code range|
|M25.50 -M25.579||Pain in joint, code range|
|M54.10 -M54.18||Radiculopathy, code range|
|M54.30 -M54.32||Sciatica, code range|
|M54.40 -M54.42||Lumbago with sciatica, code range|
|M54.5||Low back pain|
|M54.6||Pain in thoracic spine|
|M54.81, M54.89||Other dorsalgia codes|
|M79.60 -M79.676||Pain in limb, hand, foot, fingers and toes code range|
|ICD-10-PCS (effective 10/1/14)||ICD-10-PCS codes are only used for inpatient services.|
|Surgical, central nervous system, insertion, spinal canal, neurostimulator lead, code by approach|
|00HV0MZ, 00HV3MZ, 00HV4MZ||Surgical, central nervous system, insertion, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, removal, spinal canal, neurostimulator lead, code by approach|
|00PV0MZ, 00PV3MZ, 00PV4MZ||Surgical, central nervous system, removal, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, revision, spinal canal, neurostimulator lead, code by approach|
|00WV0MZ, 00WV3MZ, 00WV4MZ||Surgical, central nervous system, revision, spinal cord, neurostimulator lead, code by approach|
|0JH60M6, 0JH60M7, 0JH60M8, 0JH60M9, 0JH63M6, 0JH63M7, 0JH63M8, 0JH63M9, 0JH70M6, 0JH70M7, 0JH70M8, 0JH70M9, 0JH73M6, 0JH73M7, 0JH73M8, 0JH73M9, 0JH80M6, 0JH80M7, 0JH80M8, 0JH80M9, 0JH83M6, 0JH83M7, 0JH83M8, 0JH83M9||Surgical, subcutaneous tissue and fascia, insertion, stimulator generator, code by body part, approach, number of arrays and whether rechargeable or not|
|0JPT0MZ, 0JPT3MZ||Surgical, subcutaneous tissue and fascia, removal, subcutaneous tissue and fascia, trunk, stimulator generator, code by approach (there aren’t ICD-10-PCS codes for removal of stimulator generator from other body parts)|
|Type of Service||Surgical|
|Place of Service||Inpatient/Outpatient|
Electrical Nerve Stimulation, Spinal
Spinal Cord Stimulation
Stimulation, Electrical, Spinal Cord
|03/31/96||Add to Surgery section||New policy|
|04/01/98||Replace policy||Policy cross-referenced to No. 7.01.63|
|07/10/98||Replace policy||Policy updated and revised|
|11/15/98||Coding update||1999 CPT coding release|
|04/29/03||Replace policy||Policy updated; new policy statement added, stating that spinal cord stimulation is investigational as a treatment of critical limb ischemia|
|11/9/04||Replace policy||Policy updated; no change to policy statement. Coding updated|
|08/17/05||Replace policy||Policy updated with literature search and coding updated; no change to policy statement|
|12/14/05||Replace policy – coding update only||Coding updated|
|12/12/06||Replace policy||Policy updated with literature search; no change to policy statement; reference numbers 7 – 9 added|
|03/13/08||Replace policy||Policy updated with literature search; references 10 – 13 added; no change to policy statements|
|01/08/09||Replace policy||Policy updated with literature search; references 14–25 added. Use in refractory angina added as investigational indication.|
|01/14/10||Replace policy||Policy updated with literature search; reference numbers 26-29 added; no change to policy statements|
|01/13/11||Replace policy||Policy updated with literature search.
|
L8680
|
KIT NRSTM 40CM STIMLOC .
|
HCPCS
|
Last accessed November, 2011. |CPT||63650||Percutaneous implantation of neurostimulator electrode array; epidural|
|63655||Laminectomy for implantation of neurostimulator electrode plate/paddle; epidural|
|63661||Removal of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63662||Removal of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy (new code 1/1/10)|
|63663||Revision including replacement, when performed, of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63664||Revision including replacement, when performed, of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy, including fluoroscopy, when performed (new code 1/1/10)|
|63685||Insertion or replacement of spinal neurostimulator pulse generator or receiver, direct or inductive coupling|
|63688||Revision or removal of implanted spinal neurostimulator pulse generator or receiver|
|95970, 95971, 95972, 95973||Neurostimulator programming and analysis code range|
|ICD-9 Procedure||03.93||Insertion or replacement of spinal neurostimulator|
|03.94||Removal of spinal neurostimulator lead(s)|
|86.05||Incision with removal of foreign body or device from skin and subcutaneous tissue (used to report removal of a neurostimulator pulse generator)|
|86.94||Insertion or replacement of single array neurostimulator pulse generator, not specified as rechargeable|
|86.95||Insertion or replacement of dual array neurostimulator pulse generator, not specified as rechargeable|
|86.97||Insertion or replacement of single array rechargeable neurostimulator pulse generator (new code effective 10/1/05)|
|86.98||Insertion or replacement of dual array rechargeable neurostimulator pulse generation (new code effective 10/1/05)|
|ICD-9 Diagnosis||See “Pain” in ICD-9 diagnosis index|
|HCPCS||L8680||Implantable neurostimulator electrode, each (new code effective 1/1/06)|
|L8685||Implantable neurostimulator pulse generator, single array, rechargeable, includes extension (new code effective 1/1/06)|
|L8686||Implantable neurostimulator pulse generator, single array, nonrechargeable, includes extension (new code effective 1/1/06)|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension (new code effective 1/1/06)|
|L8688||Implantable neurostimulator pulse generator, dual array, nonrechargeable, includes extension (new code effective 1/1/06)|
|ICD-10-CM (effective 10/1/14)||This list is a representative list of severe and chronic pain of the trunk and limbs diagnosis codes.|
|G56.40 -G56.42||Causalgia of upper limb code range|
|G57.70 -G57.72||Causalgia of lower limb code range|
|G89.21 -G89.8||Chronic pain, not elsewhere classified, code range|
|G89.4||Chronic pain syndrome|
|G90.50 -G90.59||Complex regional pain syndrome I (CRPS I), code range|
|M25.50 -M25.579||Pain in joint, code range|
|M54.10 -M54.18||Radiculopathy, code range|
|M54.30 -M54.32||Sciatica, code range|
|M54.40 -M54.42||Lumbago with sciatica, code range|
|M54.5||Low back pain|
|M54.6||Pain in thoracic spine|
|M54.81, M54.89||Other dorsalgia codes|
|M79.60 -M79.676||Pain in limb, hand, foot, fingers and toes code range|
|ICD-10-PCS (effective 10/1/14)||ICD-10-PCS codes are only used for inpatient services.|
|Surgical, central nervous system, insertion, spinal canal, neurostimulator lead, code by approach|
|00HV0MZ, 00HV3MZ, 00HV4MZ||Surgical, central nervous system, insertion, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, removal, spinal canal, neurostimulator lead, code by approach|
|00PV0MZ, 00PV3MZ, 00PV4MZ||Surgical, central nervous system, removal, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, revision, spinal canal, neurostimulator lead, code by approach|
|00WV0MZ, 00WV3MZ, 00WV4MZ||Surgical, central nervous system, revision, spinal cord, neurostimulator lead, code by approach|
|0JH60M6, 0JH60M7, 0JH60M8, 0JH60M9, 0JH63M6, 0JH63M7, 0JH63M8, 0JH63M9, 0JH70M6, 0JH70M7, 0JH70M8, 0JH70M9, 0JH73M6, 0JH73M7, 0JH73M8, 0JH73M9, 0JH80M6, 0JH80M7, 0JH80M8, 0JH80M9, 0JH83M6, 0JH83M7, 0JH83M8, 0JH83M9||Surgical, subcutaneous tissue and fascia, insertion, stimulator generator, code by body part, approach, number of arrays and whether rechargeable or not|
|0JPT0MZ, 0JPT3MZ||Surgical, subcutaneous tissue and fascia, removal, subcutaneous tissue and fascia, trunk, stimulator generator, code by approach (there aren’t ICD-10-PCS codes for removal of stimulator generator from other body parts)|
|Type of Service||Surgical|
|Place of Service||Inpatient/Outpatient|
Electrical Nerve Stimulation, Spinal
Spinal Cord Stimulation
Stimulation, Electrical, Spinal Cord
|03/31/96||Add to Surgery section||New policy|
|04/01/98||Replace policy||Policy cross-referenced to No. 7.01.63|
|07/10/98||Replace policy||Policy updated and revised|
|11/15/98||Coding update||1999 CPT coding release|
|04/29/03||Replace policy||Policy updated; new policy statement added, stating that spinal cord stimulation is investigational as a treatment of critical limb ischemia|
|11/9/04||Replace policy||Policy updated; no change to policy statement. Coding updated|
|08/17/05||Replace policy||Policy updated with literature search and coding updated; no change to policy statement|
|12/14/05||Replace policy – coding update only||Coding updated|
|12/12/06||Replace policy||Policy updated with literature search; no change to policy statement; reference numbers 7 – 9 added|
|03/13/08||Replace policy||Policy updated with literature search; references 10 – 13 added; no change to policy statements|
|01/08/09||Replace policy||Policy updated with literature search; references 14–25 added. Use in refractory angina added as investigational indication.|
|01/14/10||Replace policy||Policy updated with literature search; reference numbers 26-29 added; no change to policy statements|
|01/13/11||Replace policy||Policy updated with literature search.
|
63662
|
Remove spine eltrd plate
|
HCPCS
|
Last accessed November, 2011. |CPT||63650||Percutaneous implantation of neurostimulator electrode array; epidural|
|63655||Laminectomy for implantation of neurostimulator electrode plate/paddle; epidural|
|63661||Removal of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63662||Removal of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy (new code 1/1/10)|
|63663||Revision including replacement, when performed, of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63664||Revision including replacement, when performed, of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy, including fluoroscopy, when performed (new code 1/1/10)|
|63685||Insertion or replacement of spinal neurostimulator pulse generator or receiver, direct or inductive coupling|
|63688||Revision or removal of implanted spinal neurostimulator pulse generator or receiver|
|95970, 95971, 95972, 95973||Neurostimulator programming and analysis code range|
|ICD-9 Procedure||03.93||Insertion or replacement of spinal neurostimulator|
|03.94||Removal of spinal neurostimulator lead(s)|
|86.05||Incision with removal of foreign body or device from skin and subcutaneous tissue (used to report removal of a neurostimulator pulse generator)|
|86.94||Insertion or replacement of single array neurostimulator pulse generator, not specified as rechargeable|
|86.95||Insertion or replacement of dual array neurostimulator pulse generator, not specified as rechargeable|
|86.97||Insertion or replacement of single array rechargeable neurostimulator pulse generator (new code effective 10/1/05)|
|86.98||Insertion or replacement of dual array rechargeable neurostimulator pulse generation (new code effective 10/1/05)|
|ICD-9 Diagnosis||See “Pain” in ICD-9 diagnosis index|
|HCPCS||L8680||Implantable neurostimulator electrode, each (new code effective 1/1/06)|
|L8685||Implantable neurostimulator pulse generator, single array, rechargeable, includes extension (new code effective 1/1/06)|
|L8686||Implantable neurostimulator pulse generator, single array, nonrechargeable, includes extension (new code effective 1/1/06)|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension (new code effective 1/1/06)|
|L8688||Implantable neurostimulator pulse generator, dual array, nonrechargeable, includes extension (new code effective 1/1/06)|
|ICD-10-CM (effective 10/1/14)||This list is a representative list of severe and chronic pain of the trunk and limbs diagnosis codes.|
|G56.40 -G56.42||Causalgia of upper limb code range|
|G57.70 -G57.72||Causalgia of lower limb code range|
|G89.21 -G89.8||Chronic pain, not elsewhere classified, code range|
|G89.4||Chronic pain syndrome|
|G90.50 -G90.59||Complex regional pain syndrome I (CRPS I), code range|
|M25.50 -M25.579||Pain in joint, code range|
|M54.10 -M54.18||Radiculopathy, code range|
|M54.30 -M54.32||Sciatica, code range|
|M54.40 -M54.42||Lumbago with sciatica, code range|
|M54.5||Low back pain|
|M54.6||Pain in thoracic spine|
|M54.81, M54.89||Other dorsalgia codes|
|M79.60 -M79.676||Pain in limb, hand, foot, fingers and toes code range|
|ICD-10-PCS (effective 10/1/14)||ICD-10-PCS codes are only used for inpatient services.|
|Surgical, central nervous system, insertion, spinal canal, neurostimulator lead, code by approach|
|00HV0MZ, 00HV3MZ, 00HV4MZ||Surgical, central nervous system, insertion, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, removal, spinal canal, neurostimulator lead, code by approach|
|00PV0MZ, 00PV3MZ, 00PV4MZ||Surgical, central nervous system, removal, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, revision, spinal canal, neurostimulator lead, code by approach|
|00WV0MZ, 00WV3MZ, 00WV4MZ||Surgical, central nervous system, revision, spinal cord, neurostimulator lead, code by approach|
|0JH60M6, 0JH60M7, 0JH60M8, 0JH60M9, 0JH63M6, 0JH63M7, 0JH63M8, 0JH63M9, 0JH70M6, 0JH70M7, 0JH70M8, 0JH70M9, 0JH73M6, 0JH73M7, 0JH73M8, 0JH73M9, 0JH80M6, 0JH80M7, 0JH80M8, 0JH80M9, 0JH83M6, 0JH83M7, 0JH83M8, 0JH83M9||Surgical, subcutaneous tissue and fascia, insertion, stimulator generator, code by body part, approach, number of arrays and whether rechargeable or not|
|0JPT0MZ, 0JPT3MZ||Surgical, subcutaneous tissue and fascia, removal, subcutaneous tissue and fascia, trunk, stimulator generator, code by approach (there aren’t ICD-10-PCS codes for removal of stimulator generator from other body parts)|
|Type of Service||Surgical|
|Place of Service||Inpatient/Outpatient|
Electrical Nerve Stimulation, Spinal
Spinal Cord Stimulation
Stimulation, Electrical, Spinal Cord
|03/31/96||Add to Surgery section||New policy|
|04/01/98||Replace policy||Policy cross-referenced to No. 7.01.63|
|07/10/98||Replace policy||Policy updated and revised|
|11/15/98||Coding update||1999 CPT coding release|
|04/29/03||Replace policy||Policy updated; new policy statement added, stating that spinal cord stimulation is investigational as a treatment of critical limb ischemia|
|11/9/04||Replace policy||Policy updated; no change to policy statement. Coding updated|
|08/17/05||Replace policy||Policy updated with literature search and coding updated; no change to policy statement|
|12/14/05||Replace policy – coding update only||Coding updated|
|12/12/06||Replace policy||Policy updated with literature search; no change to policy statement; reference numbers 7 – 9 added|
|03/13/08||Replace policy||Policy updated with literature search; references 10 – 13 added; no change to policy statements|
|01/08/09||Replace policy||Policy updated with literature search; references 14–25 added. Use in refractory angina added as investigational indication.|
|01/14/10||Replace policy||Policy updated with literature search; reference numbers 26-29 added; no change to policy statements|
|01/13/11||Replace policy||Policy updated with literature search.
|
L8687
|
KIT NEUROSTIMULATOR SENZA IPG STERILE LATEX FREE DISPOSABLE
|
HCPCS
|
Last accessed November, 2011. |CPT||63650||Percutaneous implantation of neurostimulator electrode array; epidural|
|63655||Laminectomy for implantation of neurostimulator electrode plate/paddle; epidural|
|63661||Removal of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63662||Removal of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy (new code 1/1/10)|
|63663||Revision including replacement, when performed, of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63664||Revision including replacement, when performed, of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy, including fluoroscopy, when performed (new code 1/1/10)|
|63685||Insertion or replacement of spinal neurostimulator pulse generator or receiver, direct or inductive coupling|
|63688||Revision or removal of implanted spinal neurostimulator pulse generator or receiver|
|95970, 95971, 95972, 95973||Neurostimulator programming and analysis code range|
|ICD-9 Procedure||03.93||Insertion or replacement of spinal neurostimulator|
|03.94||Removal of spinal neurostimulator lead(s)|
|86.05||Incision with removal of foreign body or device from skin and subcutaneous tissue (used to report removal of a neurostimulator pulse generator)|
|86.94||Insertion or replacement of single array neurostimulator pulse generator, not specified as rechargeable|
|86.95||Insertion or replacement of dual array neurostimulator pulse generator, not specified as rechargeable|
|86.97||Insertion or replacement of single array rechargeable neurostimulator pulse generator (new code effective 10/1/05)|
|86.98||Insertion or replacement of dual array rechargeable neurostimulator pulse generation (new code effective 10/1/05)|
|ICD-9 Diagnosis||See “Pain” in ICD-9 diagnosis index|
|HCPCS||L8680||Implantable neurostimulator electrode, each (new code effective 1/1/06)|
|L8685||Implantable neurostimulator pulse generator, single array, rechargeable, includes extension (new code effective 1/1/06)|
|L8686||Implantable neurostimulator pulse generator, single array, nonrechargeable, includes extension (new code effective 1/1/06)|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension (new code effective 1/1/06)|
|L8688||Implantable neurostimulator pulse generator, dual array, nonrechargeable, includes extension (new code effective 1/1/06)|
|ICD-10-CM (effective 10/1/14)||This list is a representative list of severe and chronic pain of the trunk and limbs diagnosis codes.|
|G56.40 -G56.42||Causalgia of upper limb code range|
|G57.70 -G57.72||Causalgia of lower limb code range|
|G89.21 -G89.8||Chronic pain, not elsewhere classified, code range|
|G89.4||Chronic pain syndrome|
|G90.50 -G90.59||Complex regional pain syndrome I (CRPS I), code range|
|M25.50 -M25.579||Pain in joint, code range|
|M54.10 -M54.18||Radiculopathy, code range|
|M54.30 -M54.32||Sciatica, code range|
|M54.40 -M54.42||Lumbago with sciatica, code range|
|M54.5||Low back pain|
|M54.6||Pain in thoracic spine|
|M54.81, M54.89||Other dorsalgia codes|
|M79.60 -M79.676||Pain in limb, hand, foot, fingers and toes code range|
|ICD-10-PCS (effective 10/1/14)||ICD-10-PCS codes are only used for inpatient services.|
|Surgical, central nervous system, insertion, spinal canal, neurostimulator lead, code by approach|
|00HV0MZ, 00HV3MZ, 00HV4MZ||Surgical, central nervous system, insertion, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, removal, spinal canal, neurostimulator lead, code by approach|
|00PV0MZ, 00PV3MZ, 00PV4MZ||Surgical, central nervous system, removal, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, revision, spinal canal, neurostimulator lead, code by approach|
|00WV0MZ, 00WV3MZ, 00WV4MZ||Surgical, central nervous system, revision, spinal cord, neurostimulator lead, code by approach|
|0JH60M6, 0JH60M7, 0JH60M8, 0JH60M9, 0JH63M6, 0JH63M7, 0JH63M8, 0JH63M9, 0JH70M6, 0JH70M7, 0JH70M8, 0JH70M9, 0JH73M6, 0JH73M7, 0JH73M8, 0JH73M9, 0JH80M6, 0JH80M7, 0JH80M8, 0JH80M9, 0JH83M6, 0JH83M7, 0JH83M8, 0JH83M9||Surgical, subcutaneous tissue and fascia, insertion, stimulator generator, code by body part, approach, number of arrays and whether rechargeable or not|
|0JPT0MZ, 0JPT3MZ||Surgical, subcutaneous tissue and fascia, removal, subcutaneous tissue and fascia, trunk, stimulator generator, code by approach (there aren’t ICD-10-PCS codes for removal of stimulator generator from other body parts)|
|Type of Service||Surgical|
|Place of Service||Inpatient/Outpatient|
Electrical Nerve Stimulation, Spinal
Spinal Cord Stimulation
Stimulation, Electrical, Spinal Cord
|03/31/96||Add to Surgery section||New policy|
|04/01/98||Replace policy||Policy cross-referenced to No. 7.01.63|
|07/10/98||Replace policy||Policy updated and revised|
|11/15/98||Coding update||1999 CPT coding release|
|04/29/03||Replace policy||Policy updated; new policy statement added, stating that spinal cord stimulation is investigational as a treatment of critical limb ischemia|
|11/9/04||Replace policy||Policy updated; no change to policy statement. Coding updated|
|08/17/05||Replace policy||Policy updated with literature search and coding updated; no change to policy statement|
|12/14/05||Replace policy – coding update only||Coding updated|
|12/12/06||Replace policy||Policy updated with literature search; no change to policy statement; reference numbers 7 – 9 added|
|03/13/08||Replace policy||Policy updated with literature search; references 10 – 13 added; no change to policy statements|
|01/08/09||Replace policy||Policy updated with literature search; references 14–25 added. Use in refractory angina added as investigational indication.|
|01/14/10||Replace policy||Policy updated with literature search; reference numbers 26-29 added; no change to policy statements|
|01/13/11||Replace policy||Policy updated with literature search.
|
63663
|
Revise spine eltrd perq aray
|
HCPCS
|
Last accessed November, 2011. |CPT||63650||Percutaneous implantation of neurostimulator electrode array; epidural|
|63655||Laminectomy for implantation of neurostimulator electrode plate/paddle; epidural|
|63661||Removal of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63662||Removal of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy (new code 1/1/10)|
|63663||Revision including replacement, when performed, of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63664||Revision including replacement, when performed, of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy, including fluoroscopy, when performed (new code 1/1/10)|
|63685||Insertion or replacement of spinal neurostimulator pulse generator or receiver, direct or inductive coupling|
|63688||Revision or removal of implanted spinal neurostimulator pulse generator or receiver|
|95970, 95971, 95972, 95973||Neurostimulator programming and analysis code range|
|ICD-9 Procedure||03.93||Insertion or replacement of spinal neurostimulator|
|03.94||Removal of spinal neurostimulator lead(s)|
|86.05||Incision with removal of foreign body or device from skin and subcutaneous tissue (used to report removal of a neurostimulator pulse generator)|
|86.94||Insertion or replacement of single array neurostimulator pulse generator, not specified as rechargeable|
|86.95||Insertion or replacement of dual array neurostimulator pulse generator, not specified as rechargeable|
|86.97||Insertion or replacement of single array rechargeable neurostimulator pulse generator (new code effective 10/1/05)|
|86.98||Insertion or replacement of dual array rechargeable neurostimulator pulse generation (new code effective 10/1/05)|
|ICD-9 Diagnosis||See “Pain” in ICD-9 diagnosis index|
|HCPCS||L8680||Implantable neurostimulator electrode, each (new code effective 1/1/06)|
|L8685||Implantable neurostimulator pulse generator, single array, rechargeable, includes extension (new code effective 1/1/06)|
|L8686||Implantable neurostimulator pulse generator, single array, nonrechargeable, includes extension (new code effective 1/1/06)|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension (new code effective 1/1/06)|
|L8688||Implantable neurostimulator pulse generator, dual array, nonrechargeable, includes extension (new code effective 1/1/06)|
|ICD-10-CM (effective 10/1/14)||This list is a representative list of severe and chronic pain of the trunk and limbs diagnosis codes.|
|G56.40 -G56.42||Causalgia of upper limb code range|
|G57.70 -G57.72||Causalgia of lower limb code range|
|G89.21 -G89.8||Chronic pain, not elsewhere classified, code range|
|G89.4||Chronic pain syndrome|
|G90.50 -G90.59||Complex regional pain syndrome I (CRPS I), code range|
|M25.50 -M25.579||Pain in joint, code range|
|M54.10 -M54.18||Radiculopathy, code range|
|M54.30 -M54.32||Sciatica, code range|
|M54.40 -M54.42||Lumbago with sciatica, code range|
|M54.5||Low back pain|
|M54.6||Pain in thoracic spine|
|M54.81, M54.89||Other dorsalgia codes|
|M79.60 -M79.676||Pain in limb, hand, foot, fingers and toes code range|
|ICD-10-PCS (effective 10/1/14)||ICD-10-PCS codes are only used for inpatient services.|
|Surgical, central nervous system, insertion, spinal canal, neurostimulator lead, code by approach|
|00HV0MZ, 00HV3MZ, 00HV4MZ||Surgical, central nervous system, insertion, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, removal, spinal canal, neurostimulator lead, code by approach|
|00PV0MZ, 00PV3MZ, 00PV4MZ||Surgical, central nervous system, removal, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, revision, spinal canal, neurostimulator lead, code by approach|
|00WV0MZ, 00WV3MZ, 00WV4MZ||Surgical, central nervous system, revision, spinal cord, neurostimulator lead, code by approach|
|0JH60M6, 0JH60M7, 0JH60M8, 0JH60M9, 0JH63M6, 0JH63M7, 0JH63M8, 0JH63M9, 0JH70M6, 0JH70M7, 0JH70M8, 0JH70M9, 0JH73M6, 0JH73M7, 0JH73M8, 0JH73M9, 0JH80M6, 0JH80M7, 0JH80M8, 0JH80M9, 0JH83M6, 0JH83M7, 0JH83M8, 0JH83M9||Surgical, subcutaneous tissue and fascia, insertion, stimulator generator, code by body part, approach, number of arrays and whether rechargeable or not|
|0JPT0MZ, 0JPT3MZ||Surgical, subcutaneous tissue and fascia, removal, subcutaneous tissue and fascia, trunk, stimulator generator, code by approach (there aren’t ICD-10-PCS codes for removal of stimulator generator from other body parts)|
|Type of Service||Surgical|
|Place of Service||Inpatient/Outpatient|
Electrical Nerve Stimulation, Spinal
Spinal Cord Stimulation
Stimulation, Electrical, Spinal Cord
|03/31/96||Add to Surgery section||New policy|
|04/01/98||Replace policy||Policy cross-referenced to No. 7.01.63|
|07/10/98||Replace policy||Policy updated and revised|
|11/15/98||Coding update||1999 CPT coding release|
|04/29/03||Replace policy||Policy updated; new policy statement added, stating that spinal cord stimulation is investigational as a treatment of critical limb ischemia|
|11/9/04||Replace policy||Policy updated; no change to policy statement. Coding updated|
|08/17/05||Replace policy||Policy updated with literature search and coding updated; no change to policy statement|
|12/14/05||Replace policy – coding update only||Coding updated|
|12/12/06||Replace policy||Policy updated with literature search; no change to policy statement; reference numbers 7 – 9 added|
|03/13/08||Replace policy||Policy updated with literature search; references 10 – 13 added; no change to policy statements|
|01/08/09||Replace policy||Policy updated with literature search; references 14–25 added. Use in refractory angina added as investigational indication.|
|01/14/10||Replace policy||Policy updated with literature search; reference numbers 26-29 added; no change to policy statements|
|01/13/11||Replace policy||Policy updated with literature search.
|
95970
|
PR ELEC ALYS IMPLT NPGT PHYS/QHP W/O PROGRAMMING
|
HCPCS
|
Last accessed November, 2011. |CPT||63650||Percutaneous implantation of neurostimulator electrode array; epidural|
|63655||Laminectomy for implantation of neurostimulator electrode plate/paddle; epidural|
|63661||Removal of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63662||Removal of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy (new code 1/1/10)|
|63663||Revision including replacement, when performed, of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63664||Revision including replacement, when performed, of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy, including fluoroscopy, when performed (new code 1/1/10)|
|63685||Insertion or replacement of spinal neurostimulator pulse generator or receiver, direct or inductive coupling|
|63688||Revision or removal of implanted spinal neurostimulator pulse generator or receiver|
|95970, 95971, 95972, 95973||Neurostimulator programming and analysis code range|
|ICD-9 Procedure||03.93||Insertion or replacement of spinal neurostimulator|
|03.94||Removal of spinal neurostimulator lead(s)|
|86.05||Incision with removal of foreign body or device from skin and subcutaneous tissue (used to report removal of a neurostimulator pulse generator)|
|86.94||Insertion or replacement of single array neurostimulator pulse generator, not specified as rechargeable|
|86.95||Insertion or replacement of dual array neurostimulator pulse generator, not specified as rechargeable|
|86.97||Insertion or replacement of single array rechargeable neurostimulator pulse generator (new code effective 10/1/05)|
|86.98||Insertion or replacement of dual array rechargeable neurostimulator pulse generation (new code effective 10/1/05)|
|ICD-9 Diagnosis||See “Pain” in ICD-9 diagnosis index|
|HCPCS||L8680||Implantable neurostimulator electrode, each (new code effective 1/1/06)|
|L8685||Implantable neurostimulator pulse generator, single array, rechargeable, includes extension (new code effective 1/1/06)|
|L8686||Implantable neurostimulator pulse generator, single array, nonrechargeable, includes extension (new code effective 1/1/06)|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension (new code effective 1/1/06)|
|L8688||Implantable neurostimulator pulse generator, dual array, nonrechargeable, includes extension (new code effective 1/1/06)|
|ICD-10-CM (effective 10/1/14)||This list is a representative list of severe and chronic pain of the trunk and limbs diagnosis codes.|
|G56.40 -G56.42||Causalgia of upper limb code range|
|G57.70 -G57.72||Causalgia of lower limb code range|
|G89.21 -G89.8||Chronic pain, not elsewhere classified, code range|
|G89.4||Chronic pain syndrome|
|G90.50 -G90.59||Complex regional pain syndrome I (CRPS I), code range|
|M25.50 -M25.579||Pain in joint, code range|
|M54.10 -M54.18||Radiculopathy, code range|
|M54.30 -M54.32||Sciatica, code range|
|M54.40 -M54.42||Lumbago with sciatica, code range|
|M54.5||Low back pain|
|M54.6||Pain in thoracic spine|
|M54.81, M54.89||Other dorsalgia codes|
|M79.60 -M79.676||Pain in limb, hand, foot, fingers and toes code range|
|ICD-10-PCS (effective 10/1/14)||ICD-10-PCS codes are only used for inpatient services.|
|Surgical, central nervous system, insertion, spinal canal, neurostimulator lead, code by approach|
|00HV0MZ, 00HV3MZ, 00HV4MZ||Surgical, central nervous system, insertion, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, removal, spinal canal, neurostimulator lead, code by approach|
|00PV0MZ, 00PV3MZ, 00PV4MZ||Surgical, central nervous system, removal, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, revision, spinal canal, neurostimulator lead, code by approach|
|00WV0MZ, 00WV3MZ, 00WV4MZ||Surgical, central nervous system, revision, spinal cord, neurostimulator lead, code by approach|
|0JH60M6, 0JH60M7, 0JH60M8, 0JH60M9, 0JH63M6, 0JH63M7, 0JH63M8, 0JH63M9, 0JH70M6, 0JH70M7, 0JH70M8, 0JH70M9, 0JH73M6, 0JH73M7, 0JH73M8, 0JH73M9, 0JH80M6, 0JH80M7, 0JH80M8, 0JH80M9, 0JH83M6, 0JH83M7, 0JH83M8, 0JH83M9||Surgical, subcutaneous tissue and fascia, insertion, stimulator generator, code by body part, approach, number of arrays and whether rechargeable or not|
|0JPT0MZ, 0JPT3MZ||Surgical, subcutaneous tissue and fascia, removal, subcutaneous tissue and fascia, trunk, stimulator generator, code by approach (there aren’t ICD-10-PCS codes for removal of stimulator generator from other body parts)|
|Type of Service||Surgical|
|Place of Service||Inpatient/Outpatient|
Electrical Nerve Stimulation, Spinal
Spinal Cord Stimulation
Stimulation, Electrical, Spinal Cord
|03/31/96||Add to Surgery section||New policy|
|04/01/98||Replace policy||Policy cross-referenced to No. 7.01.63|
|07/10/98||Replace policy||Policy updated and revised|
|11/15/98||Coding update||1999 CPT coding release|
|04/29/03||Replace policy||Policy updated; new policy statement added, stating that spinal cord stimulation is investigational as a treatment of critical limb ischemia|
|11/9/04||Replace policy||Policy updated; no change to policy statement. Coding updated|
|08/17/05||Replace policy||Policy updated with literature search and coding updated; no change to policy statement|
|12/14/05||Replace policy – coding update only||Coding updated|
|12/12/06||Replace policy||Policy updated with literature search; no change to policy statement; reference numbers 7 – 9 added|
|03/13/08||Replace policy||Policy updated with literature search; references 10 – 13 added; no change to policy statements|
|01/08/09||Replace policy||Policy updated with literature search; references 14–25 added. Use in refractory angina added as investigational indication.|
|01/14/10||Replace policy||Policy updated with literature search; reference numbers 26-29 added; no change to policy statements|
|01/13/11||Replace policy||Policy updated with literature search.
|
63688
|
Rev/rmv imp sp npg/r dtch cn
|
HCPCS
|
Last accessed November, 2011. |CPT||63650||Percutaneous implantation of neurostimulator electrode array; epidural|
|63655||Laminectomy for implantation of neurostimulator electrode plate/paddle; epidural|
|63661||Removal of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63662||Removal of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy (new code 1/1/10)|
|63663||Revision including replacement, when performed, of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63664||Revision including replacement, when performed, of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy, including fluoroscopy, when performed (new code 1/1/10)|
|63685||Insertion or replacement of spinal neurostimulator pulse generator or receiver, direct or inductive coupling|
|63688||Revision or removal of implanted spinal neurostimulator pulse generator or receiver|
|95970, 95971, 95972, 95973||Neurostimulator programming and analysis code range|
|ICD-9 Procedure||03.93||Insertion or replacement of spinal neurostimulator|
|03.94||Removal of spinal neurostimulator lead(s)|
|86.05||Incision with removal of foreign body or device from skin and subcutaneous tissue (used to report removal of a neurostimulator pulse generator)|
|86.94||Insertion or replacement of single array neurostimulator pulse generator, not specified as rechargeable|
|86.95||Insertion or replacement of dual array neurostimulator pulse generator, not specified as rechargeable|
|86.97||Insertion or replacement of single array rechargeable neurostimulator pulse generator (new code effective 10/1/05)|
|86.98||Insertion or replacement of dual array rechargeable neurostimulator pulse generation (new code effective 10/1/05)|
|ICD-9 Diagnosis||See “Pain” in ICD-9 diagnosis index|
|HCPCS||L8680||Implantable neurostimulator electrode, each (new code effective 1/1/06)|
|L8685||Implantable neurostimulator pulse generator, single array, rechargeable, includes extension (new code effective 1/1/06)|
|L8686||Implantable neurostimulator pulse generator, single array, nonrechargeable, includes extension (new code effective 1/1/06)|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension (new code effective 1/1/06)|
|L8688||Implantable neurostimulator pulse generator, dual array, nonrechargeable, includes extension (new code effective 1/1/06)|
|ICD-10-CM (effective 10/1/14)||This list is a representative list of severe and chronic pain of the trunk and limbs diagnosis codes.|
|G56.40 -G56.42||Causalgia of upper limb code range|
|G57.70 -G57.72||Causalgia of lower limb code range|
|G89.21 -G89.8||Chronic pain, not elsewhere classified, code range|
|G89.4||Chronic pain syndrome|
|G90.50 -G90.59||Complex regional pain syndrome I (CRPS I), code range|
|M25.50 -M25.579||Pain in joint, code range|
|M54.10 -M54.18||Radiculopathy, code range|
|M54.30 -M54.32||Sciatica, code range|
|M54.40 -M54.42||Lumbago with sciatica, code range|
|M54.5||Low back pain|
|M54.6||Pain in thoracic spine|
|M54.81, M54.89||Other dorsalgia codes|
|M79.60 -M79.676||Pain in limb, hand, foot, fingers and toes code range|
|ICD-10-PCS (effective 10/1/14)||ICD-10-PCS codes are only used for inpatient services.|
|Surgical, central nervous system, insertion, spinal canal, neurostimulator lead, code by approach|
|00HV0MZ, 00HV3MZ, 00HV4MZ||Surgical, central nervous system, insertion, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, removal, spinal canal, neurostimulator lead, code by approach|
|00PV0MZ, 00PV3MZ, 00PV4MZ||Surgical, central nervous system, removal, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, revision, spinal canal, neurostimulator lead, code by approach|
|00WV0MZ, 00WV3MZ, 00WV4MZ||Surgical, central nervous system, revision, spinal cord, neurostimulator lead, code by approach|
|0JH60M6, 0JH60M7, 0JH60M8, 0JH60M9, 0JH63M6, 0JH63M7, 0JH63M8, 0JH63M9, 0JH70M6, 0JH70M7, 0JH70M8, 0JH70M9, 0JH73M6, 0JH73M7, 0JH73M8, 0JH73M9, 0JH80M6, 0JH80M7, 0JH80M8, 0JH80M9, 0JH83M6, 0JH83M7, 0JH83M8, 0JH83M9||Surgical, subcutaneous tissue and fascia, insertion, stimulator generator, code by body part, approach, number of arrays and whether rechargeable or not|
|0JPT0MZ, 0JPT3MZ||Surgical, subcutaneous tissue and fascia, removal, subcutaneous tissue and fascia, trunk, stimulator generator, code by approach (there aren’t ICD-10-PCS codes for removal of stimulator generator from other body parts)|
|Type of Service||Surgical|
|Place of Service||Inpatient/Outpatient|
Electrical Nerve Stimulation, Spinal
Spinal Cord Stimulation
Stimulation, Electrical, Spinal Cord
|03/31/96||Add to Surgery section||New policy|
|04/01/98||Replace policy||Policy cross-referenced to No. 7.01.63|
|07/10/98||Replace policy||Policy updated and revised|
|11/15/98||Coding update||1999 CPT coding release|
|04/29/03||Replace policy||Policy updated; new policy statement added, stating that spinal cord stimulation is investigational as a treatment of critical limb ischemia|
|11/9/04||Replace policy||Policy updated; no change to policy statement. Coding updated|
|08/17/05||Replace policy||Policy updated with literature search and coding updated; no change to policy statement|
|12/14/05||Replace policy – coding update only||Coding updated|
|12/12/06||Replace policy||Policy updated with literature search; no change to policy statement; reference numbers 7 – 9 added|
|03/13/08||Replace policy||Policy updated with literature search; references 10 – 13 added; no change to policy statements|
|01/08/09||Replace policy||Policy updated with literature search; references 14–25 added. Use in refractory angina added as investigational indication.|
|01/14/10||Replace policy||Policy updated with literature search; reference numbers 26-29 added; no change to policy statements|
|01/13/11||Replace policy||Policy updated with literature search.
|
63685
|
PR INSJ/RPLCMT SPINAL NPG/RCVR POCKET CRTJ&CONNJ
|
HCPCS
|
Last accessed November, 2011. |CPT||63650||Percutaneous implantation of neurostimulator electrode array; epidural|
|63655||Laminectomy for implantation of neurostimulator electrode plate/paddle; epidural|
|63661||Removal of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63662||Removal of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy (new code 1/1/10)|
|63663||Revision including replacement, when performed, of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63664||Revision including replacement, when performed, of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy, including fluoroscopy, when performed (new code 1/1/10)|
|63685||Insertion or replacement of spinal neurostimulator pulse generator or receiver, direct or inductive coupling|
|63688||Revision or removal of implanted spinal neurostimulator pulse generator or receiver|
|95970, 95971, 95972, 95973||Neurostimulator programming and analysis code range|
|ICD-9 Procedure||03.93||Insertion or replacement of spinal neurostimulator|
|03.94||Removal of spinal neurostimulator lead(s)|
|86.05||Incision with removal of foreign body or device from skin and subcutaneous tissue (used to report removal of a neurostimulator pulse generator)|
|86.94||Insertion or replacement of single array neurostimulator pulse generator, not specified as rechargeable|
|86.95||Insertion or replacement of dual array neurostimulator pulse generator, not specified as rechargeable|
|86.97||Insertion or replacement of single array rechargeable neurostimulator pulse generator (new code effective 10/1/05)|
|86.98||Insertion or replacement of dual array rechargeable neurostimulator pulse generation (new code effective 10/1/05)|
|ICD-9 Diagnosis||See “Pain” in ICD-9 diagnosis index|
|HCPCS||L8680||Implantable neurostimulator electrode, each (new code effective 1/1/06)|
|L8685||Implantable neurostimulator pulse generator, single array, rechargeable, includes extension (new code effective 1/1/06)|
|L8686||Implantable neurostimulator pulse generator, single array, nonrechargeable, includes extension (new code effective 1/1/06)|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension (new code effective 1/1/06)|
|L8688||Implantable neurostimulator pulse generator, dual array, nonrechargeable, includes extension (new code effective 1/1/06)|
|ICD-10-CM (effective 10/1/14)||This list is a representative list of severe and chronic pain of the trunk and limbs diagnosis codes.|
|G56.40 -G56.42||Causalgia of upper limb code range|
|G57.70 -G57.72||Causalgia of lower limb code range|
|G89.21 -G89.8||Chronic pain, not elsewhere classified, code range|
|G89.4||Chronic pain syndrome|
|G90.50 -G90.59||Complex regional pain syndrome I (CRPS I), code range|
|M25.50 -M25.579||Pain in joint, code range|
|M54.10 -M54.18||Radiculopathy, code range|
|M54.30 -M54.32||Sciatica, code range|
|M54.40 -M54.42||Lumbago with sciatica, code range|
|M54.5||Low back pain|
|M54.6||Pain in thoracic spine|
|M54.81, M54.89||Other dorsalgia codes|
|M79.60 -M79.676||Pain in limb, hand, foot, fingers and toes code range|
|ICD-10-PCS (effective 10/1/14)||ICD-10-PCS codes are only used for inpatient services.|
|Surgical, central nervous system, insertion, spinal canal, neurostimulator lead, code by approach|
|00HV0MZ, 00HV3MZ, 00HV4MZ||Surgical, central nervous system, insertion, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, removal, spinal canal, neurostimulator lead, code by approach|
|00PV0MZ, 00PV3MZ, 00PV4MZ||Surgical, central nervous system, removal, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, revision, spinal canal, neurostimulator lead, code by approach|
|00WV0MZ, 00WV3MZ, 00WV4MZ||Surgical, central nervous system, revision, spinal cord, neurostimulator lead, code by approach|
|0JH60M6, 0JH60M7, 0JH60M8, 0JH60M9, 0JH63M6, 0JH63M7, 0JH63M8, 0JH63M9, 0JH70M6, 0JH70M7, 0JH70M8, 0JH70M9, 0JH73M6, 0JH73M7, 0JH73M8, 0JH73M9, 0JH80M6, 0JH80M7, 0JH80M8, 0JH80M9, 0JH83M6, 0JH83M7, 0JH83M8, 0JH83M9||Surgical, subcutaneous tissue and fascia, insertion, stimulator generator, code by body part, approach, number of arrays and whether rechargeable or not|
|0JPT0MZ, 0JPT3MZ||Surgical, subcutaneous tissue and fascia, removal, subcutaneous tissue and fascia, trunk, stimulator generator, code by approach (there aren’t ICD-10-PCS codes for removal of stimulator generator from other body parts)|
|Type of Service||Surgical|
|Place of Service||Inpatient/Outpatient|
Electrical Nerve Stimulation, Spinal
Spinal Cord Stimulation
Stimulation, Electrical, Spinal Cord
|03/31/96||Add to Surgery section||New policy|
|04/01/98||Replace policy||Policy cross-referenced to No. 7.01.63|
|07/10/98||Replace policy||Policy updated and revised|
|11/15/98||Coding update||1999 CPT coding release|
|04/29/03||Replace policy||Policy updated; new policy statement added, stating that spinal cord stimulation is investigational as a treatment of critical limb ischemia|
|11/9/04||Replace policy||Policy updated; no change to policy statement. Coding updated|
|08/17/05||Replace policy||Policy updated with literature search and coding updated; no change to policy statement|
|12/14/05||Replace policy – coding update only||Coding updated|
|12/12/06||Replace policy||Policy updated with literature search; no change to policy statement; reference numbers 7 – 9 added|
|03/13/08||Replace policy||Policy updated with literature search; references 10 – 13 added; no change to policy statements|
|01/08/09||Replace policy||Policy updated with literature search; references 14–25 added. Use in refractory angina added as investigational indication.|
|01/14/10||Replace policy||Policy updated with literature search; reference numbers 26-29 added; no change to policy statements|
|01/13/11||Replace policy||Policy updated with literature search.
|
63655
|
PR LAM IMPLTJ NSTIM ELTRDS PLATE/PADDLE EDRL
|
HCPCS
|
Last accessed November, 2011. |CPT||63650||Percutaneous implantation of neurostimulator electrode array; epidural|
|63655||Laminectomy for implantation of neurostimulator electrode plate/paddle; epidural|
|63661||Removal of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63662||Removal of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy (new code 1/1/10)|
|63663||Revision including replacement, when performed, of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63664||Revision including replacement, when performed, of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy, including fluoroscopy, when performed (new code 1/1/10)|
|63685||Insertion or replacement of spinal neurostimulator pulse generator or receiver, direct or inductive coupling|
|63688||Revision or removal of implanted spinal neurostimulator pulse generator or receiver|
|95970, 95971, 95972, 95973||Neurostimulator programming and analysis code range|
|ICD-9 Procedure||03.93||Insertion or replacement of spinal neurostimulator|
|03.94||Removal of spinal neurostimulator lead(s)|
|86.05||Incision with removal of foreign body or device from skin and subcutaneous tissue (used to report removal of a neurostimulator pulse generator)|
|86.94||Insertion or replacement of single array neurostimulator pulse generator, not specified as rechargeable|
|86.95||Insertion or replacement of dual array neurostimulator pulse generator, not specified as rechargeable|
|86.97||Insertion or replacement of single array rechargeable neurostimulator pulse generator (new code effective 10/1/05)|
|86.98||Insertion or replacement of dual array rechargeable neurostimulator pulse generation (new code effective 10/1/05)|
|ICD-9 Diagnosis||See “Pain” in ICD-9 diagnosis index|
|HCPCS||L8680||Implantable neurostimulator electrode, each (new code effective 1/1/06)|
|L8685||Implantable neurostimulator pulse generator, single array, rechargeable, includes extension (new code effective 1/1/06)|
|L8686||Implantable neurostimulator pulse generator, single array, nonrechargeable, includes extension (new code effective 1/1/06)|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension (new code effective 1/1/06)|
|L8688||Implantable neurostimulator pulse generator, dual array, nonrechargeable, includes extension (new code effective 1/1/06)|
|ICD-10-CM (effective 10/1/14)||This list is a representative list of severe and chronic pain of the trunk and limbs diagnosis codes.|
|G56.40 -G56.42||Causalgia of upper limb code range|
|G57.70 -G57.72||Causalgia of lower limb code range|
|G89.21 -G89.8||Chronic pain, not elsewhere classified, code range|
|G89.4||Chronic pain syndrome|
|G90.50 -G90.59||Complex regional pain syndrome I (CRPS I), code range|
|M25.50 -M25.579||Pain in joint, code range|
|M54.10 -M54.18||Radiculopathy, code range|
|M54.30 -M54.32||Sciatica, code range|
|M54.40 -M54.42||Lumbago with sciatica, code range|
|M54.5||Low back pain|
|M54.6||Pain in thoracic spine|
|M54.81, M54.89||Other dorsalgia codes|
|M79.60 -M79.676||Pain in limb, hand, foot, fingers and toes code range|
|ICD-10-PCS (effective 10/1/14)||ICD-10-PCS codes are only used for inpatient services.|
|Surgical, central nervous system, insertion, spinal canal, neurostimulator lead, code by approach|
|00HV0MZ, 00HV3MZ, 00HV4MZ||Surgical, central nervous system, insertion, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, removal, spinal canal, neurostimulator lead, code by approach|
|00PV0MZ, 00PV3MZ, 00PV4MZ||Surgical, central nervous system, removal, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, revision, spinal canal, neurostimulator lead, code by approach|
|00WV0MZ, 00WV3MZ, 00WV4MZ||Surgical, central nervous system, revision, spinal cord, neurostimulator lead, code by approach|
|0JH60M6, 0JH60M7, 0JH60M8, 0JH60M9, 0JH63M6, 0JH63M7, 0JH63M8, 0JH63M9, 0JH70M6, 0JH70M7, 0JH70M8, 0JH70M9, 0JH73M6, 0JH73M7, 0JH73M8, 0JH73M9, 0JH80M6, 0JH80M7, 0JH80M8, 0JH80M9, 0JH83M6, 0JH83M7, 0JH83M8, 0JH83M9||Surgical, subcutaneous tissue and fascia, insertion, stimulator generator, code by body part, approach, number of arrays and whether rechargeable or not|
|0JPT0MZ, 0JPT3MZ||Surgical, subcutaneous tissue and fascia, removal, subcutaneous tissue and fascia, trunk, stimulator generator, code by approach (there aren’t ICD-10-PCS codes for removal of stimulator generator from other body parts)|
|Type of Service||Surgical|
|Place of Service||Inpatient/Outpatient|
Electrical Nerve Stimulation, Spinal
Spinal Cord Stimulation
Stimulation, Electrical, Spinal Cord
|03/31/96||Add to Surgery section||New policy|
|04/01/98||Replace policy||Policy cross-referenced to No. 7.01.63|
|07/10/98||Replace policy||Policy updated and revised|
|11/15/98||Coding update||1999 CPT coding release|
|04/29/03||Replace policy||Policy updated; new policy statement added, stating that spinal cord stimulation is investigational as a treatment of critical limb ischemia|
|11/9/04||Replace policy||Policy updated; no change to policy statement. Coding updated|
|08/17/05||Replace policy||Policy updated with literature search and coding updated; no change to policy statement|
|12/14/05||Replace policy – coding update only||Coding updated|
|12/12/06||Replace policy||Policy updated with literature search; no change to policy statement; reference numbers 7 – 9 added|
|03/13/08||Replace policy||Policy updated with literature search; references 10 – 13 added; no change to policy statements|
|01/08/09||Replace policy||Policy updated with literature search; references 14–25 added. Use in refractory angina added as investigational indication.|
|01/14/10||Replace policy||Policy updated with literature search; reference numbers 26-29 added; no change to policy statements|
|01/13/11||Replace policy||Policy updated with literature search.
|
95971
|
PR ELEC ALYS IMPLT NPGT SMPL SP/PN NPGT PRGRMG
|
HCPCS
|
Last accessed November, 2011. |CPT||63650||Percutaneous implantation of neurostimulator electrode array; epidural|
|63655||Laminectomy for implantation of neurostimulator electrode plate/paddle; epidural|
|63661||Removal of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63662||Removal of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy (new code 1/1/10)|
|63663||Revision including replacement, when performed, of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63664||Revision including replacement, when performed, of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy, including fluoroscopy, when performed (new code 1/1/10)|
|63685||Insertion or replacement of spinal neurostimulator pulse generator or receiver, direct or inductive coupling|
|63688||Revision or removal of implanted spinal neurostimulator pulse generator or receiver|
|95970, 95971, 95972, 95973||Neurostimulator programming and analysis code range|
|ICD-9 Procedure||03.93||Insertion or replacement of spinal neurostimulator|
|03.94||Removal of spinal neurostimulator lead(s)|
|86.05||Incision with removal of foreign body or device from skin and subcutaneous tissue (used to report removal of a neurostimulator pulse generator)|
|86.94||Insertion or replacement of single array neurostimulator pulse generator, not specified as rechargeable|
|86.95||Insertion or replacement of dual array neurostimulator pulse generator, not specified as rechargeable|
|86.97||Insertion or replacement of single array rechargeable neurostimulator pulse generator (new code effective 10/1/05)|
|86.98||Insertion or replacement of dual array rechargeable neurostimulator pulse generation (new code effective 10/1/05)|
|ICD-9 Diagnosis||See “Pain” in ICD-9 diagnosis index|
|HCPCS||L8680||Implantable neurostimulator electrode, each (new code effective 1/1/06)|
|L8685||Implantable neurostimulator pulse generator, single array, rechargeable, includes extension (new code effective 1/1/06)|
|L8686||Implantable neurostimulator pulse generator, single array, nonrechargeable, includes extension (new code effective 1/1/06)|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension (new code effective 1/1/06)|
|L8688||Implantable neurostimulator pulse generator, dual array, nonrechargeable, includes extension (new code effective 1/1/06)|
|ICD-10-CM (effective 10/1/14)||This list is a representative list of severe and chronic pain of the trunk and limbs diagnosis codes.|
|G56.40 -G56.42||Causalgia of upper limb code range|
|G57.70 -G57.72||Causalgia of lower limb code range|
|G89.21 -G89.8||Chronic pain, not elsewhere classified, code range|
|G89.4||Chronic pain syndrome|
|G90.50 -G90.59||Complex regional pain syndrome I (CRPS I), code range|
|M25.50 -M25.579||Pain in joint, code range|
|M54.10 -M54.18||Radiculopathy, code range|
|M54.30 -M54.32||Sciatica, code range|
|M54.40 -M54.42||Lumbago with sciatica, code range|
|M54.5||Low back pain|
|M54.6||Pain in thoracic spine|
|M54.81, M54.89||Other dorsalgia codes|
|M79.60 -M79.676||Pain in limb, hand, foot, fingers and toes code range|
|ICD-10-PCS (effective 10/1/14)||ICD-10-PCS codes are only used for inpatient services.|
|Surgical, central nervous system, insertion, spinal canal, neurostimulator lead, code by approach|
|00HV0MZ, 00HV3MZ, 00HV4MZ||Surgical, central nervous system, insertion, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, removal, spinal canal, neurostimulator lead, code by approach|
|00PV0MZ, 00PV3MZ, 00PV4MZ||Surgical, central nervous system, removal, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, revision, spinal canal, neurostimulator lead, code by approach|
|00WV0MZ, 00WV3MZ, 00WV4MZ||Surgical, central nervous system, revision, spinal cord, neurostimulator lead, code by approach|
|0JH60M6, 0JH60M7, 0JH60M8, 0JH60M9, 0JH63M6, 0JH63M7, 0JH63M8, 0JH63M9, 0JH70M6, 0JH70M7, 0JH70M8, 0JH70M9, 0JH73M6, 0JH73M7, 0JH73M8, 0JH73M9, 0JH80M6, 0JH80M7, 0JH80M8, 0JH80M9, 0JH83M6, 0JH83M7, 0JH83M8, 0JH83M9||Surgical, subcutaneous tissue and fascia, insertion, stimulator generator, code by body part, approach, number of arrays and whether rechargeable or not|
|0JPT0MZ, 0JPT3MZ||Surgical, subcutaneous tissue and fascia, removal, subcutaneous tissue and fascia, trunk, stimulator generator, code by approach (there aren’t ICD-10-PCS codes for removal of stimulator generator from other body parts)|
|Type of Service||Surgical|
|Place of Service||Inpatient/Outpatient|
Electrical Nerve Stimulation, Spinal
Spinal Cord Stimulation
Stimulation, Electrical, Spinal Cord
|03/31/96||Add to Surgery section||New policy|
|04/01/98||Replace policy||Policy cross-referenced to No. 7.01.63|
|07/10/98||Replace policy||Policy updated and revised|
|11/15/98||Coding update||1999 CPT coding release|
|04/29/03||Replace policy||Policy updated; new policy statement added, stating that spinal cord stimulation is investigational as a treatment of critical limb ischemia|
|11/9/04||Replace policy||Policy updated; no change to policy statement. Coding updated|
|08/17/05||Replace policy||Policy updated with literature search and coding updated; no change to policy statement|
|12/14/05||Replace policy – coding update only||Coding updated|
|12/12/06||Replace policy||Policy updated with literature search; no change to policy statement; reference numbers 7 – 9 added|
|03/13/08||Replace policy||Policy updated with literature search; references 10 – 13 added; no change to policy statements|
|01/08/09||Replace policy||Policy updated with literature search; references 14–25 added. Use in refractory angina added as investigational indication.|
|01/14/10||Replace policy||Policy updated with literature search; reference numbers 26-29 added; no change to policy statements|
|01/13/11||Replace policy||Policy updated with literature search.
|
L8686
|
Implt nrostm pls gen sng non
|
HCPCS
|
Last accessed November, 2011. |CPT||63650||Percutaneous implantation of neurostimulator electrode array; epidural|
|63655||Laminectomy for implantation of neurostimulator electrode plate/paddle; epidural|
|63661||Removal of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63662||Removal of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy (new code 1/1/10)|
|63663||Revision including replacement, when performed, of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63664||Revision including replacement, when performed, of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy, including fluoroscopy, when performed (new code 1/1/10)|
|63685||Insertion or replacement of spinal neurostimulator pulse generator or receiver, direct or inductive coupling|
|63688||Revision or removal of implanted spinal neurostimulator pulse generator or receiver|
|95970, 95971, 95972, 95973||Neurostimulator programming and analysis code range|
|ICD-9 Procedure||03.93||Insertion or replacement of spinal neurostimulator|
|03.94||Removal of spinal neurostimulator lead(s)|
|86.05||Incision with removal of foreign body or device from skin and subcutaneous tissue (used to report removal of a neurostimulator pulse generator)|
|86.94||Insertion or replacement of single array neurostimulator pulse generator, not specified as rechargeable|
|86.95||Insertion or replacement of dual array neurostimulator pulse generator, not specified as rechargeable|
|86.97||Insertion or replacement of single array rechargeable neurostimulator pulse generator (new code effective 10/1/05)|
|86.98||Insertion or replacement of dual array rechargeable neurostimulator pulse generation (new code effective 10/1/05)|
|ICD-9 Diagnosis||See “Pain” in ICD-9 diagnosis index|
|HCPCS||L8680||Implantable neurostimulator electrode, each (new code effective 1/1/06)|
|L8685||Implantable neurostimulator pulse generator, single array, rechargeable, includes extension (new code effective 1/1/06)|
|L8686||Implantable neurostimulator pulse generator, single array, nonrechargeable, includes extension (new code effective 1/1/06)|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension (new code effective 1/1/06)|
|L8688||Implantable neurostimulator pulse generator, dual array, nonrechargeable, includes extension (new code effective 1/1/06)|
|ICD-10-CM (effective 10/1/14)||This list is a representative list of severe and chronic pain of the trunk and limbs diagnosis codes.|
|G56.40 -G56.42||Causalgia of upper limb code range|
|G57.70 -G57.72||Causalgia of lower limb code range|
|G89.21 -G89.8||Chronic pain, not elsewhere classified, code range|
|G89.4||Chronic pain syndrome|
|G90.50 -G90.59||Complex regional pain syndrome I (CRPS I), code range|
|M25.50 -M25.579||Pain in joint, code range|
|M54.10 -M54.18||Radiculopathy, code range|
|M54.30 -M54.32||Sciatica, code range|
|M54.40 -M54.42||Lumbago with sciatica, code range|
|M54.5||Low back pain|
|M54.6||Pain in thoracic spine|
|M54.81, M54.89||Other dorsalgia codes|
|M79.60 -M79.676||Pain in limb, hand, foot, fingers and toes code range|
|ICD-10-PCS (effective 10/1/14)||ICD-10-PCS codes are only used for inpatient services.|
|Surgical, central nervous system, insertion, spinal canal, neurostimulator lead, code by approach|
|00HV0MZ, 00HV3MZ, 00HV4MZ||Surgical, central nervous system, insertion, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, removal, spinal canal, neurostimulator lead, code by approach|
|00PV0MZ, 00PV3MZ, 00PV4MZ||Surgical, central nervous system, removal, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, revision, spinal canal, neurostimulator lead, code by approach|
|00WV0MZ, 00WV3MZ, 00WV4MZ||Surgical, central nervous system, revision, spinal cord, neurostimulator lead, code by approach|
|0JH60M6, 0JH60M7, 0JH60M8, 0JH60M9, 0JH63M6, 0JH63M7, 0JH63M8, 0JH63M9, 0JH70M6, 0JH70M7, 0JH70M8, 0JH70M9, 0JH73M6, 0JH73M7, 0JH73M8, 0JH73M9, 0JH80M6, 0JH80M7, 0JH80M8, 0JH80M9, 0JH83M6, 0JH83M7, 0JH83M8, 0JH83M9||Surgical, subcutaneous tissue and fascia, insertion, stimulator generator, code by body part, approach, number of arrays and whether rechargeable or not|
|0JPT0MZ, 0JPT3MZ||Surgical, subcutaneous tissue and fascia, removal, subcutaneous tissue and fascia, trunk, stimulator generator, code by approach (there aren’t ICD-10-PCS codes for removal of stimulator generator from other body parts)|
|Type of Service||Surgical|
|Place of Service||Inpatient/Outpatient|
Electrical Nerve Stimulation, Spinal
Spinal Cord Stimulation
Stimulation, Electrical, Spinal Cord
|03/31/96||Add to Surgery section||New policy|
|04/01/98||Replace policy||Policy cross-referenced to No. 7.01.63|
|07/10/98||Replace policy||Policy updated and revised|
|11/15/98||Coding update||1999 CPT coding release|
|04/29/03||Replace policy||Policy updated; new policy statement added, stating that spinal cord stimulation is investigational as a treatment of critical limb ischemia|
|11/9/04||Replace policy||Policy updated; no change to policy statement. Coding updated|
|08/17/05||Replace policy||Policy updated with literature search and coding updated; no change to policy statement|
|12/14/05||Replace policy – coding update only||Coding updated|
|12/12/06||Replace policy||Policy updated with literature search; no change to policy statement; reference numbers 7 – 9 added|
|03/13/08||Replace policy||Policy updated with literature search; references 10 – 13 added; no change to policy statements|
|01/08/09||Replace policy||Policy updated with literature search; references 14–25 added. Use in refractory angina added as investigational indication.|
|01/14/10||Replace policy||Policy updated with literature search; reference numbers 26-29 added; no change to policy statements|
|01/13/11||Replace policy||Policy updated with literature search.
|
63664
|
Revise spine eltrd plate
|
HCPCS
|
Last accessed November, 2011. |CPT||63650||Percutaneous implantation of neurostimulator electrode array; epidural|
|63655||Laminectomy for implantation of neurostimulator electrode plate/paddle; epidural|
|63661||Removal of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63662||Removal of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy (new code 1/1/10)|
|63663||Revision including replacement, when performed, of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63664||Revision including replacement, when performed, of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy, including fluoroscopy, when performed (new code 1/1/10)|
|63685||Insertion or replacement of spinal neurostimulator pulse generator or receiver, direct or inductive coupling|
|63688||Revision or removal of implanted spinal neurostimulator pulse generator or receiver|
|95970, 95971, 95972, 95973||Neurostimulator programming and analysis code range|
|ICD-9 Procedure||03.93||Insertion or replacement of spinal neurostimulator|
|03.94||Removal of spinal neurostimulator lead(s)|
|86.05||Incision with removal of foreign body or device from skin and subcutaneous tissue (used to report removal of a neurostimulator pulse generator)|
|86.94||Insertion or replacement of single array neurostimulator pulse generator, not specified as rechargeable|
|86.95||Insertion or replacement of dual array neurostimulator pulse generator, not specified as rechargeable|
|86.97||Insertion or replacement of single array rechargeable neurostimulator pulse generator (new code effective 10/1/05)|
|86.98||Insertion or replacement of dual array rechargeable neurostimulator pulse generation (new code effective 10/1/05)|
|ICD-9 Diagnosis||See “Pain” in ICD-9 diagnosis index|
|HCPCS||L8680||Implantable neurostimulator electrode, each (new code effective 1/1/06)|
|L8685||Implantable neurostimulator pulse generator, single array, rechargeable, includes extension (new code effective 1/1/06)|
|L8686||Implantable neurostimulator pulse generator, single array, nonrechargeable, includes extension (new code effective 1/1/06)|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension (new code effective 1/1/06)|
|L8688||Implantable neurostimulator pulse generator, dual array, nonrechargeable, includes extension (new code effective 1/1/06)|
|ICD-10-CM (effective 10/1/14)||This list is a representative list of severe and chronic pain of the trunk and limbs diagnosis codes.|
|G56.40 -G56.42||Causalgia of upper limb code range|
|G57.70 -G57.72||Causalgia of lower limb code range|
|G89.21 -G89.8||Chronic pain, not elsewhere classified, code range|
|G89.4||Chronic pain syndrome|
|G90.50 -G90.59||Complex regional pain syndrome I (CRPS I), code range|
|M25.50 -M25.579||Pain in joint, code range|
|M54.10 -M54.18||Radiculopathy, code range|
|M54.30 -M54.32||Sciatica, code range|
|M54.40 -M54.42||Lumbago with sciatica, code range|
|M54.5||Low back pain|
|M54.6||Pain in thoracic spine|
|M54.81, M54.89||Other dorsalgia codes|
|M79.60 -M79.676||Pain in limb, hand, foot, fingers and toes code range|
|ICD-10-PCS (effective 10/1/14)||ICD-10-PCS codes are only used for inpatient services.|
|Surgical, central nervous system, insertion, spinal canal, neurostimulator lead, code by approach|
|00HV0MZ, 00HV3MZ, 00HV4MZ||Surgical, central nervous system, insertion, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, removal, spinal canal, neurostimulator lead, code by approach|
|00PV0MZ, 00PV3MZ, 00PV4MZ||Surgical, central nervous system, removal, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, revision, spinal canal, neurostimulator lead, code by approach|
|00WV0MZ, 00WV3MZ, 00WV4MZ||Surgical, central nervous system, revision, spinal cord, neurostimulator lead, code by approach|
|0JH60M6, 0JH60M7, 0JH60M8, 0JH60M9, 0JH63M6, 0JH63M7, 0JH63M8, 0JH63M9, 0JH70M6, 0JH70M7, 0JH70M8, 0JH70M9, 0JH73M6, 0JH73M7, 0JH73M8, 0JH73M9, 0JH80M6, 0JH80M7, 0JH80M8, 0JH80M9, 0JH83M6, 0JH83M7, 0JH83M8, 0JH83M9||Surgical, subcutaneous tissue and fascia, insertion, stimulator generator, code by body part, approach, number of arrays and whether rechargeable or not|
|0JPT0MZ, 0JPT3MZ||Surgical, subcutaneous tissue and fascia, removal, subcutaneous tissue and fascia, trunk, stimulator generator, code by approach (there aren’t ICD-10-PCS codes for removal of stimulator generator from other body parts)|
|Type of Service||Surgical|
|Place of Service||Inpatient/Outpatient|
Electrical Nerve Stimulation, Spinal
Spinal Cord Stimulation
Stimulation, Electrical, Spinal Cord
|03/31/96||Add to Surgery section||New policy|
|04/01/98||Replace policy||Policy cross-referenced to No. 7.01.63|
|07/10/98||Replace policy||Policy updated and revised|
|11/15/98||Coding update||1999 CPT coding release|
|04/29/03||Replace policy||Policy updated; new policy statement added, stating that spinal cord stimulation is investigational as a treatment of critical limb ischemia|
|11/9/04||Replace policy||Policy updated; no change to policy statement. Coding updated|
|08/17/05||Replace policy||Policy updated with literature search and coding updated; no change to policy statement|
|12/14/05||Replace policy – coding update only||Coding updated|
|12/12/06||Replace policy||Policy updated with literature search; no change to policy statement; reference numbers 7 – 9 added|
|03/13/08||Replace policy||Policy updated with literature search; references 10 – 13 added; no change to policy statements|
|01/08/09||Replace policy||Policy updated with literature search; references 14–25 added. Use in refractory angina added as investigational indication.|
|01/14/10||Replace policy||Policy updated with literature search; reference numbers 26-29 added; no change to policy statements|
|01/13/11||Replace policy||Policy updated with literature search.
|
L8685
|
Implt nrostm pls gen sng rec
|
HCPCS
|
Last accessed November, 2011. |CPT||63650||Percutaneous implantation of neurostimulator electrode array; epidural|
|63655||Laminectomy for implantation of neurostimulator electrode plate/paddle; epidural|
|63661||Removal of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63662||Removal of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy (new code 1/1/10)|
|63663||Revision including replacement, when performed, of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63664||Revision including replacement, when performed, of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy, including fluoroscopy, when performed (new code 1/1/10)|
|63685||Insertion or replacement of spinal neurostimulator pulse generator or receiver, direct or inductive coupling|
|63688||Revision or removal of implanted spinal neurostimulator pulse generator or receiver|
|95970, 95971, 95972, 95973||Neurostimulator programming and analysis code range|
|ICD-9 Procedure||03.93||Insertion or replacement of spinal neurostimulator|
|03.94||Removal of spinal neurostimulator lead(s)|
|86.05||Incision with removal of foreign body or device from skin and subcutaneous tissue (used to report removal of a neurostimulator pulse generator)|
|86.94||Insertion or replacement of single array neurostimulator pulse generator, not specified as rechargeable|
|86.95||Insertion or replacement of dual array neurostimulator pulse generator, not specified as rechargeable|
|86.97||Insertion or replacement of single array rechargeable neurostimulator pulse generator (new code effective 10/1/05)|
|86.98||Insertion or replacement of dual array rechargeable neurostimulator pulse generation (new code effective 10/1/05)|
|ICD-9 Diagnosis||See “Pain” in ICD-9 diagnosis index|
|HCPCS||L8680||Implantable neurostimulator electrode, each (new code effective 1/1/06)|
|L8685||Implantable neurostimulator pulse generator, single array, rechargeable, includes extension (new code effective 1/1/06)|
|L8686||Implantable neurostimulator pulse generator, single array, nonrechargeable, includes extension (new code effective 1/1/06)|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension (new code effective 1/1/06)|
|L8688||Implantable neurostimulator pulse generator, dual array, nonrechargeable, includes extension (new code effective 1/1/06)|
|ICD-10-CM (effective 10/1/14)||This list is a representative list of severe and chronic pain of the trunk and limbs diagnosis codes.|
|G56.40 -G56.42||Causalgia of upper limb code range|
|G57.70 -G57.72||Causalgia of lower limb code range|
|G89.21 -G89.8||Chronic pain, not elsewhere classified, code range|
|G89.4||Chronic pain syndrome|
|G90.50 -G90.59||Complex regional pain syndrome I (CRPS I), code range|
|M25.50 -M25.579||Pain in joint, code range|
|M54.10 -M54.18||Radiculopathy, code range|
|M54.30 -M54.32||Sciatica, code range|
|M54.40 -M54.42||Lumbago with sciatica, code range|
|M54.5||Low back pain|
|M54.6||Pain in thoracic spine|
|M54.81, M54.89||Other dorsalgia codes|
|M79.60 -M79.676||Pain in limb, hand, foot, fingers and toes code range|
|ICD-10-PCS (effective 10/1/14)||ICD-10-PCS codes are only used for inpatient services.|
|Surgical, central nervous system, insertion, spinal canal, neurostimulator lead, code by approach|
|00HV0MZ, 00HV3MZ, 00HV4MZ||Surgical, central nervous system, insertion, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, removal, spinal canal, neurostimulator lead, code by approach|
|00PV0MZ, 00PV3MZ, 00PV4MZ||Surgical, central nervous system, removal, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, revision, spinal canal, neurostimulator lead, code by approach|
|00WV0MZ, 00WV3MZ, 00WV4MZ||Surgical, central nervous system, revision, spinal cord, neurostimulator lead, code by approach|
|0JH60M6, 0JH60M7, 0JH60M8, 0JH60M9, 0JH63M6, 0JH63M7, 0JH63M8, 0JH63M9, 0JH70M6, 0JH70M7, 0JH70M8, 0JH70M9, 0JH73M6, 0JH73M7, 0JH73M8, 0JH73M9, 0JH80M6, 0JH80M7, 0JH80M8, 0JH80M9, 0JH83M6, 0JH83M7, 0JH83M8, 0JH83M9||Surgical, subcutaneous tissue and fascia, insertion, stimulator generator, code by body part, approach, number of arrays and whether rechargeable or not|
|0JPT0MZ, 0JPT3MZ||Surgical, subcutaneous tissue and fascia, removal, subcutaneous tissue and fascia, trunk, stimulator generator, code by approach (there aren’t ICD-10-PCS codes for removal of stimulator generator from other body parts)|
|Type of Service||Surgical|
|Place of Service||Inpatient/Outpatient|
Electrical Nerve Stimulation, Spinal
Spinal Cord Stimulation
Stimulation, Electrical, Spinal Cord
|03/31/96||Add to Surgery section||New policy|
|04/01/98||Replace policy||Policy cross-referenced to No. 7.01.63|
|07/10/98||Replace policy||Policy updated and revised|
|11/15/98||Coding update||1999 CPT coding release|
|04/29/03||Replace policy||Policy updated; new policy statement added, stating that spinal cord stimulation is investigational as a treatment of critical limb ischemia|
|11/9/04||Replace policy||Policy updated; no change to policy statement. Coding updated|
|08/17/05||Replace policy||Policy updated with literature search and coding updated; no change to policy statement|
|12/14/05||Replace policy – coding update only||Coding updated|
|12/12/06||Replace policy||Policy updated with literature search; no change to policy statement; reference numbers 7 – 9 added|
|03/13/08||Replace policy||Policy updated with literature search; references 10 – 13 added; no change to policy statements|
|01/08/09||Replace policy||Policy updated with literature search; references 14–25 added. Use in refractory angina added as investigational indication.|
|01/14/10||Replace policy||Policy updated with literature search; reference numbers 26-29 added; no change to policy statements|
|01/13/11||Replace policy||Policy updated with literature search.
|
95973
|
Analyze neurostim complex
|
HCPCS
|
Last accessed November, 2011. |CPT||63650||Percutaneous implantation of neurostimulator electrode array; epidural|
|63655||Laminectomy for implantation of neurostimulator electrode plate/paddle; epidural|
|63661||Removal of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63662||Removal of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy (new code 1/1/10)|
|63663||Revision including replacement, when performed, of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63664||Revision including replacement, when performed, of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy, including fluoroscopy, when performed (new code 1/1/10)|
|63685||Insertion or replacement of spinal neurostimulator pulse generator or receiver, direct or inductive coupling|
|63688||Revision or removal of implanted spinal neurostimulator pulse generator or receiver|
|95970, 95971, 95972, 95973||Neurostimulator programming and analysis code range|
|ICD-9 Procedure||03.93||Insertion or replacement of spinal neurostimulator|
|03.94||Removal of spinal neurostimulator lead(s)|
|86.05||Incision with removal of foreign body or device from skin and subcutaneous tissue (used to report removal of a neurostimulator pulse generator)|
|86.94||Insertion or replacement of single array neurostimulator pulse generator, not specified as rechargeable|
|86.95||Insertion or replacement of dual array neurostimulator pulse generator, not specified as rechargeable|
|86.97||Insertion or replacement of single array rechargeable neurostimulator pulse generator (new code effective 10/1/05)|
|86.98||Insertion or replacement of dual array rechargeable neurostimulator pulse generation (new code effective 10/1/05)|
|ICD-9 Diagnosis||See “Pain” in ICD-9 diagnosis index|
|HCPCS||L8680||Implantable neurostimulator electrode, each (new code effective 1/1/06)|
|L8685||Implantable neurostimulator pulse generator, single array, rechargeable, includes extension (new code effective 1/1/06)|
|L8686||Implantable neurostimulator pulse generator, single array, nonrechargeable, includes extension (new code effective 1/1/06)|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension (new code effective 1/1/06)|
|L8688||Implantable neurostimulator pulse generator, dual array, nonrechargeable, includes extension (new code effective 1/1/06)|
|ICD-10-CM (effective 10/1/14)||This list is a representative list of severe and chronic pain of the trunk and limbs diagnosis codes.|
|G56.40 -G56.42||Causalgia of upper limb code range|
|G57.70 -G57.72||Causalgia of lower limb code range|
|G89.21 -G89.8||Chronic pain, not elsewhere classified, code range|
|G89.4||Chronic pain syndrome|
|G90.50 -G90.59||Complex regional pain syndrome I (CRPS I), code range|
|M25.50 -M25.579||Pain in joint, code range|
|M54.10 -M54.18||Radiculopathy, code range|
|M54.30 -M54.32||Sciatica, code range|
|M54.40 -M54.42||Lumbago with sciatica, code range|
|M54.5||Low back pain|
|M54.6||Pain in thoracic spine|
|M54.81, M54.89||Other dorsalgia codes|
|M79.60 -M79.676||Pain in limb, hand, foot, fingers and toes code range|
|ICD-10-PCS (effective 10/1/14)||ICD-10-PCS codes are only used for inpatient services.|
|Surgical, central nervous system, insertion, spinal canal, neurostimulator lead, code by approach|
|00HV0MZ, 00HV3MZ, 00HV4MZ||Surgical, central nervous system, insertion, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, removal, spinal canal, neurostimulator lead, code by approach|
|00PV0MZ, 00PV3MZ, 00PV4MZ||Surgical, central nervous system, removal, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, revision, spinal canal, neurostimulator lead, code by approach|
|00WV0MZ, 00WV3MZ, 00WV4MZ||Surgical, central nervous system, revision, spinal cord, neurostimulator lead, code by approach|
|0JH60M6, 0JH60M7, 0JH60M8, 0JH60M9, 0JH63M6, 0JH63M7, 0JH63M8, 0JH63M9, 0JH70M6, 0JH70M7, 0JH70M8, 0JH70M9, 0JH73M6, 0JH73M7, 0JH73M8, 0JH73M9, 0JH80M6, 0JH80M7, 0JH80M8, 0JH80M9, 0JH83M6, 0JH83M7, 0JH83M8, 0JH83M9||Surgical, subcutaneous tissue and fascia, insertion, stimulator generator, code by body part, approach, number of arrays and whether rechargeable or not|
|0JPT0MZ, 0JPT3MZ||Surgical, subcutaneous tissue and fascia, removal, subcutaneous tissue and fascia, trunk, stimulator generator, code by approach (there aren’t ICD-10-PCS codes for removal of stimulator generator from other body parts)|
|Type of Service||Surgical|
|Place of Service||Inpatient/Outpatient|
Electrical Nerve Stimulation, Spinal
Spinal Cord Stimulation
Stimulation, Electrical, Spinal Cord
|03/31/96||Add to Surgery section||New policy|
|04/01/98||Replace policy||Policy cross-referenced to No. 7.01.63|
|07/10/98||Replace policy||Policy updated and revised|
|11/15/98||Coding update||1999 CPT coding release|
|04/29/03||Replace policy||Policy updated; new policy statement added, stating that spinal cord stimulation is investigational as a treatment of critical limb ischemia|
|11/9/04||Replace policy||Policy updated; no change to policy statement. Coding updated|
|08/17/05||Replace policy||Policy updated with literature search and coding updated; no change to policy statement|
|12/14/05||Replace policy – coding update only||Coding updated|
|12/12/06||Replace policy||Policy updated with literature search; no change to policy statement; reference numbers 7 – 9 added|
|03/13/08||Replace policy||Policy updated with literature search; references 10 – 13 added; no change to policy statements|
|01/08/09||Replace policy||Policy updated with literature search; references 14–25 added. Use in refractory angina added as investigational indication.|
|01/14/10||Replace policy||Policy updated with literature search; reference numbers 26-29 added; no change to policy statements|
|01/13/11||Replace policy||Policy updated with literature search.
|
63650
|
PR PRQ IMPLTJ NSTIM ELECTRODE ARRAY EPIDURAL
|
HCPCS
|
|CPT||63650||Percutaneous implantation of neurostimulator electrode array; epidural|
|63655||Laminectomy for implantation of neurostimulator electrode plate/paddle; epidural|
|63661||Removal of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63662||Removal of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy (new code 1/1/10)|
|63663||Revision including replacement, when performed, of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63664||Revision including replacement, when performed, of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy, including fluoroscopy, when performed (new code 1/1/10)|
|63685||Insertion or replacement of spinal neurostimulator pulse generator or receiver, direct or inductive coupling|
|63688||Revision or removal of implanted spinal neurostimulator pulse generator or receiver|
|95970, 95971, 95972, 95973||Neurostimulator programming and analysis code range|
|ICD-9 Procedure||03.93||Insertion or replacement of spinal neurostimulator|
|03.94||Removal of spinal neurostimulator lead(s)|
|86.05||Incision with removal of foreign body or device from skin and subcutaneous tissue (used to report removal of a neurostimulator pulse generator)|
|86.94||Insertion or replacement of single array neurostimulator pulse generator, not specified as rechargeable|
|86.95||Insertion or replacement of dual array neurostimulator pulse generator, not specified as rechargeable|
|86.97||Insertion or replacement of single array rechargeable neurostimulator pulse generator (new code effective 10/1/05)|
|86.98||Insertion or replacement of dual array rechargeable neurostimulator pulse generation (new code effective 10/1/05)|
|ICD-9 Diagnosis||See “Pain” in ICD-9 diagnosis index|
|HCPCS||L8680||Implantable neurostimulator electrode, each (new code effective 1/1/06)|
|L8685||Implantable neurostimulator pulse generator, single array, rechargeable, includes extension (new code effective 1/1/06)|
|L8686||Implantable neurostimulator pulse generator, single array, nonrechargeable, includes extension (new code effective 1/1/06)|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension (new code effective 1/1/06)|
|L8688||Implantable neurostimulator pulse generator, dual array, nonrechargeable, includes extension (new code effective 1/1/06)|
|ICD-10-CM (effective 10/1/14)||This list is a representative list of severe and chronic pain of the trunk and limbs diagnosis codes.|
|G56.40 -G56.42||Causalgia of upper limb code range|
|G57.70 -G57.72||Causalgia of lower limb code range|
|G89.21 -G89.8||Chronic pain, not elsewhere classified, code range|
|G89.4||Chronic pain syndrome|
|G90.50 -G90.59||Complex regional pain syndrome I (CRPS I), code range|
|M25.50 -M25.579||Pain in joint, code range|
|M54.10 -M54.18||Radiculopathy, code range|
|M54.30 -M54.32||Sciatica, code range|
|M54.40 -M54.42||Lumbago with sciatica, code range|
|M54.5||Low back pain|
|M54.6||Pain in thoracic spine|
|M54.81, M54.89||Other dorsalgia codes|
|M79.60 -M79.676||Pain in limb, hand, foot, fingers and toes code range|
|ICD-10-PCS (effective 10/1/14)||ICD-10-PCS codes are only used for inpatient services.|
|Surgical, central nervous system, insertion, spinal canal, neurostimulator lead, code by approach|
|00HV0MZ, 00HV3MZ, 00HV4MZ||Surgical, central nervous system, insertion, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, removal, spinal canal, neurostimulator lead, code by approach|
|00PV0MZ, 00PV3MZ, 00PV4MZ||Surgical, central nervous system, removal, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, revision, spinal canal, neurostimulator lead, code by approach|
|00WV0MZ, 00WV3MZ, 00WV4MZ||Surgical, central nervous system, revision, spinal cord, neurostimulator lead, code by approach|
|0JH60M6, 0JH60M7, 0JH60M8, 0JH60M9, 0JH63M6, 0JH63M7, 0JH63M8, 0JH63M9, 0JH70M6, 0JH70M7, 0JH70M8, 0JH70M9, 0JH73M6, 0JH73M7, 0JH73M8, 0JH73M9, 0JH80M6, 0JH80M7, 0JH80M8, 0JH80M9, 0JH83M6, 0JH83M7, 0JH83M8, 0JH83M9||Surgical, subcutaneous tissue and fascia, insertion, stimulator generator, code by body part, approach, number of arrays and whether rechargeable or not|
|0JPT0MZ, 0JPT3MZ||Surgical, subcutaneous tissue and fascia, removal, subcutaneous tissue and fascia, trunk, stimulator generator, code by approach (there aren’t ICD-10-PCS codes for removal of stimulator generator from other body parts)|
|Type of Service||Surgical|
|Place of Service||Inpatient/Outpatient|
Electrical Nerve Stimulation, Spinal
Spinal Cord Stimulation
Stimulation, Electrical, Spinal Cord
|03/31/96||Add to Surgery section||New policy|
|04/01/98||Replace policy||Policy cross-referenced to No. 7.01.63|
|07/10/98||Replace policy||Policy updated and revised|
|11/15/98||Coding update||1999 CPT coding release|
|04/29/03||Replace policy||Policy updated; new policy statement added, stating that spinal cord stimulation is investigational as a treatment of critical limb ischemia|
|11/9/04||Replace policy||Policy updated; no change to policy statement. Coding updated|
|08/17/05||Replace policy||Policy updated with literature search and coding updated; no change to policy statement|
|12/14/05||Replace policy – coding update only||Coding updated|
|12/12/06||Replace policy||Policy updated with literature search; no change to policy statement; reference numbers 7 – 9 added|
|03/13/08||Replace policy||Policy updated with literature search; references 10 – 13 added; no change to policy statements|
|01/08/09||Replace policy||Policy updated with literature search; references 14–25 added. Use in refractory angina added as investigational indication.|
|01/14/10||Replace policy||Policy updated with literature search; reference numbers 26-29 added; no change to policy statements|
|01/13/11||Replace policy||Policy updated with literature search. Rationale extensively reqritten; references numbers 15 and 16 added, other references reordered or removed.
|
63661
|
Remove spine eltrd perq aray
|
HCPCS
|
|CPT||63650||Percutaneous implantation of neurostimulator electrode array; epidural|
|63655||Laminectomy for implantation of neurostimulator electrode plate/paddle; epidural|
|63661||Removal of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63662||Removal of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy (new code 1/1/10)|
|63663||Revision including replacement, when performed, of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63664||Revision including replacement, when performed, of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy, including fluoroscopy, when performed (new code 1/1/10)|
|63685||Insertion or replacement of spinal neurostimulator pulse generator or receiver, direct or inductive coupling|
|63688||Revision or removal of implanted spinal neurostimulator pulse generator or receiver|
|95970, 95971, 95972, 95973||Neurostimulator programming and analysis code range|
|ICD-9 Procedure||03.93||Insertion or replacement of spinal neurostimulator|
|03.94||Removal of spinal neurostimulator lead(s)|
|86.05||Incision with removal of foreign body or device from skin and subcutaneous tissue (used to report removal of a neurostimulator pulse generator)|
|86.94||Insertion or replacement of single array neurostimulator pulse generator, not specified as rechargeable|
|86.95||Insertion or replacement of dual array neurostimulator pulse generator, not specified as rechargeable|
|86.97||Insertion or replacement of single array rechargeable neurostimulator pulse generator (new code effective 10/1/05)|
|86.98||Insertion or replacement of dual array rechargeable neurostimulator pulse generation (new code effective 10/1/05)|
|ICD-9 Diagnosis||See “Pain” in ICD-9 diagnosis index|
|HCPCS||L8680||Implantable neurostimulator electrode, each (new code effective 1/1/06)|
|L8685||Implantable neurostimulator pulse generator, single array, rechargeable, includes extension (new code effective 1/1/06)|
|L8686||Implantable neurostimulator pulse generator, single array, nonrechargeable, includes extension (new code effective 1/1/06)|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension (new code effective 1/1/06)|
|L8688||Implantable neurostimulator pulse generator, dual array, nonrechargeable, includes extension (new code effective 1/1/06)|
|ICD-10-CM (effective 10/1/14)||This list is a representative list of severe and chronic pain of the trunk and limbs diagnosis codes.|
|G56.40 -G56.42||Causalgia of upper limb code range|
|G57.70 -G57.72||Causalgia of lower limb code range|
|G89.21 -G89.8||Chronic pain, not elsewhere classified, code range|
|G89.4||Chronic pain syndrome|
|G90.50 -G90.59||Complex regional pain syndrome I (CRPS I), code range|
|M25.50 -M25.579||Pain in joint, code range|
|M54.10 -M54.18||Radiculopathy, code range|
|M54.30 -M54.32||Sciatica, code range|
|M54.40 -M54.42||Lumbago with sciatica, code range|
|M54.5||Low back pain|
|M54.6||Pain in thoracic spine|
|M54.81, M54.89||Other dorsalgia codes|
|M79.60 -M79.676||Pain in limb, hand, foot, fingers and toes code range|
|ICD-10-PCS (effective 10/1/14)||ICD-10-PCS codes are only used for inpatient services.|
|Surgical, central nervous system, insertion, spinal canal, neurostimulator lead, code by approach|
|00HV0MZ, 00HV3MZ, 00HV4MZ||Surgical, central nervous system, insertion, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, removal, spinal canal, neurostimulator lead, code by approach|
|00PV0MZ, 00PV3MZ, 00PV4MZ||Surgical, central nervous system, removal, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, revision, spinal canal, neurostimulator lead, code by approach|
|00WV0MZ, 00WV3MZ, 00WV4MZ||Surgical, central nervous system, revision, spinal cord, neurostimulator lead, code by approach|
|0JH60M6, 0JH60M7, 0JH60M8, 0JH60M9, 0JH63M6, 0JH63M7, 0JH63M8, 0JH63M9, 0JH70M6, 0JH70M7, 0JH70M8, 0JH70M9, 0JH73M6, 0JH73M7, 0JH73M8, 0JH73M9, 0JH80M6, 0JH80M7, 0JH80M8, 0JH80M9, 0JH83M6, 0JH83M7, 0JH83M8, 0JH83M9||Surgical, subcutaneous tissue and fascia, insertion, stimulator generator, code by body part, approach, number of arrays and whether rechargeable or not|
|0JPT0MZ, 0JPT3MZ||Surgical, subcutaneous tissue and fascia, removal, subcutaneous tissue and fascia, trunk, stimulator generator, code by approach (there aren’t ICD-10-PCS codes for removal of stimulator generator from other body parts)|
|Type of Service||Surgical|
|Place of Service||Inpatient/Outpatient|
Electrical Nerve Stimulation, Spinal
Spinal Cord Stimulation
Stimulation, Electrical, Spinal Cord
|03/31/96||Add to Surgery section||New policy|
|04/01/98||Replace policy||Policy cross-referenced to No. 7.01.63|
|07/10/98||Replace policy||Policy updated and revised|
|11/15/98||Coding update||1999 CPT coding release|
|04/29/03||Replace policy||Policy updated; new policy statement added, stating that spinal cord stimulation is investigational as a treatment of critical limb ischemia|
|11/9/04||Replace policy||Policy updated; no change to policy statement. Coding updated|
|08/17/05||Replace policy||Policy updated with literature search and coding updated; no change to policy statement|
|12/14/05||Replace policy – coding update only||Coding updated|
|12/12/06||Replace policy||Policy updated with literature search; no change to policy statement; reference numbers 7 – 9 added|
|03/13/08||Replace policy||Policy updated with literature search; references 10 – 13 added; no change to policy statements|
|01/08/09||Replace policy||Policy updated with literature search; references 14–25 added. Use in refractory angina added as investigational indication.|
|01/14/10||Replace policy||Policy updated with literature search; reference numbers 26-29 added; no change to policy statements|
|01/13/11||Replace policy||Policy updated with literature search. Rationale extensively reqritten; references numbers 15 and 16 added, other references reordered or removed.
|
95972
|
PR ELEC ALYS IMPLT NPGT CPLX SP/PN PRGRMG
|
HCPCS
|
|CPT||63650||Percutaneous implantation of neurostimulator electrode array; epidural|
|63655||Laminectomy for implantation of neurostimulator electrode plate/paddle; epidural|
|63661||Removal of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63662||Removal of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy (new code 1/1/10)|
|63663||Revision including replacement, when performed, of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63664||Revision including replacement, when performed, of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy, including fluoroscopy, when performed (new code 1/1/10)|
|63685||Insertion or replacement of spinal neurostimulator pulse generator or receiver, direct or inductive coupling|
|63688||Revision or removal of implanted spinal neurostimulator pulse generator or receiver|
|95970, 95971, 95972, 95973||Neurostimulator programming and analysis code range|
|ICD-9 Procedure||03.93||Insertion or replacement of spinal neurostimulator|
|03.94||Removal of spinal neurostimulator lead(s)|
|86.05||Incision with removal of foreign body or device from skin and subcutaneous tissue (used to report removal of a neurostimulator pulse generator)|
|86.94||Insertion or replacement of single array neurostimulator pulse generator, not specified as rechargeable|
|86.95||Insertion or replacement of dual array neurostimulator pulse generator, not specified as rechargeable|
|86.97||Insertion or replacement of single array rechargeable neurostimulator pulse generator (new code effective 10/1/05)|
|86.98||Insertion or replacement of dual array rechargeable neurostimulator pulse generation (new code effective 10/1/05)|
|ICD-9 Diagnosis||See “Pain” in ICD-9 diagnosis index|
|HCPCS||L8680||Implantable neurostimulator electrode, each (new code effective 1/1/06)|
|L8685||Implantable neurostimulator pulse generator, single array, rechargeable, includes extension (new code effective 1/1/06)|
|L8686||Implantable neurostimulator pulse generator, single array, nonrechargeable, includes extension (new code effective 1/1/06)|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension (new code effective 1/1/06)|
|L8688||Implantable neurostimulator pulse generator, dual array, nonrechargeable, includes extension (new code effective 1/1/06)|
|ICD-10-CM (effective 10/1/14)||This list is a representative list of severe and chronic pain of the trunk and limbs diagnosis codes.|
|G56.40 -G56.42||Causalgia of upper limb code range|
|G57.70 -G57.72||Causalgia of lower limb code range|
|G89.21 -G89.8||Chronic pain, not elsewhere classified, code range|
|G89.4||Chronic pain syndrome|
|G90.50 -G90.59||Complex regional pain syndrome I (CRPS I), code range|
|M25.50 -M25.579||Pain in joint, code range|
|M54.10 -M54.18||Radiculopathy, code range|
|M54.30 -M54.32||Sciatica, code range|
|M54.40 -M54.42||Lumbago with sciatica, code range|
|M54.5||Low back pain|
|M54.6||Pain in thoracic spine|
|M54.81, M54.89||Other dorsalgia codes|
|M79.60 -M79.676||Pain in limb, hand, foot, fingers and toes code range|
|ICD-10-PCS (effective 10/1/14)||ICD-10-PCS codes are only used for inpatient services.|
|Surgical, central nervous system, insertion, spinal canal, neurostimulator lead, code by approach|
|00HV0MZ, 00HV3MZ, 00HV4MZ||Surgical, central nervous system, insertion, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, removal, spinal canal, neurostimulator lead, code by approach|
|00PV0MZ, 00PV3MZ, 00PV4MZ||Surgical, central nervous system, removal, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, revision, spinal canal, neurostimulator lead, code by approach|
|00WV0MZ, 00WV3MZ, 00WV4MZ||Surgical, central nervous system, revision, spinal cord, neurostimulator lead, code by approach|
|0JH60M6, 0JH60M7, 0JH60M8, 0JH60M9, 0JH63M6, 0JH63M7, 0JH63M8, 0JH63M9, 0JH70M6, 0JH70M7, 0JH70M8, 0JH70M9, 0JH73M6, 0JH73M7, 0JH73M8, 0JH73M9, 0JH80M6, 0JH80M7, 0JH80M8, 0JH80M9, 0JH83M6, 0JH83M7, 0JH83M8, 0JH83M9||Surgical, subcutaneous tissue and fascia, insertion, stimulator generator, code by body part, approach, number of arrays and whether rechargeable or not|
|0JPT0MZ, 0JPT3MZ||Surgical, subcutaneous tissue and fascia, removal, subcutaneous tissue and fascia, trunk, stimulator generator, code by approach (there aren’t ICD-10-PCS codes for removal of stimulator generator from other body parts)|
|Type of Service||Surgical|
|Place of Service||Inpatient/Outpatient|
Electrical Nerve Stimulation, Spinal
Spinal Cord Stimulation
Stimulation, Electrical, Spinal Cord
|03/31/96||Add to Surgery section||New policy|
|04/01/98||Replace policy||Policy cross-referenced to No. 7.01.63|
|07/10/98||Replace policy||Policy updated and revised|
|11/15/98||Coding update||1999 CPT coding release|
|04/29/03||Replace policy||Policy updated; new policy statement added, stating that spinal cord stimulation is investigational as a treatment of critical limb ischemia|
|11/9/04||Replace policy||Policy updated; no change to policy statement. Coding updated|
|08/17/05||Replace policy||Policy updated with literature search and coding updated; no change to policy statement|
|12/14/05||Replace policy – coding update only||Coding updated|
|12/12/06||Replace policy||Policy updated with literature search; no change to policy statement; reference numbers 7 – 9 added|
|03/13/08||Replace policy||Policy updated with literature search; references 10 – 13 added; no change to policy statements|
|01/08/09||Replace policy||Policy updated with literature search; references 14–25 added. Use in refractory angina added as investigational indication.|
|01/14/10||Replace policy||Policy updated with literature search; reference numbers 26-29 added; no change to policy statements|
|01/13/11||Replace policy||Policy updated with literature search. Rationale extensively reqritten; references numbers 15 and 16 added, other references reordered or removed.
|
L8688
|
Implt nrostm pls gen dua non
|
HCPCS
|
|CPT||63650||Percutaneous implantation of neurostimulator electrode array; epidural|
|63655||Laminectomy for implantation of neurostimulator electrode plate/paddle; epidural|
|63661||Removal of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63662||Removal of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy (new code 1/1/10)|
|63663||Revision including replacement, when performed, of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63664||Revision including replacement, when performed, of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy, including fluoroscopy, when performed (new code 1/1/10)|
|63685||Insertion or replacement of spinal neurostimulator pulse generator or receiver, direct or inductive coupling|
|63688||Revision or removal of implanted spinal neurostimulator pulse generator or receiver|
|95970, 95971, 95972, 95973||Neurostimulator programming and analysis code range|
|ICD-9 Procedure||03.93||Insertion or replacement of spinal neurostimulator|
|03.94||Removal of spinal neurostimulator lead(s)|
|86.05||Incision with removal of foreign body or device from skin and subcutaneous tissue (used to report removal of a neurostimulator pulse generator)|
|86.94||Insertion or replacement of single array neurostimulator pulse generator, not specified as rechargeable|
|86.95||Insertion or replacement of dual array neurostimulator pulse generator, not specified as rechargeable|
|86.97||Insertion or replacement of single array rechargeable neurostimulator pulse generator (new code effective 10/1/05)|
|86.98||Insertion or replacement of dual array rechargeable neurostimulator pulse generation (new code effective 10/1/05)|
|ICD-9 Diagnosis||See “Pain” in ICD-9 diagnosis index|
|HCPCS||L8680||Implantable neurostimulator electrode, each (new code effective 1/1/06)|
|L8685||Implantable neurostimulator pulse generator, single array, rechargeable, includes extension (new code effective 1/1/06)|
|L8686||Implantable neurostimulator pulse generator, single array, nonrechargeable, includes extension (new code effective 1/1/06)|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension (new code effective 1/1/06)|
|L8688||Implantable neurostimulator pulse generator, dual array, nonrechargeable, includes extension (new code effective 1/1/06)|
|ICD-10-CM (effective 10/1/14)||This list is a representative list of severe and chronic pain of the trunk and limbs diagnosis codes.|
|G56.40 -G56.42||Causalgia of upper limb code range|
|G57.70 -G57.72||Causalgia of lower limb code range|
|G89.21 -G89.8||Chronic pain, not elsewhere classified, code range|
|G89.4||Chronic pain syndrome|
|G90.50 -G90.59||Complex regional pain syndrome I (CRPS I), code range|
|M25.50 -M25.579||Pain in joint, code range|
|M54.10 -M54.18||Radiculopathy, code range|
|M54.30 -M54.32||Sciatica, code range|
|M54.40 -M54.42||Lumbago with sciatica, code range|
|M54.5||Low back pain|
|M54.6||Pain in thoracic spine|
|M54.81, M54.89||Other dorsalgia codes|
|M79.60 -M79.676||Pain in limb, hand, foot, fingers and toes code range|
|ICD-10-PCS (effective 10/1/14)||ICD-10-PCS codes are only used for inpatient services.|
|Surgical, central nervous system, insertion, spinal canal, neurostimulator lead, code by approach|
|00HV0MZ, 00HV3MZ, 00HV4MZ||Surgical, central nervous system, insertion, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, removal, spinal canal, neurostimulator lead, code by approach|
|00PV0MZ, 00PV3MZ, 00PV4MZ||Surgical, central nervous system, removal, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, revision, spinal canal, neurostimulator lead, code by approach|
|00WV0MZ, 00WV3MZ, 00WV4MZ||Surgical, central nervous system, revision, spinal cord, neurostimulator lead, code by approach|
|0JH60M6, 0JH60M7, 0JH60M8, 0JH60M9, 0JH63M6, 0JH63M7, 0JH63M8, 0JH63M9, 0JH70M6, 0JH70M7, 0JH70M8, 0JH70M9, 0JH73M6, 0JH73M7, 0JH73M8, 0JH73M9, 0JH80M6, 0JH80M7, 0JH80M8, 0JH80M9, 0JH83M6, 0JH83M7, 0JH83M8, 0JH83M9||Surgical, subcutaneous tissue and fascia, insertion, stimulator generator, code by body part, approach, number of arrays and whether rechargeable or not|
|0JPT0MZ, 0JPT3MZ||Surgical, subcutaneous tissue and fascia, removal, subcutaneous tissue and fascia, trunk, stimulator generator, code by approach (there aren’t ICD-10-PCS codes for removal of stimulator generator from other body parts)|
|Type of Service||Surgical|
|Place of Service||Inpatient/Outpatient|
Electrical Nerve Stimulation, Spinal
Spinal Cord Stimulation
Stimulation, Electrical, Spinal Cord
|03/31/96||Add to Surgery section||New policy|
|04/01/98||Replace policy||Policy cross-referenced to No. 7.01.63|
|07/10/98||Replace policy||Policy updated and revised|
|11/15/98||Coding update||1999 CPT coding release|
|04/29/03||Replace policy||Policy updated; new policy statement added, stating that spinal cord stimulation is investigational as a treatment of critical limb ischemia|
|11/9/04||Replace policy||Policy updated; no change to policy statement. Coding updated|
|08/17/05||Replace policy||Policy updated with literature search and coding updated; no change to policy statement|
|12/14/05||Replace policy – coding update only||Coding updated|
|12/12/06||Replace policy||Policy updated with literature search; no change to policy statement; reference numbers 7 – 9 added|
|03/13/08||Replace policy||Policy updated with literature search; references 10 – 13 added; no change to policy statements|
|01/08/09||Replace policy||Policy updated with literature search; references 14–25 added. Use in refractory angina added as investigational indication.|
|01/14/10||Replace policy||Policy updated with literature search; reference numbers 26-29 added; no change to policy statements|
|01/13/11||Replace policy||Policy updated with literature search. Rationale extensively reqritten; references numbers 15 and 16 added, other references reordered or removed.
|
1999
|
ANESTHESIOLOGY GROUP
|
CPT
|
|CPT||63650||Percutaneous implantation of neurostimulator electrode array; epidural|
|63655||Laminectomy for implantation of neurostimulator electrode plate/paddle; epidural|
|63661||Removal of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63662||Removal of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy (new code 1/1/10)|
|63663||Revision including replacement, when performed, of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63664||Revision including replacement, when performed, of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy, including fluoroscopy, when performed (new code 1/1/10)|
|63685||Insertion or replacement of spinal neurostimulator pulse generator or receiver, direct or inductive coupling|
|63688||Revision or removal of implanted spinal neurostimulator pulse generator or receiver|
|95970, 95971, 95972, 95973||Neurostimulator programming and analysis code range|
|ICD-9 Procedure||03.93||Insertion or replacement of spinal neurostimulator|
|03.94||Removal of spinal neurostimulator lead(s)|
|86.05||Incision with removal of foreign body or device from skin and subcutaneous tissue (used to report removal of a neurostimulator pulse generator)|
|86.94||Insertion or replacement of single array neurostimulator pulse generator, not specified as rechargeable|
|86.95||Insertion or replacement of dual array neurostimulator pulse generator, not specified as rechargeable|
|86.97||Insertion or replacement of single array rechargeable neurostimulator pulse generator (new code effective 10/1/05)|
|86.98||Insertion or replacement of dual array rechargeable neurostimulator pulse generation (new code effective 10/1/05)|
|ICD-9 Diagnosis||See “Pain” in ICD-9 diagnosis index|
|HCPCS||L8680||Implantable neurostimulator electrode, each (new code effective 1/1/06)|
|L8685||Implantable neurostimulator pulse generator, single array, rechargeable, includes extension (new code effective 1/1/06)|
|L8686||Implantable neurostimulator pulse generator, single array, nonrechargeable, includes extension (new code effective 1/1/06)|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension (new code effective 1/1/06)|
|L8688||Implantable neurostimulator pulse generator, dual array, nonrechargeable, includes extension (new code effective 1/1/06)|
|ICD-10-CM (effective 10/1/14)||This list is a representative list of severe and chronic pain of the trunk and limbs diagnosis codes.|
|G56.40 -G56.42||Causalgia of upper limb code range|
|G57.70 -G57.72||Causalgia of lower limb code range|
|G89.21 -G89.8||Chronic pain, not elsewhere classified, code range|
|G89.4||Chronic pain syndrome|
|G90.50 -G90.59||Complex regional pain syndrome I (CRPS I), code range|
|M25.50 -M25.579||Pain in joint, code range|
|M54.10 -M54.18||Radiculopathy, code range|
|M54.30 -M54.32||Sciatica, code range|
|M54.40 -M54.42||Lumbago with sciatica, code range|
|M54.5||Low back pain|
|M54.6||Pain in thoracic spine|
|M54.81, M54.89||Other dorsalgia codes|
|M79.60 -M79.676||Pain in limb, hand, foot, fingers and toes code range|
|ICD-10-PCS (effective 10/1/14)||ICD-10-PCS codes are only used for inpatient services.|
|Surgical, central nervous system, insertion, spinal canal, neurostimulator lead, code by approach|
|00HV0MZ, 00HV3MZ, 00HV4MZ||Surgical, central nervous system, insertion, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, removal, spinal canal, neurostimulator lead, code by approach|
|00PV0MZ, 00PV3MZ, 00PV4MZ||Surgical, central nervous system, removal, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, revision, spinal canal, neurostimulator lead, code by approach|
|00WV0MZ, 00WV3MZ, 00WV4MZ||Surgical, central nervous system, revision, spinal cord, neurostimulator lead, code by approach|
|0JH60M6, 0JH60M7, 0JH60M8, 0JH60M9, 0JH63M6, 0JH63M7, 0JH63M8, 0JH63M9, 0JH70M6, 0JH70M7, 0JH70M8, 0JH70M9, 0JH73M6, 0JH73M7, 0JH73M8, 0JH73M9, 0JH80M6, 0JH80M7, 0JH80M8, 0JH80M9, 0JH83M6, 0JH83M7, 0JH83M8, 0JH83M9||Surgical, subcutaneous tissue and fascia, insertion, stimulator generator, code by body part, approach, number of arrays and whether rechargeable or not|
|0JPT0MZ, 0JPT3MZ||Surgical, subcutaneous tissue and fascia, removal, subcutaneous tissue and fascia, trunk, stimulator generator, code by approach (there aren’t ICD-10-PCS codes for removal of stimulator generator from other body parts)|
|Type of Service||Surgical|
|Place of Service||Inpatient/Outpatient|
Electrical Nerve Stimulation, Spinal
Spinal Cord Stimulation
Stimulation, Electrical, Spinal Cord
|03/31/96||Add to Surgery section||New policy|
|04/01/98||Replace policy||Policy cross-referenced to No. 7.01.63|
|07/10/98||Replace policy||Policy updated and revised|
|11/15/98||Coding update||1999 CPT coding release|
|04/29/03||Replace policy||Policy updated; new policy statement added, stating that spinal cord stimulation is investigational as a treatment of critical limb ischemia|
|11/9/04||Replace policy||Policy updated; no change to policy statement. Coding updated|
|08/17/05||Replace policy||Policy updated with literature search and coding updated; no change to policy statement|
|12/14/05||Replace policy – coding update only||Coding updated|
|12/12/06||Replace policy||Policy updated with literature search; no change to policy statement; reference numbers 7 – 9 added|
|03/13/08||Replace policy||Policy updated with literature search; references 10 – 13 added; no change to policy statements|
|01/08/09||Replace policy||Policy updated with literature search; references 14–25 added. Use in refractory angina added as investigational indication.|
|01/14/10||Replace policy||Policy updated with literature search; reference numbers 26-29 added; no change to policy statements|
|01/13/11||Replace policy||Policy updated with literature search. Rationale extensively reqritten; references numbers 15 and 16 added, other references reordered or removed.
|
L8680
|
KIT NRSTM 40CM STIMLOC .
|
HCPCS
|
|CPT||63650||Percutaneous implantation of neurostimulator electrode array; epidural|
|63655||Laminectomy for implantation of neurostimulator electrode plate/paddle; epidural|
|63661||Removal of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63662||Removal of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy (new code 1/1/10)|
|63663||Revision including replacement, when performed, of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63664||Revision including replacement, when performed, of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy, including fluoroscopy, when performed (new code 1/1/10)|
|63685||Insertion or replacement of spinal neurostimulator pulse generator or receiver, direct or inductive coupling|
|63688||Revision or removal of implanted spinal neurostimulator pulse generator or receiver|
|95970, 95971, 95972, 95973||Neurostimulator programming and analysis code range|
|ICD-9 Procedure||03.93||Insertion or replacement of spinal neurostimulator|
|03.94||Removal of spinal neurostimulator lead(s)|
|86.05||Incision with removal of foreign body or device from skin and subcutaneous tissue (used to report removal of a neurostimulator pulse generator)|
|86.94||Insertion or replacement of single array neurostimulator pulse generator, not specified as rechargeable|
|86.95||Insertion or replacement of dual array neurostimulator pulse generator, not specified as rechargeable|
|86.97||Insertion or replacement of single array rechargeable neurostimulator pulse generator (new code effective 10/1/05)|
|86.98||Insertion or replacement of dual array rechargeable neurostimulator pulse generation (new code effective 10/1/05)|
|ICD-9 Diagnosis||See “Pain” in ICD-9 diagnosis index|
|HCPCS||L8680||Implantable neurostimulator electrode, each (new code effective 1/1/06)|
|L8685||Implantable neurostimulator pulse generator, single array, rechargeable, includes extension (new code effective 1/1/06)|
|L8686||Implantable neurostimulator pulse generator, single array, nonrechargeable, includes extension (new code effective 1/1/06)|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension (new code effective 1/1/06)|
|L8688||Implantable neurostimulator pulse generator, dual array, nonrechargeable, includes extension (new code effective 1/1/06)|
|ICD-10-CM (effective 10/1/14)||This list is a representative list of severe and chronic pain of the trunk and limbs diagnosis codes.|
|G56.40 -G56.42||Causalgia of upper limb code range|
|G57.70 -G57.72||Causalgia of lower limb code range|
|G89.21 -G89.8||Chronic pain, not elsewhere classified, code range|
|G89.4||Chronic pain syndrome|
|G90.50 -G90.59||Complex regional pain syndrome I (CRPS I), code range|
|M25.50 -M25.579||Pain in joint, code range|
|M54.10 -M54.18||Radiculopathy, code range|
|M54.30 -M54.32||Sciatica, code range|
|M54.40 -M54.42||Lumbago with sciatica, code range|
|M54.5||Low back pain|
|M54.6||Pain in thoracic spine|
|M54.81, M54.89||Other dorsalgia codes|
|M79.60 -M79.676||Pain in limb, hand, foot, fingers and toes code range|
|ICD-10-PCS (effective 10/1/14)||ICD-10-PCS codes are only used for inpatient services.|
|Surgical, central nervous system, insertion, spinal canal, neurostimulator lead, code by approach|
|00HV0MZ, 00HV3MZ, 00HV4MZ||Surgical, central nervous system, insertion, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, removal, spinal canal, neurostimulator lead, code by approach|
|00PV0MZ, 00PV3MZ, 00PV4MZ||Surgical, central nervous system, removal, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, revision, spinal canal, neurostimulator lead, code by approach|
|00WV0MZ, 00WV3MZ, 00WV4MZ||Surgical, central nervous system, revision, spinal cord, neurostimulator lead, code by approach|
|0JH60M6, 0JH60M7, 0JH60M8, 0JH60M9, 0JH63M6, 0JH63M7, 0JH63M8, 0JH63M9, 0JH70M6, 0JH70M7, 0JH70M8, 0JH70M9, 0JH73M6, 0JH73M7, 0JH73M8, 0JH73M9, 0JH80M6, 0JH80M7, 0JH80M8, 0JH80M9, 0JH83M6, 0JH83M7, 0JH83M8, 0JH83M9||Surgical, subcutaneous tissue and fascia, insertion, stimulator generator, code by body part, approach, number of arrays and whether rechargeable or not|
|0JPT0MZ, 0JPT3MZ||Surgical, subcutaneous tissue and fascia, removal, subcutaneous tissue and fascia, trunk, stimulator generator, code by approach (there aren’t ICD-10-PCS codes for removal of stimulator generator from other body parts)|
|Type of Service||Surgical|
|Place of Service||Inpatient/Outpatient|
Electrical Nerve Stimulation, Spinal
Spinal Cord Stimulation
Stimulation, Electrical, Spinal Cord
|03/31/96||Add to Surgery section||New policy|
|04/01/98||Replace policy||Policy cross-referenced to No. 7.01.63|
|07/10/98||Replace policy||Policy updated and revised|
|11/15/98||Coding update||1999 CPT coding release|
|04/29/03||Replace policy||Policy updated; new policy statement added, stating that spinal cord stimulation is investigational as a treatment of critical limb ischemia|
|11/9/04||Replace policy||Policy updated; no change to policy statement. Coding updated|
|08/17/05||Replace policy||Policy updated with literature search and coding updated; no change to policy statement|
|12/14/05||Replace policy – coding update only||Coding updated|
|12/12/06||Replace policy||Policy updated with literature search; no change to policy statement; reference numbers 7 – 9 added|
|03/13/08||Replace policy||Policy updated with literature search; references 10 – 13 added; no change to policy statements|
|01/08/09||Replace policy||Policy updated with literature search; references 14–25 added. Use in refractory angina added as investigational indication.|
|01/14/10||Replace policy||Policy updated with literature search; reference numbers 26-29 added; no change to policy statements|
|01/13/11||Replace policy||Policy updated with literature search. Rationale extensively reqritten; references numbers 15 and 16 added, other references reordered or removed.
|
63662
|
Remove spine eltrd plate
|
HCPCS
|
|CPT||63650||Percutaneous implantation of neurostimulator electrode array; epidural|
|63655||Laminectomy for implantation of neurostimulator electrode plate/paddle; epidural|
|63661||Removal of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63662||Removal of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy (new code 1/1/10)|
|63663||Revision including replacement, when performed, of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63664||Revision including replacement, when performed, of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy, including fluoroscopy, when performed (new code 1/1/10)|
|63685||Insertion or replacement of spinal neurostimulator pulse generator or receiver, direct or inductive coupling|
|63688||Revision or removal of implanted spinal neurostimulator pulse generator or receiver|
|95970, 95971, 95972, 95973||Neurostimulator programming and analysis code range|
|ICD-9 Procedure||03.93||Insertion or replacement of spinal neurostimulator|
|03.94||Removal of spinal neurostimulator lead(s)|
|86.05||Incision with removal of foreign body or device from skin and subcutaneous tissue (used to report removal of a neurostimulator pulse generator)|
|86.94||Insertion or replacement of single array neurostimulator pulse generator, not specified as rechargeable|
|86.95||Insertion or replacement of dual array neurostimulator pulse generator, not specified as rechargeable|
|86.97||Insertion or replacement of single array rechargeable neurostimulator pulse generator (new code effective 10/1/05)|
|86.98||Insertion or replacement of dual array rechargeable neurostimulator pulse generation (new code effective 10/1/05)|
|ICD-9 Diagnosis||See “Pain” in ICD-9 diagnosis index|
|HCPCS||L8680||Implantable neurostimulator electrode, each (new code effective 1/1/06)|
|L8685||Implantable neurostimulator pulse generator, single array, rechargeable, includes extension (new code effective 1/1/06)|
|L8686||Implantable neurostimulator pulse generator, single array, nonrechargeable, includes extension (new code effective 1/1/06)|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension (new code effective 1/1/06)|
|L8688||Implantable neurostimulator pulse generator, dual array, nonrechargeable, includes extension (new code effective 1/1/06)|
|ICD-10-CM (effective 10/1/14)||This list is a representative list of severe and chronic pain of the trunk and limbs diagnosis codes.|
|G56.40 -G56.42||Causalgia of upper limb code range|
|G57.70 -G57.72||Causalgia of lower limb code range|
|G89.21 -G89.8||Chronic pain, not elsewhere classified, code range|
|G89.4||Chronic pain syndrome|
|G90.50 -G90.59||Complex regional pain syndrome I (CRPS I), code range|
|M25.50 -M25.579||Pain in joint, code range|
|M54.10 -M54.18||Radiculopathy, code range|
|M54.30 -M54.32||Sciatica, code range|
|M54.40 -M54.42||Lumbago with sciatica, code range|
|M54.5||Low back pain|
|M54.6||Pain in thoracic spine|
|M54.81, M54.89||Other dorsalgia codes|
|M79.60 -M79.676||Pain in limb, hand, foot, fingers and toes code range|
|ICD-10-PCS (effective 10/1/14)||ICD-10-PCS codes are only used for inpatient services.|
|Surgical, central nervous system, insertion, spinal canal, neurostimulator lead, code by approach|
|00HV0MZ, 00HV3MZ, 00HV4MZ||Surgical, central nervous system, insertion, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, removal, spinal canal, neurostimulator lead, code by approach|
|00PV0MZ, 00PV3MZ, 00PV4MZ||Surgical, central nervous system, removal, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, revision, spinal canal, neurostimulator lead, code by approach|
|00WV0MZ, 00WV3MZ, 00WV4MZ||Surgical, central nervous system, revision, spinal cord, neurostimulator lead, code by approach|
|0JH60M6, 0JH60M7, 0JH60M8, 0JH60M9, 0JH63M6, 0JH63M7, 0JH63M8, 0JH63M9, 0JH70M6, 0JH70M7, 0JH70M8, 0JH70M9, 0JH73M6, 0JH73M7, 0JH73M8, 0JH73M9, 0JH80M6, 0JH80M7, 0JH80M8, 0JH80M9, 0JH83M6, 0JH83M7, 0JH83M8, 0JH83M9||Surgical, subcutaneous tissue and fascia, insertion, stimulator generator, code by body part, approach, number of arrays and whether rechargeable or not|
|0JPT0MZ, 0JPT3MZ||Surgical, subcutaneous tissue and fascia, removal, subcutaneous tissue and fascia, trunk, stimulator generator, code by approach (there aren’t ICD-10-PCS codes for removal of stimulator generator from other body parts)|
|Type of Service||Surgical|
|Place of Service||Inpatient/Outpatient|
Electrical Nerve Stimulation, Spinal
Spinal Cord Stimulation
Stimulation, Electrical, Spinal Cord
|03/31/96||Add to Surgery section||New policy|
|04/01/98||Replace policy||Policy cross-referenced to No. 7.01.63|
|07/10/98||Replace policy||Policy updated and revised|
|11/15/98||Coding update||1999 CPT coding release|
|04/29/03||Replace policy||Policy updated; new policy statement added, stating that spinal cord stimulation is investigational as a treatment of critical limb ischemia|
|11/9/04||Replace policy||Policy updated; no change to policy statement. Coding updated|
|08/17/05||Replace policy||Policy updated with literature search and coding updated; no change to policy statement|
|12/14/05||Replace policy – coding update only||Coding updated|
|12/12/06||Replace policy||Policy updated with literature search; no change to policy statement; reference numbers 7 – 9 added|
|03/13/08||Replace policy||Policy updated with literature search; references 10 – 13 added; no change to policy statements|
|01/08/09||Replace policy||Policy updated with literature search; references 14–25 added. Use in refractory angina added as investigational indication.|
|01/14/10||Replace policy||Policy updated with literature search; reference numbers 26-29 added; no change to policy statements|
|01/13/11||Replace policy||Policy updated with literature search. Rationale extensively reqritten; references numbers 15 and 16 added, other references reordered or removed.
|
L8687
|
KIT NEUROSTIMULATOR SENZA IPG STERILE LATEX FREE DISPOSABLE
|
HCPCS
|
|CPT||63650||Percutaneous implantation of neurostimulator electrode array; epidural|
|63655||Laminectomy for implantation of neurostimulator electrode plate/paddle; epidural|
|63661||Removal of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63662||Removal of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy (new code 1/1/10)|
|63663||Revision including replacement, when performed, of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63664||Revision including replacement, when performed, of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy, including fluoroscopy, when performed (new code 1/1/10)|
|63685||Insertion or replacement of spinal neurostimulator pulse generator or receiver, direct or inductive coupling|
|63688||Revision or removal of implanted spinal neurostimulator pulse generator or receiver|
|95970, 95971, 95972, 95973||Neurostimulator programming and analysis code range|
|ICD-9 Procedure||03.93||Insertion or replacement of spinal neurostimulator|
|03.94||Removal of spinal neurostimulator lead(s)|
|86.05||Incision with removal of foreign body or device from skin and subcutaneous tissue (used to report removal of a neurostimulator pulse generator)|
|86.94||Insertion or replacement of single array neurostimulator pulse generator, not specified as rechargeable|
|86.95||Insertion or replacement of dual array neurostimulator pulse generator, not specified as rechargeable|
|86.97||Insertion or replacement of single array rechargeable neurostimulator pulse generator (new code effective 10/1/05)|
|86.98||Insertion or replacement of dual array rechargeable neurostimulator pulse generation (new code effective 10/1/05)|
|ICD-9 Diagnosis||See “Pain” in ICD-9 diagnosis index|
|HCPCS||L8680||Implantable neurostimulator electrode, each (new code effective 1/1/06)|
|L8685||Implantable neurostimulator pulse generator, single array, rechargeable, includes extension (new code effective 1/1/06)|
|L8686||Implantable neurostimulator pulse generator, single array, nonrechargeable, includes extension (new code effective 1/1/06)|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension (new code effective 1/1/06)|
|L8688||Implantable neurostimulator pulse generator, dual array, nonrechargeable, includes extension (new code effective 1/1/06)|
|ICD-10-CM (effective 10/1/14)||This list is a representative list of severe and chronic pain of the trunk and limbs diagnosis codes.|
|G56.40 -G56.42||Causalgia of upper limb code range|
|G57.70 -G57.72||Causalgia of lower limb code range|
|G89.21 -G89.8||Chronic pain, not elsewhere classified, code range|
|G89.4||Chronic pain syndrome|
|G90.50 -G90.59||Complex regional pain syndrome I (CRPS I), code range|
|M25.50 -M25.579||Pain in joint, code range|
|M54.10 -M54.18||Radiculopathy, code range|
|M54.30 -M54.32||Sciatica, code range|
|M54.40 -M54.42||Lumbago with sciatica, code range|
|M54.5||Low back pain|
|M54.6||Pain in thoracic spine|
|M54.81, M54.89||Other dorsalgia codes|
|M79.60 -M79.676||Pain in limb, hand, foot, fingers and toes code range|
|ICD-10-PCS (effective 10/1/14)||ICD-10-PCS codes are only used for inpatient services.|
|Surgical, central nervous system, insertion, spinal canal, neurostimulator lead, code by approach|
|00HV0MZ, 00HV3MZ, 00HV4MZ||Surgical, central nervous system, insertion, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, removal, spinal canal, neurostimulator lead, code by approach|
|00PV0MZ, 00PV3MZ, 00PV4MZ||Surgical, central nervous system, removal, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, revision, spinal canal, neurostimulator lead, code by approach|
|00WV0MZ, 00WV3MZ, 00WV4MZ||Surgical, central nervous system, revision, spinal cord, neurostimulator lead, code by approach|
|0JH60M6, 0JH60M7, 0JH60M8, 0JH60M9, 0JH63M6, 0JH63M7, 0JH63M8, 0JH63M9, 0JH70M6, 0JH70M7, 0JH70M8, 0JH70M9, 0JH73M6, 0JH73M7, 0JH73M8, 0JH73M9, 0JH80M6, 0JH80M7, 0JH80M8, 0JH80M9, 0JH83M6, 0JH83M7, 0JH83M8, 0JH83M9||Surgical, subcutaneous tissue and fascia, insertion, stimulator generator, code by body part, approach, number of arrays and whether rechargeable or not|
|0JPT0MZ, 0JPT3MZ||Surgical, subcutaneous tissue and fascia, removal, subcutaneous tissue and fascia, trunk, stimulator generator, code by approach (there aren’t ICD-10-PCS codes for removal of stimulator generator from other body parts)|
|Type of Service||Surgical|
|Place of Service||Inpatient/Outpatient|
Electrical Nerve Stimulation, Spinal
Spinal Cord Stimulation
Stimulation, Electrical, Spinal Cord
|03/31/96||Add to Surgery section||New policy|
|04/01/98||Replace policy||Policy cross-referenced to No. 7.01.63|
|07/10/98||Replace policy||Policy updated and revised|
|11/15/98||Coding update||1999 CPT coding release|
|04/29/03||Replace policy||Policy updated; new policy statement added, stating that spinal cord stimulation is investigational as a treatment of critical limb ischemia|
|11/9/04||Replace policy||Policy updated; no change to policy statement. Coding updated|
|08/17/05||Replace policy||Policy updated with literature search and coding updated; no change to policy statement|
|12/14/05||Replace policy – coding update only||Coding updated|
|12/12/06||Replace policy||Policy updated with literature search; no change to policy statement; reference numbers 7 – 9 added|
|03/13/08||Replace policy||Policy updated with literature search; references 10 – 13 added; no change to policy statements|
|01/08/09||Replace policy||Policy updated with literature search; references 14–25 added. Use in refractory angina added as investigational indication.|
|01/14/10||Replace policy||Policy updated with literature search; reference numbers 26-29 added; no change to policy statements|
|01/13/11||Replace policy||Policy updated with literature search. Rationale extensively reqritten; references numbers 15 and 16 added, other references reordered or removed.
|
63663
|
Revise spine eltrd perq aray
|
HCPCS
|
|CPT||63650||Percutaneous implantation of neurostimulator electrode array; epidural|
|63655||Laminectomy for implantation of neurostimulator electrode plate/paddle; epidural|
|63661||Removal of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63662||Removal of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy (new code 1/1/10)|
|63663||Revision including replacement, when performed, of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63664||Revision including replacement, when performed, of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy, including fluoroscopy, when performed (new code 1/1/10)|
|63685||Insertion or replacement of spinal neurostimulator pulse generator or receiver, direct or inductive coupling|
|63688||Revision or removal of implanted spinal neurostimulator pulse generator or receiver|
|95970, 95971, 95972, 95973||Neurostimulator programming and analysis code range|
|ICD-9 Procedure||03.93||Insertion or replacement of spinal neurostimulator|
|03.94||Removal of spinal neurostimulator lead(s)|
|86.05||Incision with removal of foreign body or device from skin and subcutaneous tissue (used to report removal of a neurostimulator pulse generator)|
|86.94||Insertion or replacement of single array neurostimulator pulse generator, not specified as rechargeable|
|86.95||Insertion or replacement of dual array neurostimulator pulse generator, not specified as rechargeable|
|86.97||Insertion or replacement of single array rechargeable neurostimulator pulse generator (new code effective 10/1/05)|
|86.98||Insertion or replacement of dual array rechargeable neurostimulator pulse generation (new code effective 10/1/05)|
|ICD-9 Diagnosis||See “Pain” in ICD-9 diagnosis index|
|HCPCS||L8680||Implantable neurostimulator electrode, each (new code effective 1/1/06)|
|L8685||Implantable neurostimulator pulse generator, single array, rechargeable, includes extension (new code effective 1/1/06)|
|L8686||Implantable neurostimulator pulse generator, single array, nonrechargeable, includes extension (new code effective 1/1/06)|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension (new code effective 1/1/06)|
|L8688||Implantable neurostimulator pulse generator, dual array, nonrechargeable, includes extension (new code effective 1/1/06)|
|ICD-10-CM (effective 10/1/14)||This list is a representative list of severe and chronic pain of the trunk and limbs diagnosis codes.|
|G56.40 -G56.42||Causalgia of upper limb code range|
|G57.70 -G57.72||Causalgia of lower limb code range|
|G89.21 -G89.8||Chronic pain, not elsewhere classified, code range|
|G89.4||Chronic pain syndrome|
|G90.50 -G90.59||Complex regional pain syndrome I (CRPS I), code range|
|M25.50 -M25.579||Pain in joint, code range|
|M54.10 -M54.18||Radiculopathy, code range|
|M54.30 -M54.32||Sciatica, code range|
|M54.40 -M54.42||Lumbago with sciatica, code range|
|M54.5||Low back pain|
|M54.6||Pain in thoracic spine|
|M54.81, M54.89||Other dorsalgia codes|
|M79.60 -M79.676||Pain in limb, hand, foot, fingers and toes code range|
|ICD-10-PCS (effective 10/1/14)||ICD-10-PCS codes are only used for inpatient services.|
|Surgical, central nervous system, insertion, spinal canal, neurostimulator lead, code by approach|
|00HV0MZ, 00HV3MZ, 00HV4MZ||Surgical, central nervous system, insertion, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, removal, spinal canal, neurostimulator lead, code by approach|
|00PV0MZ, 00PV3MZ, 00PV4MZ||Surgical, central nervous system, removal, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, revision, spinal canal, neurostimulator lead, code by approach|
|00WV0MZ, 00WV3MZ, 00WV4MZ||Surgical, central nervous system, revision, spinal cord, neurostimulator lead, code by approach|
|0JH60M6, 0JH60M7, 0JH60M8, 0JH60M9, 0JH63M6, 0JH63M7, 0JH63M8, 0JH63M9, 0JH70M6, 0JH70M7, 0JH70M8, 0JH70M9, 0JH73M6, 0JH73M7, 0JH73M8, 0JH73M9, 0JH80M6, 0JH80M7, 0JH80M8, 0JH80M9, 0JH83M6, 0JH83M7, 0JH83M8, 0JH83M9||Surgical, subcutaneous tissue and fascia, insertion, stimulator generator, code by body part, approach, number of arrays and whether rechargeable or not|
|0JPT0MZ, 0JPT3MZ||Surgical, subcutaneous tissue and fascia, removal, subcutaneous tissue and fascia, trunk, stimulator generator, code by approach (there aren’t ICD-10-PCS codes for removal of stimulator generator from other body parts)|
|Type of Service||Surgical|
|Place of Service||Inpatient/Outpatient|
Electrical Nerve Stimulation, Spinal
Spinal Cord Stimulation
Stimulation, Electrical, Spinal Cord
|03/31/96||Add to Surgery section||New policy|
|04/01/98||Replace policy||Policy cross-referenced to No. 7.01.63|
|07/10/98||Replace policy||Policy updated and revised|
|11/15/98||Coding update||1999 CPT coding release|
|04/29/03||Replace policy||Policy updated; new policy statement added, stating that spinal cord stimulation is investigational as a treatment of critical limb ischemia|
|11/9/04||Replace policy||Policy updated; no change to policy statement. Coding updated|
|08/17/05||Replace policy||Policy updated with literature search and coding updated; no change to policy statement|
|12/14/05||Replace policy – coding update only||Coding updated|
|12/12/06||Replace policy||Policy updated with literature search; no change to policy statement; reference numbers 7 – 9 added|
|03/13/08||Replace policy||Policy updated with literature search; references 10 – 13 added; no change to policy statements|
|01/08/09||Replace policy||Policy updated with literature search; references 14–25 added. Use in refractory angina added as investigational indication.|
|01/14/10||Replace policy||Policy updated with literature search; reference numbers 26-29 added; no change to policy statements|
|01/13/11||Replace policy||Policy updated with literature search. Rationale extensively reqritten; references numbers 15 and 16 added, other references reordered or removed.
|
95970
|
PR ELEC ALYS IMPLT NPGT PHYS/QHP W/O PROGRAMMING
|
HCPCS
|
|CPT||63650||Percutaneous implantation of neurostimulator electrode array; epidural|
|63655||Laminectomy for implantation of neurostimulator electrode plate/paddle; epidural|
|63661||Removal of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63662||Removal of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy (new code 1/1/10)|
|63663||Revision including replacement, when performed, of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63664||Revision including replacement, when performed, of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy, including fluoroscopy, when performed (new code 1/1/10)|
|63685||Insertion or replacement of spinal neurostimulator pulse generator or receiver, direct or inductive coupling|
|63688||Revision or removal of implanted spinal neurostimulator pulse generator or receiver|
|95970, 95971, 95972, 95973||Neurostimulator programming and analysis code range|
|ICD-9 Procedure||03.93||Insertion or replacement of spinal neurostimulator|
|03.94||Removal of spinal neurostimulator lead(s)|
|86.05||Incision with removal of foreign body or device from skin and subcutaneous tissue (used to report removal of a neurostimulator pulse generator)|
|86.94||Insertion or replacement of single array neurostimulator pulse generator, not specified as rechargeable|
|86.95||Insertion or replacement of dual array neurostimulator pulse generator, not specified as rechargeable|
|86.97||Insertion or replacement of single array rechargeable neurostimulator pulse generator (new code effective 10/1/05)|
|86.98||Insertion or replacement of dual array rechargeable neurostimulator pulse generation (new code effective 10/1/05)|
|ICD-9 Diagnosis||See “Pain” in ICD-9 diagnosis index|
|HCPCS||L8680||Implantable neurostimulator electrode, each (new code effective 1/1/06)|
|L8685||Implantable neurostimulator pulse generator, single array, rechargeable, includes extension (new code effective 1/1/06)|
|L8686||Implantable neurostimulator pulse generator, single array, nonrechargeable, includes extension (new code effective 1/1/06)|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension (new code effective 1/1/06)|
|L8688||Implantable neurostimulator pulse generator, dual array, nonrechargeable, includes extension (new code effective 1/1/06)|
|ICD-10-CM (effective 10/1/14)||This list is a representative list of severe and chronic pain of the trunk and limbs diagnosis codes.|
|G56.40 -G56.42||Causalgia of upper limb code range|
|G57.70 -G57.72||Causalgia of lower limb code range|
|G89.21 -G89.8||Chronic pain, not elsewhere classified, code range|
|G89.4||Chronic pain syndrome|
|G90.50 -G90.59||Complex regional pain syndrome I (CRPS I), code range|
|M25.50 -M25.579||Pain in joint, code range|
|M54.10 -M54.18||Radiculopathy, code range|
|M54.30 -M54.32||Sciatica, code range|
|M54.40 -M54.42||Lumbago with sciatica, code range|
|M54.5||Low back pain|
|M54.6||Pain in thoracic spine|
|M54.81, M54.89||Other dorsalgia codes|
|M79.60 -M79.676||Pain in limb, hand, foot, fingers and toes code range|
|ICD-10-PCS (effective 10/1/14)||ICD-10-PCS codes are only used for inpatient services.|
|Surgical, central nervous system, insertion, spinal canal, neurostimulator lead, code by approach|
|00HV0MZ, 00HV3MZ, 00HV4MZ||Surgical, central nervous system, insertion, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, removal, spinal canal, neurostimulator lead, code by approach|
|00PV0MZ, 00PV3MZ, 00PV4MZ||Surgical, central nervous system, removal, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, revision, spinal canal, neurostimulator lead, code by approach|
|00WV0MZ, 00WV3MZ, 00WV4MZ||Surgical, central nervous system, revision, spinal cord, neurostimulator lead, code by approach|
|0JH60M6, 0JH60M7, 0JH60M8, 0JH60M9, 0JH63M6, 0JH63M7, 0JH63M8, 0JH63M9, 0JH70M6, 0JH70M7, 0JH70M8, 0JH70M9, 0JH73M6, 0JH73M7, 0JH73M8, 0JH73M9, 0JH80M6, 0JH80M7, 0JH80M8, 0JH80M9, 0JH83M6, 0JH83M7, 0JH83M8, 0JH83M9||Surgical, subcutaneous tissue and fascia, insertion, stimulator generator, code by body part, approach, number of arrays and whether rechargeable or not|
|0JPT0MZ, 0JPT3MZ||Surgical, subcutaneous tissue and fascia, removal, subcutaneous tissue and fascia, trunk, stimulator generator, code by approach (there aren’t ICD-10-PCS codes for removal of stimulator generator from other body parts)|
|Type of Service||Surgical|
|Place of Service||Inpatient/Outpatient|
Electrical Nerve Stimulation, Spinal
Spinal Cord Stimulation
Stimulation, Electrical, Spinal Cord
|03/31/96||Add to Surgery section||New policy|
|04/01/98||Replace policy||Policy cross-referenced to No. 7.01.63|
|07/10/98||Replace policy||Policy updated and revised|
|11/15/98||Coding update||1999 CPT coding release|
|04/29/03||Replace policy||Policy updated; new policy statement added, stating that spinal cord stimulation is investigational as a treatment of critical limb ischemia|
|11/9/04||Replace policy||Policy updated; no change to policy statement. Coding updated|
|08/17/05||Replace policy||Policy updated with literature search and coding updated; no change to policy statement|
|12/14/05||Replace policy – coding update only||Coding updated|
|12/12/06||Replace policy||Policy updated with literature search; no change to policy statement; reference numbers 7 – 9 added|
|03/13/08||Replace policy||Policy updated with literature search; references 10 – 13 added; no change to policy statements|
|01/08/09||Replace policy||Policy updated with literature search; references 14–25 added. Use in refractory angina added as investigational indication.|
|01/14/10||Replace policy||Policy updated with literature search; reference numbers 26-29 added; no change to policy statements|
|01/13/11||Replace policy||Policy updated with literature search. Rationale extensively reqritten; references numbers 15 and 16 added, other references reordered or removed.
|
63688
|
Rev/rmv imp sp npg/r dtch cn
|
HCPCS
|
|CPT||63650||Percutaneous implantation of neurostimulator electrode array; epidural|
|63655||Laminectomy for implantation of neurostimulator electrode plate/paddle; epidural|
|63661||Removal of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63662||Removal of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy (new code 1/1/10)|
|63663||Revision including replacement, when performed, of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63664||Revision including replacement, when performed, of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy, including fluoroscopy, when performed (new code 1/1/10)|
|63685||Insertion or replacement of spinal neurostimulator pulse generator or receiver, direct or inductive coupling|
|63688||Revision or removal of implanted spinal neurostimulator pulse generator or receiver|
|95970, 95971, 95972, 95973||Neurostimulator programming and analysis code range|
|ICD-9 Procedure||03.93||Insertion or replacement of spinal neurostimulator|
|03.94||Removal of spinal neurostimulator lead(s)|
|86.05||Incision with removal of foreign body or device from skin and subcutaneous tissue (used to report removal of a neurostimulator pulse generator)|
|86.94||Insertion or replacement of single array neurostimulator pulse generator, not specified as rechargeable|
|86.95||Insertion or replacement of dual array neurostimulator pulse generator, not specified as rechargeable|
|86.97||Insertion or replacement of single array rechargeable neurostimulator pulse generator (new code effective 10/1/05)|
|86.98||Insertion or replacement of dual array rechargeable neurostimulator pulse generation (new code effective 10/1/05)|
|ICD-9 Diagnosis||See “Pain” in ICD-9 diagnosis index|
|HCPCS||L8680||Implantable neurostimulator electrode, each (new code effective 1/1/06)|
|L8685||Implantable neurostimulator pulse generator, single array, rechargeable, includes extension (new code effective 1/1/06)|
|L8686||Implantable neurostimulator pulse generator, single array, nonrechargeable, includes extension (new code effective 1/1/06)|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension (new code effective 1/1/06)|
|L8688||Implantable neurostimulator pulse generator, dual array, nonrechargeable, includes extension (new code effective 1/1/06)|
|ICD-10-CM (effective 10/1/14)||This list is a representative list of severe and chronic pain of the trunk and limbs diagnosis codes.|
|G56.40 -G56.42||Causalgia of upper limb code range|
|G57.70 -G57.72||Causalgia of lower limb code range|
|G89.21 -G89.8||Chronic pain, not elsewhere classified, code range|
|G89.4||Chronic pain syndrome|
|G90.50 -G90.59||Complex regional pain syndrome I (CRPS I), code range|
|M25.50 -M25.579||Pain in joint, code range|
|M54.10 -M54.18||Radiculopathy, code range|
|M54.30 -M54.32||Sciatica, code range|
|M54.40 -M54.42||Lumbago with sciatica, code range|
|M54.5||Low back pain|
|M54.6||Pain in thoracic spine|
|M54.81, M54.89||Other dorsalgia codes|
|M79.60 -M79.676||Pain in limb, hand, foot, fingers and toes code range|
|ICD-10-PCS (effective 10/1/14)||ICD-10-PCS codes are only used for inpatient services.|
|Surgical, central nervous system, insertion, spinal canal, neurostimulator lead, code by approach|
|00HV0MZ, 00HV3MZ, 00HV4MZ||Surgical, central nervous system, insertion, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, removal, spinal canal, neurostimulator lead, code by approach|
|00PV0MZ, 00PV3MZ, 00PV4MZ||Surgical, central nervous system, removal, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, revision, spinal canal, neurostimulator lead, code by approach|
|00WV0MZ, 00WV3MZ, 00WV4MZ||Surgical, central nervous system, revision, spinal cord, neurostimulator lead, code by approach|
|0JH60M6, 0JH60M7, 0JH60M8, 0JH60M9, 0JH63M6, 0JH63M7, 0JH63M8, 0JH63M9, 0JH70M6, 0JH70M7, 0JH70M8, 0JH70M9, 0JH73M6, 0JH73M7, 0JH73M8, 0JH73M9, 0JH80M6, 0JH80M7, 0JH80M8, 0JH80M9, 0JH83M6, 0JH83M7, 0JH83M8, 0JH83M9||Surgical, subcutaneous tissue and fascia, insertion, stimulator generator, code by body part, approach, number of arrays and whether rechargeable or not|
|0JPT0MZ, 0JPT3MZ||Surgical, subcutaneous tissue and fascia, removal, subcutaneous tissue and fascia, trunk, stimulator generator, code by approach (there aren’t ICD-10-PCS codes for removal of stimulator generator from other body parts)|
|Type of Service||Surgical|
|Place of Service||Inpatient/Outpatient|
Electrical Nerve Stimulation, Spinal
Spinal Cord Stimulation
Stimulation, Electrical, Spinal Cord
|03/31/96||Add to Surgery section||New policy|
|04/01/98||Replace policy||Policy cross-referenced to No. 7.01.63|
|07/10/98||Replace policy||Policy updated and revised|
|11/15/98||Coding update||1999 CPT coding release|
|04/29/03||Replace policy||Policy updated; new policy statement added, stating that spinal cord stimulation is investigational as a treatment of critical limb ischemia|
|11/9/04||Replace policy||Policy updated; no change to policy statement. Coding updated|
|08/17/05||Replace policy||Policy updated with literature search and coding updated; no change to policy statement|
|12/14/05||Replace policy – coding update only||Coding updated|
|12/12/06||Replace policy||Policy updated with literature search; no change to policy statement; reference numbers 7 – 9 added|
|03/13/08||Replace policy||Policy updated with literature search; references 10 – 13 added; no change to policy statements|
|01/08/09||Replace policy||Policy updated with literature search; references 14–25 added. Use in refractory angina added as investigational indication.|
|01/14/10||Replace policy||Policy updated with literature search; reference numbers 26-29 added; no change to policy statements|
|01/13/11||Replace policy||Policy updated with literature search. Rationale extensively reqritten; references numbers 15 and 16 added, other references reordered or removed.
|
63685
|
PR INSJ/RPLCMT SPINAL NPG/RCVR POCKET CRTJ&CONNJ
|
HCPCS
|
|CPT||63650||Percutaneous implantation of neurostimulator electrode array; epidural|
|63655||Laminectomy for implantation of neurostimulator electrode plate/paddle; epidural|
|63661||Removal of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63662||Removal of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy (new code 1/1/10)|
|63663||Revision including replacement, when performed, of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63664||Revision including replacement, when performed, of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy, including fluoroscopy, when performed (new code 1/1/10)|
|63685||Insertion or replacement of spinal neurostimulator pulse generator or receiver, direct or inductive coupling|
|63688||Revision or removal of implanted spinal neurostimulator pulse generator or receiver|
|95970, 95971, 95972, 95973||Neurostimulator programming and analysis code range|
|ICD-9 Procedure||03.93||Insertion or replacement of spinal neurostimulator|
|03.94||Removal of spinal neurostimulator lead(s)|
|86.05||Incision with removal of foreign body or device from skin and subcutaneous tissue (used to report removal of a neurostimulator pulse generator)|
|86.94||Insertion or replacement of single array neurostimulator pulse generator, not specified as rechargeable|
|86.95||Insertion or replacement of dual array neurostimulator pulse generator, not specified as rechargeable|
|86.97||Insertion or replacement of single array rechargeable neurostimulator pulse generator (new code effective 10/1/05)|
|86.98||Insertion or replacement of dual array rechargeable neurostimulator pulse generation (new code effective 10/1/05)|
|ICD-9 Diagnosis||See “Pain” in ICD-9 diagnosis index|
|HCPCS||L8680||Implantable neurostimulator electrode, each (new code effective 1/1/06)|
|L8685||Implantable neurostimulator pulse generator, single array, rechargeable, includes extension (new code effective 1/1/06)|
|L8686||Implantable neurostimulator pulse generator, single array, nonrechargeable, includes extension (new code effective 1/1/06)|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension (new code effective 1/1/06)|
|L8688||Implantable neurostimulator pulse generator, dual array, nonrechargeable, includes extension (new code effective 1/1/06)|
|ICD-10-CM (effective 10/1/14)||This list is a representative list of severe and chronic pain of the trunk and limbs diagnosis codes.|
|G56.40 -G56.42||Causalgia of upper limb code range|
|G57.70 -G57.72||Causalgia of lower limb code range|
|G89.21 -G89.8||Chronic pain, not elsewhere classified, code range|
|G89.4||Chronic pain syndrome|
|G90.50 -G90.59||Complex regional pain syndrome I (CRPS I), code range|
|M25.50 -M25.579||Pain in joint, code range|
|M54.10 -M54.18||Radiculopathy, code range|
|M54.30 -M54.32||Sciatica, code range|
|M54.40 -M54.42||Lumbago with sciatica, code range|
|M54.5||Low back pain|
|M54.6||Pain in thoracic spine|
|M54.81, M54.89||Other dorsalgia codes|
|M79.60 -M79.676||Pain in limb, hand, foot, fingers and toes code range|
|ICD-10-PCS (effective 10/1/14)||ICD-10-PCS codes are only used for inpatient services.|
|Surgical, central nervous system, insertion, spinal canal, neurostimulator lead, code by approach|
|00HV0MZ, 00HV3MZ, 00HV4MZ||Surgical, central nervous system, insertion, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, removal, spinal canal, neurostimulator lead, code by approach|
|00PV0MZ, 00PV3MZ, 00PV4MZ||Surgical, central nervous system, removal, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, revision, spinal canal, neurostimulator lead, code by approach|
|00WV0MZ, 00WV3MZ, 00WV4MZ||Surgical, central nervous system, revision, spinal cord, neurostimulator lead, code by approach|
|0JH60M6, 0JH60M7, 0JH60M8, 0JH60M9, 0JH63M6, 0JH63M7, 0JH63M8, 0JH63M9, 0JH70M6, 0JH70M7, 0JH70M8, 0JH70M9, 0JH73M6, 0JH73M7, 0JH73M8, 0JH73M9, 0JH80M6, 0JH80M7, 0JH80M8, 0JH80M9, 0JH83M6, 0JH83M7, 0JH83M8, 0JH83M9||Surgical, subcutaneous tissue and fascia, insertion, stimulator generator, code by body part, approach, number of arrays and whether rechargeable or not|
|0JPT0MZ, 0JPT3MZ||Surgical, subcutaneous tissue and fascia, removal, subcutaneous tissue and fascia, trunk, stimulator generator, code by approach (there aren’t ICD-10-PCS codes for removal of stimulator generator from other body parts)|
|Type of Service||Surgical|
|Place of Service||Inpatient/Outpatient|
Electrical Nerve Stimulation, Spinal
Spinal Cord Stimulation
Stimulation, Electrical, Spinal Cord
|03/31/96||Add to Surgery section||New policy|
|04/01/98||Replace policy||Policy cross-referenced to No. 7.01.63|
|07/10/98||Replace policy||Policy updated and revised|
|11/15/98||Coding update||1999 CPT coding release|
|04/29/03||Replace policy||Policy updated; new policy statement added, stating that spinal cord stimulation is investigational as a treatment of critical limb ischemia|
|11/9/04||Replace policy||Policy updated; no change to policy statement. Coding updated|
|08/17/05||Replace policy||Policy updated with literature search and coding updated; no change to policy statement|
|12/14/05||Replace policy – coding update only||Coding updated|
|12/12/06||Replace policy||Policy updated with literature search; no change to policy statement; reference numbers 7 – 9 added|
|03/13/08||Replace policy||Policy updated with literature search; references 10 – 13 added; no change to policy statements|
|01/08/09||Replace policy||Policy updated with literature search; references 14–25 added. Use in refractory angina added as investigational indication.|
|01/14/10||Replace policy||Policy updated with literature search; reference numbers 26-29 added; no change to policy statements|
|01/13/11||Replace policy||Policy updated with literature search. Rationale extensively reqritten; references numbers 15 and 16 added, other references reordered or removed.
|
63655
|
PR LAM IMPLTJ NSTIM ELTRDS PLATE/PADDLE EDRL
|
HCPCS
|
|CPT||63650||Percutaneous implantation of neurostimulator electrode array; epidural|
|63655||Laminectomy for implantation of neurostimulator electrode plate/paddle; epidural|
|63661||Removal of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63662||Removal of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy (new code 1/1/10)|
|63663||Revision including replacement, when performed, of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63664||Revision including replacement, when performed, of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy, including fluoroscopy, when performed (new code 1/1/10)|
|63685||Insertion or replacement of spinal neurostimulator pulse generator or receiver, direct or inductive coupling|
|63688||Revision or removal of implanted spinal neurostimulator pulse generator or receiver|
|95970, 95971, 95972, 95973||Neurostimulator programming and analysis code range|
|ICD-9 Procedure||03.93||Insertion or replacement of spinal neurostimulator|
|03.94||Removal of spinal neurostimulator lead(s)|
|86.05||Incision with removal of foreign body or device from skin and subcutaneous tissue (used to report removal of a neurostimulator pulse generator)|
|86.94||Insertion or replacement of single array neurostimulator pulse generator, not specified as rechargeable|
|86.95||Insertion or replacement of dual array neurostimulator pulse generator, not specified as rechargeable|
|86.97||Insertion or replacement of single array rechargeable neurostimulator pulse generator (new code effective 10/1/05)|
|86.98||Insertion or replacement of dual array rechargeable neurostimulator pulse generation (new code effective 10/1/05)|
|ICD-9 Diagnosis||See “Pain” in ICD-9 diagnosis index|
|HCPCS||L8680||Implantable neurostimulator electrode, each (new code effective 1/1/06)|
|L8685||Implantable neurostimulator pulse generator, single array, rechargeable, includes extension (new code effective 1/1/06)|
|L8686||Implantable neurostimulator pulse generator, single array, nonrechargeable, includes extension (new code effective 1/1/06)|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension (new code effective 1/1/06)|
|L8688||Implantable neurostimulator pulse generator, dual array, nonrechargeable, includes extension (new code effective 1/1/06)|
|ICD-10-CM (effective 10/1/14)||This list is a representative list of severe and chronic pain of the trunk and limbs diagnosis codes.|
|G56.40 -G56.42||Causalgia of upper limb code range|
|G57.70 -G57.72||Causalgia of lower limb code range|
|G89.21 -G89.8||Chronic pain, not elsewhere classified, code range|
|G89.4||Chronic pain syndrome|
|G90.50 -G90.59||Complex regional pain syndrome I (CRPS I), code range|
|M25.50 -M25.579||Pain in joint, code range|
|M54.10 -M54.18||Radiculopathy, code range|
|M54.30 -M54.32||Sciatica, code range|
|M54.40 -M54.42||Lumbago with sciatica, code range|
|M54.5||Low back pain|
|M54.6||Pain in thoracic spine|
|M54.81, M54.89||Other dorsalgia codes|
|M79.60 -M79.676||Pain in limb, hand, foot, fingers and toes code range|
|ICD-10-PCS (effective 10/1/14)||ICD-10-PCS codes are only used for inpatient services.|
|Surgical, central nervous system, insertion, spinal canal, neurostimulator lead, code by approach|
|00HV0MZ, 00HV3MZ, 00HV4MZ||Surgical, central nervous system, insertion, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, removal, spinal canal, neurostimulator lead, code by approach|
|00PV0MZ, 00PV3MZ, 00PV4MZ||Surgical, central nervous system, removal, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, revision, spinal canal, neurostimulator lead, code by approach|
|00WV0MZ, 00WV3MZ, 00WV4MZ||Surgical, central nervous system, revision, spinal cord, neurostimulator lead, code by approach|
|0JH60M6, 0JH60M7, 0JH60M8, 0JH60M9, 0JH63M6, 0JH63M7, 0JH63M8, 0JH63M9, 0JH70M6, 0JH70M7, 0JH70M8, 0JH70M9, 0JH73M6, 0JH73M7, 0JH73M8, 0JH73M9, 0JH80M6, 0JH80M7, 0JH80M8, 0JH80M9, 0JH83M6, 0JH83M7, 0JH83M8, 0JH83M9||Surgical, subcutaneous tissue and fascia, insertion, stimulator generator, code by body part, approach, number of arrays and whether rechargeable or not|
|0JPT0MZ, 0JPT3MZ||Surgical, subcutaneous tissue and fascia, removal, subcutaneous tissue and fascia, trunk, stimulator generator, code by approach (there aren’t ICD-10-PCS codes for removal of stimulator generator from other body parts)|
|Type of Service||Surgical|
|Place of Service||Inpatient/Outpatient|
Electrical Nerve Stimulation, Spinal
Spinal Cord Stimulation
Stimulation, Electrical, Spinal Cord
|03/31/96||Add to Surgery section||New policy|
|04/01/98||Replace policy||Policy cross-referenced to No. 7.01.63|
|07/10/98||Replace policy||Policy updated and revised|
|11/15/98||Coding update||1999 CPT coding release|
|04/29/03||Replace policy||Policy updated; new policy statement added, stating that spinal cord stimulation is investigational as a treatment of critical limb ischemia|
|11/9/04||Replace policy||Policy updated; no change to policy statement. Coding updated|
|08/17/05||Replace policy||Policy updated with literature search and coding updated; no change to policy statement|
|12/14/05||Replace policy – coding update only||Coding updated|
|12/12/06||Replace policy||Policy updated with literature search; no change to policy statement; reference numbers 7 – 9 added|
|03/13/08||Replace policy||Policy updated with literature search; references 10 – 13 added; no change to policy statements|
|01/08/09||Replace policy||Policy updated with literature search; references 14–25 added. Use in refractory angina added as investigational indication.|
|01/14/10||Replace policy||Policy updated with literature search; reference numbers 26-29 added; no change to policy statements|
|01/13/11||Replace policy||Policy updated with literature search. Rationale extensively reqritten; references numbers 15 and 16 added, other references reordered or removed.
|
95971
|
PR ELEC ALYS IMPLT NPGT SMPL SP/PN NPGT PRGRMG
|
HCPCS
|
|CPT||63650||Percutaneous implantation of neurostimulator electrode array; epidural|
|63655||Laminectomy for implantation of neurostimulator electrode plate/paddle; epidural|
|63661||Removal of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63662||Removal of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy (new code 1/1/10)|
|63663||Revision including replacement, when performed, of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63664||Revision including replacement, when performed, of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy, including fluoroscopy, when performed (new code 1/1/10)|
|63685||Insertion or replacement of spinal neurostimulator pulse generator or receiver, direct or inductive coupling|
|63688||Revision or removal of implanted spinal neurostimulator pulse generator or receiver|
|95970, 95971, 95972, 95973||Neurostimulator programming and analysis code range|
|ICD-9 Procedure||03.93||Insertion or replacement of spinal neurostimulator|
|03.94||Removal of spinal neurostimulator lead(s)|
|86.05||Incision with removal of foreign body or device from skin and subcutaneous tissue (used to report removal of a neurostimulator pulse generator)|
|86.94||Insertion or replacement of single array neurostimulator pulse generator, not specified as rechargeable|
|86.95||Insertion or replacement of dual array neurostimulator pulse generator, not specified as rechargeable|
|86.97||Insertion or replacement of single array rechargeable neurostimulator pulse generator (new code effective 10/1/05)|
|86.98||Insertion or replacement of dual array rechargeable neurostimulator pulse generation (new code effective 10/1/05)|
|ICD-9 Diagnosis||See “Pain” in ICD-9 diagnosis index|
|HCPCS||L8680||Implantable neurostimulator electrode, each (new code effective 1/1/06)|
|L8685||Implantable neurostimulator pulse generator, single array, rechargeable, includes extension (new code effective 1/1/06)|
|L8686||Implantable neurostimulator pulse generator, single array, nonrechargeable, includes extension (new code effective 1/1/06)|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension (new code effective 1/1/06)|
|L8688||Implantable neurostimulator pulse generator, dual array, nonrechargeable, includes extension (new code effective 1/1/06)|
|ICD-10-CM (effective 10/1/14)||This list is a representative list of severe and chronic pain of the trunk and limbs diagnosis codes.|
|G56.40 -G56.42||Causalgia of upper limb code range|
|G57.70 -G57.72||Causalgia of lower limb code range|
|G89.21 -G89.8||Chronic pain, not elsewhere classified, code range|
|G89.4||Chronic pain syndrome|
|G90.50 -G90.59||Complex regional pain syndrome I (CRPS I), code range|
|M25.50 -M25.579||Pain in joint, code range|
|M54.10 -M54.18||Radiculopathy, code range|
|M54.30 -M54.32||Sciatica, code range|
|M54.40 -M54.42||Lumbago with sciatica, code range|
|M54.5||Low back pain|
|M54.6||Pain in thoracic spine|
|M54.81, M54.89||Other dorsalgia codes|
|M79.60 -M79.676||Pain in limb, hand, foot, fingers and toes code range|
|ICD-10-PCS (effective 10/1/14)||ICD-10-PCS codes are only used for inpatient services.|
|Surgical, central nervous system, insertion, spinal canal, neurostimulator lead, code by approach|
|00HV0MZ, 00HV3MZ, 00HV4MZ||Surgical, central nervous system, insertion, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, removal, spinal canal, neurostimulator lead, code by approach|
|00PV0MZ, 00PV3MZ, 00PV4MZ||Surgical, central nervous system, removal, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, revision, spinal canal, neurostimulator lead, code by approach|
|00WV0MZ, 00WV3MZ, 00WV4MZ||Surgical, central nervous system, revision, spinal cord, neurostimulator lead, code by approach|
|0JH60M6, 0JH60M7, 0JH60M8, 0JH60M9, 0JH63M6, 0JH63M7, 0JH63M8, 0JH63M9, 0JH70M6, 0JH70M7, 0JH70M8, 0JH70M9, 0JH73M6, 0JH73M7, 0JH73M8, 0JH73M9, 0JH80M6, 0JH80M7, 0JH80M8, 0JH80M9, 0JH83M6, 0JH83M7, 0JH83M8, 0JH83M9||Surgical, subcutaneous tissue and fascia, insertion, stimulator generator, code by body part, approach, number of arrays and whether rechargeable or not|
|0JPT0MZ, 0JPT3MZ||Surgical, subcutaneous tissue and fascia, removal, subcutaneous tissue and fascia, trunk, stimulator generator, code by approach (there aren’t ICD-10-PCS codes for removal of stimulator generator from other body parts)|
|Type of Service||Surgical|
|Place of Service||Inpatient/Outpatient|
Electrical Nerve Stimulation, Spinal
Spinal Cord Stimulation
Stimulation, Electrical, Spinal Cord
|03/31/96||Add to Surgery section||New policy|
|04/01/98||Replace policy||Policy cross-referenced to No. 7.01.63|
|07/10/98||Replace policy||Policy updated and revised|
|11/15/98||Coding update||1999 CPT coding release|
|04/29/03||Replace policy||Policy updated; new policy statement added, stating that spinal cord stimulation is investigational as a treatment of critical limb ischemia|
|11/9/04||Replace policy||Policy updated; no change to policy statement. Coding updated|
|08/17/05||Replace policy||Policy updated with literature search and coding updated; no change to policy statement|
|12/14/05||Replace policy – coding update only||Coding updated|
|12/12/06||Replace policy||Policy updated with literature search; no change to policy statement; reference numbers 7 – 9 added|
|03/13/08||Replace policy||Policy updated with literature search; references 10 – 13 added; no change to policy statements|
|01/08/09||Replace policy||Policy updated with literature search; references 14–25 added. Use in refractory angina added as investigational indication.|
|01/14/10||Replace policy||Policy updated with literature search; reference numbers 26-29 added; no change to policy statements|
|01/13/11||Replace policy||Policy updated with literature search. Rationale extensively reqritten; references numbers 15 and 16 added, other references reordered or removed.
|
L8686
|
Implt nrostm pls gen sng non
|
HCPCS
|
|CPT||63650||Percutaneous implantation of neurostimulator electrode array; epidural|
|63655||Laminectomy for implantation of neurostimulator electrode plate/paddle; epidural|
|63661||Removal of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63662||Removal of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy (new code 1/1/10)|
|63663||Revision including replacement, when performed, of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63664||Revision including replacement, when performed, of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy, including fluoroscopy, when performed (new code 1/1/10)|
|63685||Insertion or replacement of spinal neurostimulator pulse generator or receiver, direct or inductive coupling|
|63688||Revision or removal of implanted spinal neurostimulator pulse generator or receiver|
|95970, 95971, 95972, 95973||Neurostimulator programming and analysis code range|
|ICD-9 Procedure||03.93||Insertion or replacement of spinal neurostimulator|
|03.94||Removal of spinal neurostimulator lead(s)|
|86.05||Incision with removal of foreign body or device from skin and subcutaneous tissue (used to report removal of a neurostimulator pulse generator)|
|86.94||Insertion or replacement of single array neurostimulator pulse generator, not specified as rechargeable|
|86.95||Insertion or replacement of dual array neurostimulator pulse generator, not specified as rechargeable|
|86.97||Insertion or replacement of single array rechargeable neurostimulator pulse generator (new code effective 10/1/05)|
|86.98||Insertion or replacement of dual array rechargeable neurostimulator pulse generation (new code effective 10/1/05)|
|ICD-9 Diagnosis||See “Pain” in ICD-9 diagnosis index|
|HCPCS||L8680||Implantable neurostimulator electrode, each (new code effective 1/1/06)|
|L8685||Implantable neurostimulator pulse generator, single array, rechargeable, includes extension (new code effective 1/1/06)|
|L8686||Implantable neurostimulator pulse generator, single array, nonrechargeable, includes extension (new code effective 1/1/06)|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension (new code effective 1/1/06)|
|L8688||Implantable neurostimulator pulse generator, dual array, nonrechargeable, includes extension (new code effective 1/1/06)|
|ICD-10-CM (effective 10/1/14)||This list is a representative list of severe and chronic pain of the trunk and limbs diagnosis codes.|
|G56.40 -G56.42||Causalgia of upper limb code range|
|G57.70 -G57.72||Causalgia of lower limb code range|
|G89.21 -G89.8||Chronic pain, not elsewhere classified, code range|
|G89.4||Chronic pain syndrome|
|G90.50 -G90.59||Complex regional pain syndrome I (CRPS I), code range|
|M25.50 -M25.579||Pain in joint, code range|
|M54.10 -M54.18||Radiculopathy, code range|
|M54.30 -M54.32||Sciatica, code range|
|M54.40 -M54.42||Lumbago with sciatica, code range|
|M54.5||Low back pain|
|M54.6||Pain in thoracic spine|
|M54.81, M54.89||Other dorsalgia codes|
|M79.60 -M79.676||Pain in limb, hand, foot, fingers and toes code range|
|ICD-10-PCS (effective 10/1/14)||ICD-10-PCS codes are only used for inpatient services.|
|Surgical, central nervous system, insertion, spinal canal, neurostimulator lead, code by approach|
|00HV0MZ, 00HV3MZ, 00HV4MZ||Surgical, central nervous system, insertion, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, removal, spinal canal, neurostimulator lead, code by approach|
|00PV0MZ, 00PV3MZ, 00PV4MZ||Surgical, central nervous system, removal, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, revision, spinal canal, neurostimulator lead, code by approach|
|00WV0MZ, 00WV3MZ, 00WV4MZ||Surgical, central nervous system, revision, spinal cord, neurostimulator lead, code by approach|
|0JH60M6, 0JH60M7, 0JH60M8, 0JH60M9, 0JH63M6, 0JH63M7, 0JH63M8, 0JH63M9, 0JH70M6, 0JH70M7, 0JH70M8, 0JH70M9, 0JH73M6, 0JH73M7, 0JH73M8, 0JH73M9, 0JH80M6, 0JH80M7, 0JH80M8, 0JH80M9, 0JH83M6, 0JH83M7, 0JH83M8, 0JH83M9||Surgical, subcutaneous tissue and fascia, insertion, stimulator generator, code by body part, approach, number of arrays and whether rechargeable or not|
|0JPT0MZ, 0JPT3MZ||Surgical, subcutaneous tissue and fascia, removal, subcutaneous tissue and fascia, trunk, stimulator generator, code by approach (there aren’t ICD-10-PCS codes for removal of stimulator generator from other body parts)|
|Type of Service||Surgical|
|Place of Service||Inpatient/Outpatient|
Electrical Nerve Stimulation, Spinal
Spinal Cord Stimulation
Stimulation, Electrical, Spinal Cord
|03/31/96||Add to Surgery section||New policy|
|04/01/98||Replace policy||Policy cross-referenced to No. 7.01.63|
|07/10/98||Replace policy||Policy updated and revised|
|11/15/98||Coding update||1999 CPT coding release|
|04/29/03||Replace policy||Policy updated; new policy statement added, stating that spinal cord stimulation is investigational as a treatment of critical limb ischemia|
|11/9/04||Replace policy||Policy updated; no change to policy statement. Coding updated|
|08/17/05||Replace policy||Policy updated with literature search and coding updated; no change to policy statement|
|12/14/05||Replace policy – coding update only||Coding updated|
|12/12/06||Replace policy||Policy updated with literature search; no change to policy statement; reference numbers 7 – 9 added|
|03/13/08||Replace policy||Policy updated with literature search; references 10 – 13 added; no change to policy statements|
|01/08/09||Replace policy||Policy updated with literature search; references 14–25 added. Use in refractory angina added as investigational indication.|
|01/14/10||Replace policy||Policy updated with literature search; reference numbers 26-29 added; no change to policy statements|
|01/13/11||Replace policy||Policy updated with literature search. Rationale extensively reqritten; references numbers 15 and 16 added, other references reordered or removed.
|
63664
|
Revise spine eltrd plate
|
HCPCS
|
|CPT||63650||Percutaneous implantation of neurostimulator electrode array; epidural|
|63655||Laminectomy for implantation of neurostimulator electrode plate/paddle; epidural|
|63661||Removal of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63662||Removal of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy (new code 1/1/10)|
|63663||Revision including replacement, when performed, of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63664||Revision including replacement, when performed, of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy, including fluoroscopy, when performed (new code 1/1/10)|
|63685||Insertion or replacement of spinal neurostimulator pulse generator or receiver, direct or inductive coupling|
|63688||Revision or removal of implanted spinal neurostimulator pulse generator or receiver|
|95970, 95971, 95972, 95973||Neurostimulator programming and analysis code range|
|ICD-9 Procedure||03.93||Insertion or replacement of spinal neurostimulator|
|03.94||Removal of spinal neurostimulator lead(s)|
|86.05||Incision with removal of foreign body or device from skin and subcutaneous tissue (used to report removal of a neurostimulator pulse generator)|
|86.94||Insertion or replacement of single array neurostimulator pulse generator, not specified as rechargeable|
|86.95||Insertion or replacement of dual array neurostimulator pulse generator, not specified as rechargeable|
|86.97||Insertion or replacement of single array rechargeable neurostimulator pulse generator (new code effective 10/1/05)|
|86.98||Insertion or replacement of dual array rechargeable neurostimulator pulse generation (new code effective 10/1/05)|
|ICD-9 Diagnosis||See “Pain” in ICD-9 diagnosis index|
|HCPCS||L8680||Implantable neurostimulator electrode, each (new code effective 1/1/06)|
|L8685||Implantable neurostimulator pulse generator, single array, rechargeable, includes extension (new code effective 1/1/06)|
|L8686||Implantable neurostimulator pulse generator, single array, nonrechargeable, includes extension (new code effective 1/1/06)|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension (new code effective 1/1/06)|
|L8688||Implantable neurostimulator pulse generator, dual array, nonrechargeable, includes extension (new code effective 1/1/06)|
|ICD-10-CM (effective 10/1/14)||This list is a representative list of severe and chronic pain of the trunk and limbs diagnosis codes.|
|G56.40 -G56.42||Causalgia of upper limb code range|
|G57.70 -G57.72||Causalgia of lower limb code range|
|G89.21 -G89.8||Chronic pain, not elsewhere classified, code range|
|G89.4||Chronic pain syndrome|
|G90.50 -G90.59||Complex regional pain syndrome I (CRPS I), code range|
|M25.50 -M25.579||Pain in joint, code range|
|M54.10 -M54.18||Radiculopathy, code range|
|M54.30 -M54.32||Sciatica, code range|
|M54.40 -M54.42||Lumbago with sciatica, code range|
|M54.5||Low back pain|
|M54.6||Pain in thoracic spine|
|M54.81, M54.89||Other dorsalgia codes|
|M79.60 -M79.676||Pain in limb, hand, foot, fingers and toes code range|
|ICD-10-PCS (effective 10/1/14)||ICD-10-PCS codes are only used for inpatient services.|
|Surgical, central nervous system, insertion, spinal canal, neurostimulator lead, code by approach|
|00HV0MZ, 00HV3MZ, 00HV4MZ||Surgical, central nervous system, insertion, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, removal, spinal canal, neurostimulator lead, code by approach|
|00PV0MZ, 00PV3MZ, 00PV4MZ||Surgical, central nervous system, removal, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, revision, spinal canal, neurostimulator lead, code by approach|
|00WV0MZ, 00WV3MZ, 00WV4MZ||Surgical, central nervous system, revision, spinal cord, neurostimulator lead, code by approach|
|0JH60M6, 0JH60M7, 0JH60M8, 0JH60M9, 0JH63M6, 0JH63M7, 0JH63M8, 0JH63M9, 0JH70M6, 0JH70M7, 0JH70M8, 0JH70M9, 0JH73M6, 0JH73M7, 0JH73M8, 0JH73M9, 0JH80M6, 0JH80M7, 0JH80M8, 0JH80M9, 0JH83M6, 0JH83M7, 0JH83M8, 0JH83M9||Surgical, subcutaneous tissue and fascia, insertion, stimulator generator, code by body part, approach, number of arrays and whether rechargeable or not|
|0JPT0MZ, 0JPT3MZ||Surgical, subcutaneous tissue and fascia, removal, subcutaneous tissue and fascia, trunk, stimulator generator, code by approach (there aren’t ICD-10-PCS codes for removal of stimulator generator from other body parts)|
|Type of Service||Surgical|
|Place of Service||Inpatient/Outpatient|
Electrical Nerve Stimulation, Spinal
Spinal Cord Stimulation
Stimulation, Electrical, Spinal Cord
|03/31/96||Add to Surgery section||New policy|
|04/01/98||Replace policy||Policy cross-referenced to No. 7.01.63|
|07/10/98||Replace policy||Policy updated and revised|
|11/15/98||Coding update||1999 CPT coding release|
|04/29/03||Replace policy||Policy updated; new policy statement added, stating that spinal cord stimulation is investigational as a treatment of critical limb ischemia|
|11/9/04||Replace policy||Policy updated; no change to policy statement. Coding updated|
|08/17/05||Replace policy||Policy updated with literature search and coding updated; no change to policy statement|
|12/14/05||Replace policy – coding update only||Coding updated|
|12/12/06||Replace policy||Policy updated with literature search; no change to policy statement; reference numbers 7 – 9 added|
|03/13/08||Replace policy||Policy updated with literature search; references 10 – 13 added; no change to policy statements|
|01/08/09||Replace policy||Policy updated with literature search; references 14–25 added. Use in refractory angina added as investigational indication.|
|01/14/10||Replace policy||Policy updated with literature search; reference numbers 26-29 added; no change to policy statements|
|01/13/11||Replace policy||Policy updated with literature search. Rationale extensively reqritten; references numbers 15 and 16 added, other references reordered or removed.
|
L8685
|
Implt nrostm pls gen sng rec
|
HCPCS
|
|CPT||63650||Percutaneous implantation of neurostimulator electrode array; epidural|
|63655||Laminectomy for implantation of neurostimulator electrode plate/paddle; epidural|
|63661||Removal of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63662||Removal of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy (new code 1/1/10)|
|63663||Revision including replacement, when performed, of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63664||Revision including replacement, when performed, of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy, including fluoroscopy, when performed (new code 1/1/10)|
|63685||Insertion or replacement of spinal neurostimulator pulse generator or receiver, direct or inductive coupling|
|63688||Revision or removal of implanted spinal neurostimulator pulse generator or receiver|
|95970, 95971, 95972, 95973||Neurostimulator programming and analysis code range|
|ICD-9 Procedure||03.93||Insertion or replacement of spinal neurostimulator|
|03.94||Removal of spinal neurostimulator lead(s)|
|86.05||Incision with removal of foreign body or device from skin and subcutaneous tissue (used to report removal of a neurostimulator pulse generator)|
|86.94||Insertion or replacement of single array neurostimulator pulse generator, not specified as rechargeable|
|86.95||Insertion or replacement of dual array neurostimulator pulse generator, not specified as rechargeable|
|86.97||Insertion or replacement of single array rechargeable neurostimulator pulse generator (new code effective 10/1/05)|
|86.98||Insertion or replacement of dual array rechargeable neurostimulator pulse generation (new code effective 10/1/05)|
|ICD-9 Diagnosis||See “Pain” in ICD-9 diagnosis index|
|HCPCS||L8680||Implantable neurostimulator electrode, each (new code effective 1/1/06)|
|L8685||Implantable neurostimulator pulse generator, single array, rechargeable, includes extension (new code effective 1/1/06)|
|L8686||Implantable neurostimulator pulse generator, single array, nonrechargeable, includes extension (new code effective 1/1/06)|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension (new code effective 1/1/06)|
|L8688||Implantable neurostimulator pulse generator, dual array, nonrechargeable, includes extension (new code effective 1/1/06)|
|ICD-10-CM (effective 10/1/14)||This list is a representative list of severe and chronic pain of the trunk and limbs diagnosis codes.|
|G56.40 -G56.42||Causalgia of upper limb code range|
|G57.70 -G57.72||Causalgia of lower limb code range|
|G89.21 -G89.8||Chronic pain, not elsewhere classified, code range|
|G89.4||Chronic pain syndrome|
|G90.50 -G90.59||Complex regional pain syndrome I (CRPS I), code range|
|M25.50 -M25.579||Pain in joint, code range|
|M54.10 -M54.18||Radiculopathy, code range|
|M54.30 -M54.32||Sciatica, code range|
|M54.40 -M54.42||Lumbago with sciatica, code range|
|M54.5||Low back pain|
|M54.6||Pain in thoracic spine|
|M54.81, M54.89||Other dorsalgia codes|
|M79.60 -M79.676||Pain in limb, hand, foot, fingers and toes code range|
|ICD-10-PCS (effective 10/1/14)||ICD-10-PCS codes are only used for inpatient services.|
|Surgical, central nervous system, insertion, spinal canal, neurostimulator lead, code by approach|
|00HV0MZ, 00HV3MZ, 00HV4MZ||Surgical, central nervous system, insertion, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, removal, spinal canal, neurostimulator lead, code by approach|
|00PV0MZ, 00PV3MZ, 00PV4MZ||Surgical, central nervous system, removal, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, revision, spinal canal, neurostimulator lead, code by approach|
|00WV0MZ, 00WV3MZ, 00WV4MZ||Surgical, central nervous system, revision, spinal cord, neurostimulator lead, code by approach|
|0JH60M6, 0JH60M7, 0JH60M8, 0JH60M9, 0JH63M6, 0JH63M7, 0JH63M8, 0JH63M9, 0JH70M6, 0JH70M7, 0JH70M8, 0JH70M9, 0JH73M6, 0JH73M7, 0JH73M8, 0JH73M9, 0JH80M6, 0JH80M7, 0JH80M8, 0JH80M9, 0JH83M6, 0JH83M7, 0JH83M8, 0JH83M9||Surgical, subcutaneous tissue and fascia, insertion, stimulator generator, code by body part, approach, number of arrays and whether rechargeable or not|
|0JPT0MZ, 0JPT3MZ||Surgical, subcutaneous tissue and fascia, removal, subcutaneous tissue and fascia, trunk, stimulator generator, code by approach (there aren’t ICD-10-PCS codes for removal of stimulator generator from other body parts)|
|Type of Service||Surgical|
|Place of Service||Inpatient/Outpatient|
Electrical Nerve Stimulation, Spinal
Spinal Cord Stimulation
Stimulation, Electrical, Spinal Cord
|03/31/96||Add to Surgery section||New policy|
|04/01/98||Replace policy||Policy cross-referenced to No. 7.01.63|
|07/10/98||Replace policy||Policy updated and revised|
|11/15/98||Coding update||1999 CPT coding release|
|04/29/03||Replace policy||Policy updated; new policy statement added, stating that spinal cord stimulation is investigational as a treatment of critical limb ischemia|
|11/9/04||Replace policy||Policy updated; no change to policy statement. Coding updated|
|08/17/05||Replace policy||Policy updated with literature search and coding updated; no change to policy statement|
|12/14/05||Replace policy – coding update only||Coding updated|
|12/12/06||Replace policy||Policy updated with literature search; no change to policy statement; reference numbers 7 – 9 added|
|03/13/08||Replace policy||Policy updated with literature search; references 10 – 13 added; no change to policy statements|
|01/08/09||Replace policy||Policy updated with literature search; references 14–25 added. Use in refractory angina added as investigational indication.|
|01/14/10||Replace policy||Policy updated with literature search; reference numbers 26-29 added; no change to policy statements|
|01/13/11||Replace policy||Policy updated with literature search. Rationale extensively reqritten; references numbers 15 and 16 added, other references reordered or removed.
|
95973
|
Analyze neurostim complex
|
HCPCS
|
|CPT||63650||Percutaneous implantation of neurostimulator electrode array; epidural|
|63655||Laminectomy for implantation of neurostimulator electrode plate/paddle; epidural|
|63661||Removal of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63662||Removal of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy (new code 1/1/10)|
|63663||Revision including replacement, when performed, of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (new code 1/1/10)|
|63664||Revision including replacement, when performed, of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy, including fluoroscopy, when performed (new code 1/1/10)|
|63685||Insertion or replacement of spinal neurostimulator pulse generator or receiver, direct or inductive coupling|
|63688||Revision or removal of implanted spinal neurostimulator pulse generator or receiver|
|95970, 95971, 95972, 95973||Neurostimulator programming and analysis code range|
|ICD-9 Procedure||03.93||Insertion or replacement of spinal neurostimulator|
|03.94||Removal of spinal neurostimulator lead(s)|
|86.05||Incision with removal of foreign body or device from skin and subcutaneous tissue (used to report removal of a neurostimulator pulse generator)|
|86.94||Insertion or replacement of single array neurostimulator pulse generator, not specified as rechargeable|
|86.95||Insertion or replacement of dual array neurostimulator pulse generator, not specified as rechargeable|
|86.97||Insertion or replacement of single array rechargeable neurostimulator pulse generator (new code effective 10/1/05)|
|86.98||Insertion or replacement of dual array rechargeable neurostimulator pulse generation (new code effective 10/1/05)|
|ICD-9 Diagnosis||See “Pain” in ICD-9 diagnosis index|
|HCPCS||L8680||Implantable neurostimulator electrode, each (new code effective 1/1/06)|
|L8685||Implantable neurostimulator pulse generator, single array, rechargeable, includes extension (new code effective 1/1/06)|
|L8686||Implantable neurostimulator pulse generator, single array, nonrechargeable, includes extension (new code effective 1/1/06)|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension (new code effective 1/1/06)|
|L8688||Implantable neurostimulator pulse generator, dual array, nonrechargeable, includes extension (new code effective 1/1/06)|
|ICD-10-CM (effective 10/1/14)||This list is a representative list of severe and chronic pain of the trunk and limbs diagnosis codes.|
|G56.40 -G56.42||Causalgia of upper limb code range|
|G57.70 -G57.72||Causalgia of lower limb code range|
|G89.21 -G89.8||Chronic pain, not elsewhere classified, code range|
|G89.4||Chronic pain syndrome|
|G90.50 -G90.59||Complex regional pain syndrome I (CRPS I), code range|
|M25.50 -M25.579||Pain in joint, code range|
|M54.10 -M54.18||Radiculopathy, code range|
|M54.30 -M54.32||Sciatica, code range|
|M54.40 -M54.42||Lumbago with sciatica, code range|
|M54.5||Low back pain|
|M54.6||Pain in thoracic spine|
|M54.81, M54.89||Other dorsalgia codes|
|M79.60 -M79.676||Pain in limb, hand, foot, fingers and toes code range|
|ICD-10-PCS (effective 10/1/14)||ICD-10-PCS codes are only used for inpatient services.|
|Surgical, central nervous system, insertion, spinal canal, neurostimulator lead, code by approach|
|00HV0MZ, 00HV3MZ, 00HV4MZ||Surgical, central nervous system, insertion, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, removal, spinal canal, neurostimulator lead, code by approach|
|00PV0MZ, 00PV3MZ, 00PV4MZ||Surgical, central nervous system, removal, spinal cord, neurostimulator lead, code by approach|
|00WU0MZ, 00WU3MZ, 00WU4MZ||Surgical, central nervous system, revision, spinal canal, neurostimulator lead, code by approach|
|00WV0MZ, 00WV3MZ, 00WV4MZ||Surgical, central nervous system, revision, spinal cord, neurostimulator lead, code by approach|
|0JH60M6, 0JH60M7, 0JH60M8, 0JH60M9, 0JH63M6, 0JH63M7, 0JH63M8, 0JH63M9, 0JH70M6, 0JH70M7, 0JH70M8, 0JH70M9, 0JH73M6, 0JH73M7, 0JH73M8, 0JH73M9, 0JH80M6, 0JH80M7, 0JH80M8, 0JH80M9, 0JH83M6, 0JH83M7, 0JH83M8, 0JH83M9||Surgical, subcutaneous tissue and fascia, insertion, stimulator generator, code by body part, approach, number of arrays and whether rechargeable or not|
|0JPT0MZ, 0JPT3MZ||Surgical, subcutaneous tissue and fascia, removal, subcutaneous tissue and fascia, trunk, stimulator generator, code by approach (there aren’t ICD-10-PCS codes for removal of stimulator generator from other body parts)|
|Type of Service||Surgical|
|Place of Service||Inpatient/Outpatient|
Electrical Nerve Stimulation, Spinal
Spinal Cord Stimulation
Stimulation, Electrical, Spinal Cord
|03/31/96||Add to Surgery section||New policy|
|04/01/98||Replace policy||Policy cross-referenced to No. 7.01.63|
|07/10/98||Replace policy||Policy updated and revised|
|11/15/98||Coding update||1999 CPT coding release|
|04/29/03||Replace policy||Policy updated; new policy statement added, stating that spinal cord stimulation is investigational as a treatment of critical limb ischemia|
|11/9/04||Replace policy||Policy updated; no change to policy statement. Coding updated|
|08/17/05||Replace policy||Policy updated with literature search and coding updated; no change to policy statement|
|12/14/05||Replace policy – coding update only||Coding updated|
|12/12/06||Replace policy||Policy updated with literature search; no change to policy statement; reference numbers 7 – 9 added|
|03/13/08||Replace policy||Policy updated with literature search; references 10 – 13 added; no change to policy statements|
|01/08/09||Replace policy||Policy updated with literature search; references 14–25 added. Use in refractory angina added as investigational indication.|
|01/14/10||Replace policy||Policy updated with literature search; reference numbers 26-29 added; no change to policy statements|
|01/13/11||Replace policy||Policy updated with literature search. Rationale extensively reqritten; references numbers 15 and 16 added, other references reordered or removed.
|
1999
|
ANESTHESIOLOGY GROUP
|
CPT
|
7.01.63|
|07/10/98||Replace policy||Policy updated and revised|
|11/15/98||Coding update||1999 CPT coding release|
|04/29/03||Replace policy||Policy updated; new policy statement added, stating that spinal cord stimulation is investigational as a treatment of critical limb ischemia|
|11/9/04||Replace policy||Policy updated; no change to policy statement. Coding updated|
|08/17/05||Replace policy||Policy updated with literature search and coding updated; no change to policy statement|
|12/14/05||Replace policy – coding update only||Coding updated|
|12/12/06||Replace policy||Policy updated with literature search; no change to policy statement; reference numbers 7 – 9 added|
|03/13/08||Replace policy||Policy updated with literature search; references 10 – 13 added; no change to policy statements|
|01/08/09||Replace policy||Policy updated with literature search; references 14–25 added. Use in refractory angina added as investigational indication.|
|01/14/10||Replace policy||Policy updated with literature search; reference numbers 26-29 added; no change to policy statements|
|01/13/11||Replace policy||Policy updated with literature search. Rationale extensively reqritten; references numbers 15 and 16 added, other references reordered or removed. No change to policy statements.|
|1/12/12||Replace policy||Policy updated with literature search.
|
1741
|
Open robotic assisted procedure
|
ICD
|
Crosswalk to ICD-10 codes.||HHS/ASPE||CMS, VA, NIH, IHS||January 2015|
|Strategy 5.B: Monitor Progress on the National Plan|
|5.B.1||Designate responsibility for action implementation.||Designate office.||ASPE||Completed|
|5.B.2||Track plan progress.||Track progress on the plan, & incorporate measures into other efforts to monitor population health such as Healthy People 2020.||ASPE||Ongoing|
|5.B.3||Update the National Plan annually.||Release updated National Plan.||ASPE||Ongoing|
Rebok GW, et al. "Ten-Year Effects of the Advanced Cognitive Training for Independent and Vital Elderly Cognitive Training Trial on Cognition and Everyday Functioning in Older Adults." J Am Geriatr Soc, 2014, doi: 10.1111/jgs.12607. http://www.ncbi.nlm.nih.gov/pubmed/24417410. Jonsson T, et al.
|
0194
|
Subacute
|
RC
|
Geneva: World Health Organization; 2014. Peden AE, Franklin RC, Mahony A, Barnsley P, Scarr J. Using a retrospective cross-sectional study to analyse unintentional fatal drowning in Australia: ICD-10 coding-based methodologies verses actual deaths. BMJ Open. 2017;7:e019407.
|
L8509
|
VOICE PROSTHESIS PROVOX VEGA 17FR 4MM 8110
|
HCPCS
|
There's also a code for tracheoesophageal voice prostheses (L8509) which are grouped by the type of service or the supply that they represent. Again, these codes are also updated annually, and there are also Medicare claims for E and L codes and V codes, which all fall under the jurisdiction of Durable Medical Equipment Medicare Administrative Contractors (DME MACs). I'll discuss with you a little further to familiarize you with what a MAC is in case you don't know. But for more information on any of the coding systems that I'm reviewing in this course, there is a reference that is available for free on the ASHA website where all these things are listed and explained: www.asha.org/practice/reimbursement/coding/hcpcs_slp/. HCPCS Level I - Voice and Resonance CPT Codes for SLPs
I'm going to spend the rest of the time discussing HCPCS Level I, rather than Level II.
|
92520
|
PR LARYNGEAL FUNCTION STUDIES
|
HCPCS
|
I'll discuss with you a little further to familiarize you with what a MAC is in case you don't know. But for more information on any of the coding systems that I'm reviewing in this course, there is a reference that is available for free on the ASHA website where all these things are listed and explained: www.asha.org/practice/reimbursement/coding/hcpcs_slp/. HCPCS Level I - Voice and Resonance CPT Codes for SLPs
I'm going to spend the rest of the time discussing HCPCS Level I, rather than Level II. I'm not going to read each of these to you, but for those of us who practice in voice and resonance, these are the most common CPT codes that we use in our daily practice. - CPT 31579 Laryngoscopy, flexible or rigid fiberoptic, with stroboscopy
- CPT 92507 Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual
- CPT 92511 Nasopharyngoscopy with endoscope (separate procedure)
- CPT 92520 Laryngeal function studies (i.e., aerodynamic testing and acoustic testing)
- CPT 92524 Behavioral and qualitative analysis of voice and resonance
- CPT 92597 Evaluation for use and/or fitting of voice prosthetic device to supplement oral speech
For example, CPT 31579 is for laryngoscopy, flexible or rigid scope, with stroboscopy.
|
92511
|
PR NASOPHARYNGOSCOPY W/ENDOSCOPE SPX
|
HCPCS
|
I'll discuss with you a little further to familiarize you with what a MAC is in case you don't know. But for more information on any of the coding systems that I'm reviewing in this course, there is a reference that is available for free on the ASHA website where all these things are listed and explained: www.asha.org/practice/reimbursement/coding/hcpcs_slp/. HCPCS Level I - Voice and Resonance CPT Codes for SLPs
I'm going to spend the rest of the time discussing HCPCS Level I, rather than Level II. I'm not going to read each of these to you, but for those of us who practice in voice and resonance, these are the most common CPT codes that we use in our daily practice. - CPT 31579 Laryngoscopy, flexible or rigid fiberoptic, with stroboscopy
- CPT 92507 Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual
- CPT 92511 Nasopharyngoscopy with endoscope (separate procedure)
- CPT 92520 Laryngeal function studies (i.e., aerodynamic testing and acoustic testing)
- CPT 92524 Behavioral and qualitative analysis of voice and resonance
- CPT 92597 Evaluation for use and/or fitting of voice prosthetic device to supplement oral speech
For example, CPT 31579 is for laryngoscopy, flexible or rigid scope, with stroboscopy.
|
31579
|
PR LARYNGOSCOPY FLX/RGD TELESCOPIC W/STROBOSCOPY
|
HCPCS
|
I'll discuss with you a little further to familiarize you with what a MAC is in case you don't know. But for more information on any of the coding systems that I'm reviewing in this course, there is a reference that is available for free on the ASHA website where all these things are listed and explained: www.asha.org/practice/reimbursement/coding/hcpcs_slp/. HCPCS Level I - Voice and Resonance CPT Codes for SLPs
I'm going to spend the rest of the time discussing HCPCS Level I, rather than Level II. I'm not going to read each of these to you, but for those of us who practice in voice and resonance, these are the most common CPT codes that we use in our daily practice. - CPT 31579 Laryngoscopy, flexible or rigid fiberoptic, with stroboscopy
- CPT 92507 Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual
- CPT 92511 Nasopharyngoscopy with endoscope (separate procedure)
- CPT 92520 Laryngeal function studies (i.e., aerodynamic testing and acoustic testing)
- CPT 92524 Behavioral and qualitative analysis of voice and resonance
- CPT 92597 Evaluation for use and/or fitting of voice prosthetic device to supplement oral speech
For example, CPT 31579 is for laryngoscopy, flexible or rigid scope, with stroboscopy.
|
92524
|
ST SPEECH BEHAVIORAL QUALI OF
|
HCPCS
|
I'll discuss with you a little further to familiarize you with what a MAC is in case you don't know. But for more information on any of the coding systems that I'm reviewing in this course, there is a reference that is available for free on the ASHA website where all these things are listed and explained: www.asha.org/practice/reimbursement/coding/hcpcs_slp/. HCPCS Level I - Voice and Resonance CPT Codes for SLPs
I'm going to spend the rest of the time discussing HCPCS Level I, rather than Level II. I'm not going to read each of these to you, but for those of us who practice in voice and resonance, these are the most common CPT codes that we use in our daily practice. - CPT 31579 Laryngoscopy, flexible or rigid fiberoptic, with stroboscopy
- CPT 92507 Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual
- CPT 92511 Nasopharyngoscopy with endoscope (separate procedure)
- CPT 92520 Laryngeal function studies (i.e., aerodynamic testing and acoustic testing)
- CPT 92524 Behavioral and qualitative analysis of voice and resonance
- CPT 92597 Evaluation for use and/or fitting of voice prosthetic device to supplement oral speech
For example, CPT 31579 is for laryngoscopy, flexible or rigid scope, with stroboscopy.
|
92597
|
PR EVAL&/FITG VOICE PROSTC DEV SUPLMNT ORAL SPEEC
|
HCPCS
|
I'll discuss with you a little further to familiarize you with what a MAC is in case you don't know. But for more information on any of the coding systems that I'm reviewing in this course, there is a reference that is available for free on the ASHA website where all these things are listed and explained: www.asha.org/practice/reimbursement/coding/hcpcs_slp/. HCPCS Level I - Voice and Resonance CPT Codes for SLPs
I'm going to spend the rest of the time discussing HCPCS Level I, rather than Level II. I'm not going to read each of these to you, but for those of us who practice in voice and resonance, these are the most common CPT codes that we use in our daily practice. - CPT 31579 Laryngoscopy, flexible or rigid fiberoptic, with stroboscopy
- CPT 92507 Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual
- CPT 92511 Nasopharyngoscopy with endoscope (separate procedure)
- CPT 92520 Laryngeal function studies (i.e., aerodynamic testing and acoustic testing)
- CPT 92524 Behavioral and qualitative analysis of voice and resonance
- CPT 92597 Evaluation for use and/or fitting of voice prosthetic device to supplement oral speech
For example, CPT 31579 is for laryngoscopy, flexible or rigid scope, with stroboscopy.
|
92507
|
Treatment of speech, language, voice, communication, and/or hearing processing disorder
|
HCPCS
|
I'll discuss with you a little further to familiarize you with what a MAC is in case you don't know. But for more information on any of the coding systems that I'm reviewing in this course, there is a reference that is available for free on the ASHA website where all these things are listed and explained: www.asha.org/practice/reimbursement/coding/hcpcs_slp/. HCPCS Level I - Voice and Resonance CPT Codes for SLPs
I'm going to spend the rest of the time discussing HCPCS Level I, rather than Level II. I'm not going to read each of these to you, but for those of us who practice in voice and resonance, these are the most common CPT codes that we use in our daily practice. - CPT 31579 Laryngoscopy, flexible or rigid fiberoptic, with stroboscopy
- CPT 92507 Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual
- CPT 92511 Nasopharyngoscopy with endoscope (separate procedure)
- CPT 92520 Laryngeal function studies (i.e., aerodynamic testing and acoustic testing)
- CPT 92524 Behavioral and qualitative analysis of voice and resonance
- CPT 92597 Evaluation for use and/or fitting of voice prosthetic device to supplement oral speech
For example, CPT 31579 is for laryngoscopy, flexible or rigid scope, with stroboscopy.
|
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