C8009, Removal of hypoglossal nerve neurostimulator array and pulse generator
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- 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.
Key Coverage Criteria
- 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.
10 Active Policies
A57944, Billing and Coding: Hypoglossal Nerve Stimulation for Treatment of Obstructive Sleep Apnea
J05
WPS-L38528, Hypoglossal Nerve Stimulation for the Treatment of Obstructive Sleep Apnea
J8 MAC Part B
WPS-L35490, Category III Codes
J8 MAC Part B
PALMETTO-L38276, Hypoglossal Nerve Stimulation for Obstructive Sleep Apnea
JJ Part B
Related Codes
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