How to Bill for Spinal Cord Stimulation Trial Placement Code CPT 63650
Effective January 01, 2014 we have some changes on how to bill for the CPT code for the Percutaneous Lead Trial.
** We are still using the same code CPT 63650 (Percutaneous implantation of neurostimulator electrode array, epidural) for the Percutaneous Lead Trial
** Medicare will no longer reimburse separately for the L8680 Implantable neurostimulator electrode, each. They are now bundled with the CPT 63650 (Percutaneous implantation of neurostimulator electrode array, epidural) service as part of the “Office-based”, Non-Facility reimbursement.
** For the Multiple Procedure of the same code, up to 4 units may be paid by Medicare at 50% Reduction Medicare allowed amount
Let’s review the coding here:
CPT Code must be billed with the number of units/leads. So if your physician did 2 leads; bill it like this:
CPT 63650 x 1 unit
CPT 63650-51 x 1 unit
** Per the CCI Edits, your Fluoro is bundled with the CPT 63650
CPT Code 63650 EXCLUDES Analysis and programming of neurostimulator pulse generator (95970-95975)
Additional CPT Programming Codes (if performed by the physician)
CPT Code 95971
Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple spinal cord, or peripheral (ie, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming
CPT Code 95972
Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); complex spinal cord, or peripheral (ie, peripheral nerve, sacral nerve, neuromuscular) (except cranial nerve) neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming
95973 (DELETED 01/01/2016) – Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude and duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); complex
spinal cord, or peripheral (except cranial nerve) neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure) – Code 95973 has been deleted effective 01/01/2016
ICD 10 Medical Necessity (some on the list below):
G89.29 Other chronic pain
G89.3 Neoplasm related pain (acute) (chronic)
G89.4 Chronic pain syndrome
G90.50 Complex regional pain syndrome I, unspecified
G90.511 Complex regional pain syndrome I of right upper limb
G90.512 Complex regional pain syndrome I of left upper limb
G90.513 Complex regional pain syndrome I of upper limb, bilateral
G90.519 Complex regional pain syndrome I of unspecified upper limb
G90.521 Complex regional pain syndrome I of right lower limb
G90.522 Complex regional pain syndrome I of left lower limb
G90.523 Complex regional pain syndrome I of lower limb, bilateral
G90.529 Complex regional pain syndrome I of unspecified lower limb
G90.59 Complex regional pain syndrome I of other specified site
M54.2 Cervicalgia
M54.30 Sciatica, unspecified side
M54.31 Sciatica, right side
M54.32 Sciatica, left side
M54.40 Lumbago with sciatica, unspecified side
M54.41 Lumbago with sciatica, right side
M54.42 Lumbago with sciatica, left side
M54.5 Low back pain
M54.6 Pain in thoracic spine
M79.2 Neuralgia and neuritis, unspecified
ICD-10-PCS Crosscode:
00HV3MZ Insertion of Neurostimulator Lead into Spinal Cord, Percutaneous Approach
HCPCS Related Codes (if it meets the guideline, criteria and necessity)
C1778 Lead, neurostimulator (implantable)
C1767 Generator, neurostimulator (implantable), nonrechargeable
C1778 Lead, neurostimulator (implantable)
C1787 Patient programmer, neurostimulator
C1816 Receiver and/or transmitter, neurostimulator (implantable)
C1820 Generator, neurostimulator (implantable), non high-frequency with rechargeable battery and charging system
C1822 Generator, neurostimulator (implantable), high frequency, with rechargeable battery and charging system
C1883 Adaptor/extension, pacing lead or neurostimulator lead (implantable)
E0745 Neuromuscular stimulator, electronic shock unit
L8680 Implantable neurostimulator electrode, each (check on bundle edits)
L8681 Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only
L8682 Implantable neurostimulator radiofrequency receiver
L8683 Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver
L8684 Radiofrequency transmitter (external) for use with implantable sacral root neurostimulator receiver for bowel and bladder management, replacement
L8685 Implantable neurostimulator pulse generator, single array, rechargeable, includes extension
L8686 Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension
L8687 Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension
L8688 Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension
L8689 External recharging system for battery (internal) for use with implantable neurostimulator, replacement only
L8695 External recharging system for battery (external) for use with implantable neurostimulator, replacement only
GLOBAL DAYS of CPT 63650 = 10 DAYS
See other related codes based on Necessity on how to bill for Trial Placement of Spinal Stimulator or Permanent Implantation of the Spinal Stimulator
63650 Percutaneous implantation of neurostimulator electrode array, epidural
63655 Laminectomy for implantation of neurostimulator electrodes, plate/paddle, epidural
63661 Removal of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed
63662 Removal of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy, including fluoroscopy, when performed
63663 Revision including replacement, when performed, of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed
63664 Revision including replacement, when performed, of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy, including fluoroscopy, when performed
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
Additional Guidance if both Insertion and Implantation:
Per the CPT Assistant April 2010 published QUESTION:
“May code 63650 be reported for both insertion of a temporary percutaneous electrode array and a permanent percutaneous electrode array?
According to the American Medical Association (AMA) Response:
“Yes. The use of code 63650, Percutaneous implantation of neurostimulator electrode array, epidural, is not altered when the implantation of the percutaneous epidural neurostimulator electrode is performed for the purpose of a ‘temporary’ trial or for ‘permanent’ neurostimulation.
The difference between the two procedures is the attachment of the electrode array to an external stimulator unit for trial stimulation as opposed to connecting to an implanted pulse generator or receiver for permanent stimulation. Attachment to an external stimulator unit is considered inherent to the work represented by code 63650. Therefore, it is not appropriate to report code 63685, Insertion or replacement of spinal neurostimulator pulse generator or receiver, direct or inductive coupling.
“However, if the percutaneous electrode array is attached to an implanted spinal neurostimulator pulse generator or receiver, then code 63685 would be reported in addition to code 63650, for the insertion or replacement of the pulse generator or receiver. Code 63685 includes the creation of a subcutaneous pocket made to house the stimulator and tunneling of the electrodes to the pocket. The generator is then placed in the subcutaneous pocket, lead impedances are tested to verify proper connection, and the device is programmed to begin stimulation (code 95972).”
Additional AMA Guidelines:
“Codes 63650-63688 apply to both simple and complex neurostimulators. For initial or subsequent electronic analysis and programming of neurostimulator pulse generators, see codes 95970-95975.
Codes 63650, 63655, and 63661-63664 describe the operative placement, revision, replacement, or removal of the spinal neurostimulator system components to provide spinal electrical stimulation. A neurostimulator system includes an implanted neurostimulator, external controller, extension, and collection of contacts. Multiple contacts or electrodes (4 or more) provide the actual electrical stimulation in the epidural space.
For percutaneously placed neurostimulator systems (63650, 63661, 63663), the contacts are on a catheter-like lead. An array defines the collection of contacts that are on one catheter.
For systems placed via an open surgical exposure (63655, 63662, 63664), the contacts are on a plate or paddle-shaped surface.
Do not report 63661 or 63663 when removing or replacing a temporary percutaneously placed array for an external generator.” – Source: AMA Guideline 2016. CPT is a Trademark and is owned by the American Medical Association.
* The information shown above is provided by and copyright ©2016 American Medical Association – All Rights Reserved. Information in other sections of this page is from other non-AMA sources unless otherwise specified.
BILLING TIPS : How to Bill for Spinal Cord Stimulation Trial Placement Code CPT 63650 Permanent Placement
- IMPERATIVE: Verify Benefits and Eligibility and Obtain Prior Authorization before rendering the service
- Make sure you check with your insurance payers if they paying separately for the L8680 Implantable neurostimulator electrode, each and other HCPCS codes
- Check your insurance payers’ reimbursement guidelines, limitations and utilization policy before you render the service
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Reference for this changes can be found here -> http://www.cms.gov/Medicare/Medicare-Fee-forService-Payment/PhysicianFeeSched/index.html
CPT Codes are a trademark and owned by the American Medical Association
Access the NCCI Edits here -> http://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/NCCI-Coding-Edits.html
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