Refer to the Proposed Local Coverage Determination (LCD) L38387, Hypoglossal Nerve Stimulation for the Treatment of Obstructive Sleep Apnea, for reasonable and necessary requirements.
The Current Procedural Terminology (CPT)/Healthcare Common Procedure Coding System (HCPCS) code(s) may be subject to National Correct Coding Initiative (NCCI) edits. This information does not take precedence over NCCI edits. Please refer to NCCI for correct coding guidelines and specific applicable code combinations prior to billing Medicare.
Coding Guidelines
Effective for dates of service on or after 01/01/2022, the following CPT codes should be used to report insertion, replacement and removal of hypoglossal nerve neurostimulator:
CPT code 64582 should be reported for insertion of hypoglossal nerve neurostimulator electrode, generator and breathing sensor electrode
CPT code 64583 should be used to report revision or replacement of hypoglossal nerve neurostimulator electrode and breathing sensor electrode with connection to existing generator
Reduced services-Use modifier 52 for revision or replacement of either the hypoglossal nerve stimulator electrode array or distal respiratory sensor, and bill at a reduced rate.
CPT code 64854 should be used to report removal of hypoglossal nerve neurostimulator electrode and generator and breathing sensor electrode
Reduced services– Use modifier 52 for removal of one or two components of the hypoglossal nerve stimulator electrode array, pulse generator, or distal respiratory sensor, and bill at a reduced rate.
For dates of service prior to 01/01/2022:
Implantation of a Hypoglossal Nerve Stimulator (HSN) for treatment of OSA utilizes 2 CPT codes:
- CPT code 64568 – Incision for implantation of cranial nerve (eg: vagus nerve) neurostimulator electrode array and pulse generator
- CPT code +0466T – Insertion of chest wall respiratory sensor electrode or electrode array, including connection to pulse generator (list separately in addition to code for primary procedure)
*Note: Per AMA CPT, use 0466T in conjunction with 64568
Revision or replacement of HSN for treatment of OSA is reported with:
- CPT code 0467T – Revision or replacement of chest wall respiratory sensor electrode or electrode array, including connection to existing pulse generator
Removal of HSN for treatment of OSA is reported with:
- CPT code 0468T – Removal of chest wall respiratory sensor electrode or electrode array
Coding Information
For dates of service on or after 01/01/2022, CPT codes 64582, 64853 and 64584 should be used to report hypoglossal nerve neurostimulation.
For dates of service prior to 01/01/2022:
- CPT code 64568 is for both the neurostimulator and its corresponding electrode array
- CPT codes 0466T, 0467T, and 0468T are codes for the insertion, revision or replacement, and removal respectively
Documentation Requirements
- All documentation must be maintained in the patient’s medical record and made available to the contractor upon request.
- Every page of the record must be legible and include appropriate patient identification information (e.g., complete name, dates of service[s]). The documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing the care to the patient.
- The submitted medical record must support the use of the selected diagnosis code(s).