Does 64584 require prior authorization?

No, 64584 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 64584?

Medicare facility rate: $631.61. Non-facility rate: $631.61. Work RVU: 11.70.

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

11.70

Facility

$631.61

Non-Facility

$631.61

All documentation must be maintained in the patient's medical record and made available to the contractor upon request; every page must be legible and include patient identification and dates of service.
The documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing the care to the patient.
The submitted medical record must support the selected ICD-10-CM code(s) and the submitted CPT/HCPCS code must accurately describe the service performed.
Refer to LCD L38385 for the full reasonable and necessary clinical criteria required to substantiate coverage of HNS services.

Implantation of a hypoglossal nerve stimulator (HNS) for the treatment of obstructive sleep apnea (OSA) is billable using CPT 64582 when the implantation is reasonable and necessary per LCD L38385.
Revision or replacement of chest wall respiratory sensor electrode or electrode array for HNS treatment of OSA is billable using CPT 64583 when clinically indicated and meets LCD L38385 requirements.
Replacement or insertion of a cranial neurostimulator pulse generator (with connection to two or more electrode arrays) is reported with CPT 61886 when medically necessary for HNS treatment of OSA and consistent with LCD L38385.
Removal of chest wall respiratory sensor electrode or electrode array for HNS is billable using CPT 64584 when removal is medically necessary and supported by the medical record.
Implantation of a hypoglossal nerve stimulator (HNS) for the treatment of obstructive sleep apnea (OSA) is billed with CPT 64582.
Revision or replacement of chest wall respiratory sensor electrode or electrode array for treatment of OSA is billed with CPT 64583.

L35490 — Category III Codes

J05

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

L38387 — Hypoglossal Nerve Stimulation for the Treatment of Obstructive Sleep Apnea

J06

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