64596
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Medicare Pricing
Work RVU
0.00
Facility
N/A
Non-Facility
N/A
Documentation Required
- 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).
Key Coverage Criteria
- Services for sacral nerve stimulation are covered only when they meet all indications specified in Local Coverage Determination L39543 for treatment of urinary and/or fecal incontinence.
- Coverage requires compliance with general CMS medical necessity requirements and any applicable National Coverage Determinations (NCDs) and Medicare payment rules.
- PNS may be covered for relief of chronic, intractable neuropathic pain in patients with conditions known to be responsive to PNS after appropriate attempts to cure underlying conditions and prior trials of medication management, physical therapy, psychological therapy, and less invasive interventional treatments.
- PNS of occipital nerves may be covered for occipital neuralgia, post-surgical neuropathic pain in the occipital distribution, cervicogenic headache, and treatment-resistant migraine.
- PNS of trigeminal nerve branches may be covered for post-traumatic and post-surgical neuropathic facial pain related to the trigeminal nerves.
- PNS of upper and lower extremity nerves may be covered for complex regional pain syndrome (CRPS) types 1 and 2, pain due to peripheral nerve injury, post-surgical scar pain, nerve entrapment, painful mononeuropathy, and painful amputation neuromas.
19 Active Policies
AMBETTER-CP.MP.117 — Spinal Cord, Peripheral Nerve, and Percutaneous Electrical Nerve Stimulation
A55530 — Billing and Coding: Peripheral Nerve Stimulation
A59332 — Billing and Coding: Sacral Nerve Stimulation for the Treatment of Urinary and Fecal Incontinence
L34328 — Peripheral Nerve Stimulation
L39543 — Sacral Nerve Stimulation for the Treatment of Urinary and Fecal Incontinence
Related Codes
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