Does 64570 require prior authorization?

No, 64570 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 64570?

Medicare facility rate: $766.22. Non-facility rate: $766.22. Work RVU: 8.87.

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

8.87

Facility

$766.22

Non-Facility

$766.22

To bill for these (denied) procedures, providers must report CPT code 64999 for both trial and permanent electrode-array insertions and indicate whether the procedure is a trial or permanent in the claim narrative/comment field adjacent to CPT 64999.
For Part B claims enter 1 unit of service (UOS) and include the text 'Peripheral Nerve Field Stimulation', 'PNFS', 'Peripheral Subcutaneous Field Stimulation', or 'PSFS' adjacent to CPT 64999 and whether the procedure is permanent or trial in the comment/narrative field (e.g., Loop 2400 or SV101-7 for 5010A1 837P; Item 19 for paper claims).
For Part A claims enter 1 UOS and include the text 'Peripheral Nerve Field Stimulation', 'PNFS', 'Peripheral Subcutaneous Field Stimulation', or 'PSFS' adjacent to CPT 64999 and whether the procedure is permanent or trial in the comment/narrative field (e.g., Line SV02-7 for 837I electronic claims; Block 80 on the UB-04 form).

Use CPT 64582 for open implantation of a hypoglossal nerve neurostimulator array, pulse generator, and distal respiratory sensor electrode or electrode array for treatment of obstructive sleep apnea (OSA).
Use CPT 64568 for open implantation of a cranial nerve (e.g., vagus nerve) neurostimulator electrode array and pulse generator for treatment of obstructive sleep apnea (OSA).
Report CPT 64583 for revision or replacement of a hypoglossal nerve neurostimulator array and distal respiratory sensor electrode or electrode array, including connection to an existing pulse generator.
Report CPT 64569 for revision or replacement of a cranial nerve (e.g., vagus) neurostimulator electrode array, including connection to an existing pulse generator.
Report CPT 64584 for removal of a hypoglossal nerve neurostimulator array, pulse generator, and distal respiratory sensor electrode array.
Report CPT 64570 for removal of a cranial nerve (e.g., vagus nerve) neurostimulator electrode array and pulse generator.

A57944 — Billing and Coding: Hypoglossal Nerve Stimulation for Treatment of Obstructive Sleep Apnea

J05

L38528 — Hypoglossal Nerve Stimulation for the Treatment of Obstructive Sleep Apnea

J05

L35490 — Category III Codes

J05

A55530 — Billing and Coding: Peripheral Nerve Stimulation

A58075 — Billing and Coding: Hypoglossal Nerve Stimulation for Obstructive Sleep Apnea

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