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prosthetic implant code for medicare

  1. Default prosthetic implant code for medicare
    Medical Coding Books
    Hi! I Need help billing medicare for prosthetic implant of electrodes. I tried billing L8699 (with detailed description) and 64555. for DX 05319 (H Zoster Nerv Syst NEC).

  2. #2
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    L8680 Implantable neurostimulator electrode, each

    In a previous post, for peripheral nerve stimulation they were mentioning they were using HCPCS code L8680 for the peripheral leads.

    I don't believe they are reimbursing separately for this code and have include the lead cost in spinal cord stimulator code CPT 63650 for Medicare.

    Which leaves 64555 without payment for the lead portion of the procedure in an office setting is what I have seen on this forum, but do not have personally experience with peripheral nerve stimulation due receiving only denials in the past.

    It is important to note if this truly peripheral subcutaneous field stimulation, as described below then the category III codes should be reported not 64555

    Description of Procedure or Service Peripheral subcutaneous field stimulation (PSFS, also called peripheral nerve field stimulation or target field stimulation) is a form of neuromodulation that is intended to treat chronic neuropathic pain. One application of PSFS that is being evaluated is occipital or craniofacial stimulation for headache/migraines, craniofacial pain, or occipital neuralgia. Also being investigated is PSFS for low back pain, neck and shoulder pain, inguinal and pelvic pain, thoracic pain, abdominal pain, fibromyalgia, and post-herpetic neuralgia.

    0282T Percutaneous or open implantation of neurostimulator electrode array(s), subcutaneous (peripheral subcutaneous field stimulation), including imaging guidance, when performed, cervical, thoracic or lumbar; for trial, including removal at the conclusion of trial period

    0283T Percutaneous or open implantation of neurostimulator electrode array(s), subcutaneous (peripheral subcutaneous field stimulation), including imaging guidance, when performed, cervical, thoracic or lumbar; permanent, with implantation of a pulse generator

    0284T Revision or removal of pulse generator or electrodes, including imaging guidance, when performed, including addition of new electrodes, when performed

    0285T Electronic analysis of implanted peripheral subcutaneous field stimulation pulse generator, with reprogramming when performed

  3. #3
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    Dwaldman is correct. The code for leads (L8680) is now included in payment for 63650. Some other payers are still reimbursing for them separately but you have to check their policies.
    Kelly A Mcfadyen, CPC

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