Diaphragmatic/Phrenic Nerve Stimulation - (0391)

Diaphragmatic/phrenic nerve stimulation (Avery Diaphragm Pacing System and NeuRx DPS RA/4) is covered only as medically necessary for select patients with severe chronic respiratory failure meeting device-specific indications (Avery as an alternative to chronic invasive ventilation for alveolar hypoventilation or neuronal interruption at/above C3; NeuRx limited to adults under the FDA HDE for stable high cervical spinal cord injury with a stimulable diaphragm); uses outside these criteria (including temporary respiratory insufficiency/difficult-to-wean contexts) or lacking covered diagnosis codes are not covered. Key requirements include documentation of severe chronic respiratory failure and qualifying diagnosis, intact intrathoracic phrenic nerve and stimulable diaphragm (EMG/nerve studies and fluoroscopic demonstration), adequate baseline pulmonary function/chest anatomy, ability to participate in training/rehabilitation, and for NeuRx HDE cases age ≥18, room-air O2 ≥90%, hemodynamic stability, committed caregiver, informed consent, and appropriate CPT/HCPCS coding.