Does C8007 require prior authorization?

No, C8007 does not require prior authorization (high confidence). Code is covered without prior authorization.

`C8007`, Open implantation of hypoglossal nerve neurostimulator array and pulse

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

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 appropriate patient identification information and dates of service.
The documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing the patient's care.
The submitted medical record must support the use of the selected diagnosis code(s).
Refer to Proposed LCD L38528 for the reasonable and necessary clinical requirements that must be met for coverage of hypoglossal nerve stimulation for OSA.

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

WPS-L35490, Category III Codes

WPS-L38528, Hypoglossal Nerve Stimulation for the Treatment of Obstructive Sleep Apnea

PALMETTO-JJ-L38276, Hypoglossal Nerve Stimulation for Obstructive Sleep Apnea

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