Does 64566 require prior authorization?

No, 64566 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 64566?

Medicare facility rate: $26.05. Non-facility rate: $117.24. Work RVU: 0.59.

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

0.59

Facility

$26.05

Non-Facility

$117.24

The initial 12-week PTNS treatment course should be periodically evaluated with documentation of beneficiary improvement and ongoing record-keeping compliance.
Medical record must document the diagnosis of OBS/OAB and explicitly document that the condition is not stress or neurogenic incontinence.
Compliance and voiding diaries for a minimum of three days must be kept and provided to document adherence to first- and second-line therapies and lack of sufficient improvement prior to PTNS.
Compliance and voiding diaries for a minimum of three days must be maintained and provided during PTNS treatment and to document any symptoms of relapse.

Posterior tibial nerve stimulation (PTNS) is covered for patients with overactive bladder syndrome (OBS)/overactive bladder (OAB) per the International Continence Society definition (urinary urgency, usually with frequency and nocturia, with or without urgency urinary incontinence, absent UTI or other obvious pathology).
PTNS is covered only for non-neurogenic, non-stress urinary incontinence etiologies (i.e., patient must NOT have stress or neurogenic incontinence).
PTNS is covered when the patient has documented inadequate improvement after appropriate first- and second-line therapies, as evidenced by compliance and a minimum 3-day voiding diary prior to initiation.
PTNS is covered for beneficiaries with overactive bladder syndrome (OBS) characterized by urinary urgency, urinary frequency, and/or urge urinary incontinence.
Coverage is allowed for selected patients as a third-line neuromodulation treatment when an appropriate specialist (typically a urologist or urogynecologist) has evaluated the patient and determined they are a candidate for PTNS.
PTNS is indicated for patients with OBS who have failed or are intolerant of prior conservative therapies (behavioral therapy and pharmacologic trials) as specified in the policy.

A57453 — Billing and Coding: Posterior Tibial Nerve Stimulation for Voiding Dysfunction

J06

L33396 — Posterior Tibial Nerve Stimulation for Voiding Dysfunction

J06

AETNA-CPB-0611 — Fecal Incontinence

HUMANA-NERVE-STIMULATION-FOR-URINARY-INCONTINENCE-MA — Nerve Stimulation for Urinary Incontinence - Medicare Advantage

Ask Verity about documentation requirements, denial risks, or coverage in your state.