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2008 Ambulatory Surgery Center
2008 Ambulatory Surgery Center Coding and Reimbursement Reference
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Spinal Cord Stimulation (Form CMS) (Site Service of 24)
Effective 1/01/08 thru 12/31/08
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Code
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Coding Comments
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Subject to Multiple Procedure Discounts1
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2008 Medicare Reimbursement2
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| Trial SCS Procedure |
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63650
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1st lead, bill per lead |
no
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$2,909.36
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63650
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For each subsequent lead |
no
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$2,909.36
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95972
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Complex programming 1st hour |
n/a
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n/a
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95973
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Each additional 30 min, use in conjunction with 95972 |
n/a
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n/a
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| Permanent SCS Procedure |
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63685
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IPG or receiver implantation |
no
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$13,727.20
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63650
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1st lead, bill per lead |
no
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$2,909.36
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63650
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For each subsequent lead |
no
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$2,909.36
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63655
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1st lead, bill per lead |
no
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$4,549.87
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95972
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Complex programming 1st hour |
n/a
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n/a
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95973
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Each additional 30 min, use in conjunction with 95972 |
n/a
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n/a
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| Revision SCS Procedure |
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63660
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Bill per lead; do not report in conjunction with 63650 |
yes
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$482.36
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63650
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Reimplant lead (during global period3 add -76) |
yes
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$2,909.36
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63660
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Revision, removal of the lead (during global period3 add -78), no
device is implanted |
yes
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$482.36
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63688
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Revision IPG - Do not report in conjunction with 63685, no device
is implanted |
yes
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$608.87
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95972
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Complex programming 1st hour |
n/a
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n/a
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95973
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Each additional 30 min, use in conjunction with 95972 |
n/a
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n/a
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Peripheral Nerve Stimulation (Form CMS-1500) (Site of Service 24)
Effective 1/01/08 thru 12/31/08
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Code
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Coding Comments
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Subject to Multiple Procedure Discounts1
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2008 Medicare Reimbursement2
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| Trial PNS Procedure |
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64575
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Incision for implantation of neurostimulator electrodes,
peripheral nerve |
no
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$3,785.92
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64555
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Percutaneous implantation of neurstimulator electrodes,
peripheral nerve |
no
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$3,440.98
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95972
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Complex programming 1st hour |
n/a
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n/a
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95973
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Each additional 30 min, use in conjunction with 95972 |
n/a
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n/a
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| Permanent PNS Procedure |
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64590
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IPG or receiver implantation |
no
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$10,493.98
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64575
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Incision for implantation of neurostimulator electrodes,
peripheral nerve |
no
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$3,785.92
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64555
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Percutaneous implantation of neurstimulator electrodes,
peripheral nerve |
no
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$3,440.98
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95972
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Complex programming 1st hour |
n/a
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n/a
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95973
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Each additional 30 min, use in conjunction with 95972 |
n/a
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n/a
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| Revision PNS Procedure |
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64585
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Bill per lead, do not report in conjunction with 64575 |
yes
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$482.36
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64575
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Reimplant lead (during global period3 add -76) |
yes
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$3,785.92
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64585
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Revision, removal of the lead (during global period3 add -78), no
device is implanted |
yes
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$482.36
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64595
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Revision IPG - Do not report in conjunction with 64590, no device
is implanted |
yes
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$605.97
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95972
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Complex programming 1st hour |
n/a
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n/a
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95973
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Each additional 30 min, use in conjunction with 95972 |
n/a
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n/a
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1Procedures listed with a “yes†are reimbursed at 100% for the first procedure listed; each subsequent procedure may be subject to multiple procedure discount.
2Medicare 2008 base rates without geographical adjustments.
3Global period for SCS and PNS procedures is 90 days
Indications for Use: Chronic, intractable pain of the trunk and limbs.
ANS Renew percutaneous leads model numbers 3143, 3146, 3153, 3156, 3183, 3186, 3066, 3161, 3163, 3166, 3169 extensions model
numbers 3382, 3383, 3341, 3342, 3343, and receiver model number 3408, transmitter model number 3508, and antenna model numbers
1220, 1230 are also indicated to stimulate electrically peripheral nerves to relieve severe intractable pain.
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SCS/PNS
CPT CODE
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CODE DESCRIPTORS
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63650
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Percutaneous implantation of neurostimulator electrode array, epidural |
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63655
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Laminectomy for implantation of neurostimulator electrodes, plate/paddle, epidural |
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63660
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Revision or removal of spinal neurostimulator electrode percutaneous array(s) or plate/paddle(s) |
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63685
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Insertion or replacement of spinal neurostimulator pulse generator or receiver, direct or inductive coupling |
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63688
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Revision or removal of implanted spinal neurostimulator pulse generator or receiver |
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64555
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Percutaneous implantation of neurostimulator electrodes; peripheral nerve |
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64575
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Incision for implantation of neurostimulator electrodes; peripheral nerve |
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64585
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Revision or removal of peripheral neurostimulator electrodes |
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64590
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Insertion or replacement of peripheral or gastric neurostimulator pulse generator or receiver, direct or inductive coupling |
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64595
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Revision or removal of peripheral or gastric neurostimulator pulse generator or receiver |
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Programming CPT CODE
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95972
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Electronic analysis of implanted neurostimulator pulse generator system, complex spinal cord, or peripheral
(except cranial nerve) neurostimulator pulse generator/transmitter, with intraoperative or subsequent
programming, 1st hour |
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95973
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Electronic analysis of implanted neurostimulator pulse generator system, complex spinal cord or peripheral
(except cranial nerve) neurostimulator pulse generator/transmitter, with intraoperative or subsequent
programming, each additional 30 minutes after first hour (List separately in addition to code for primary
procedure) |
References:
CMS Manual System Pub-100-04 Medicare Claims Processing Transmittal 1325 Form CMS–1500
American Medical Association. ICD-9-CM 2008: Physician. Vols. 1 & 2. 9th rev. Chicago, Il: Ingenix; 2008.
US Dept. of Health and Human Services. CMS-1392 FC: Final Changes to the ASC Payment System and CY 2008 Payment Rate. Addenda
AA, BB, DDI, DD2. Available at: http://www.cms.hhs.gov. Accessed Jan. 7, 2008.
For additional information please contact:
Advanced Neuromodulation Systsems (ANS)
ANS Reimbursement Services Department
6901 Preston Rd. Plano, TX 75024
800-727-7846
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