G44.321 — Chronic post-traumatic headache, intractable
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
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
- 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.
- PNS of intercostal and ilio-inguinal nerves may be covered for post-surgical and post-traumatic neuropathic pain involving those nerve distributions.
- A successful temporary PNS stimulation trial (prerequisite for permanent implant) is defined as at least a 50% reduction in target pain intensity or at least a 50% reduction in analgesic medication use plus some functional improvement.
6 Active Policies
AMBETTER-CP.VP.63 — Visual Field Testing
A55531 — Billing and Coding: Peripheral Nerve Stimulation
A55530 — Billing and Coding: Peripheral Nerve Stimulation
A56612 — Billing and Coding: CT of the Head
L34328 — Peripheral Nerve Stimulation
Related Codes
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