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2008 Medicare Inpatient
Print friendly version
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Spinal Cord Stimulation (UB-04) (Site of Service 21)
Effective 10/1/07 thru 9/30/08
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| Implantation of Leads(s) |
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Surgical
Code
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Description
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03.93
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Implantation or replacement, neurostimulator lead(s), spinal |
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DRG*
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Description
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2008 Medicare Base Payment Rates
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030
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Spinal procedures w/o CC/MCC** |
$9,543
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029
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Spinal procedures w CC or spinal neurostimulators** |
$15,360
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028
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Spinal procedures w MCC** |
$22,934
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| Implantation of Leads(s) and IPG |
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Surgical
Code
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Description
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03.93
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Implantation or replacement, neurostimulator lead(s), spinal |
| With one of the following: |
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86.94
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Insertion or replacement, neurostimulator pulse generator, single array |
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86.95
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Insertion or replacement, neurostimulator pulse generator, dual array |
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86.96
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Insertion or replacement, neurostimulator pulse generator, other |
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86.97
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Insertion or replacement of single array rechargeable neurostimulator pulse generator |
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86.98
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Insertion or replacement of dual array rechargeable neurostimulator pulse generator |
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DRG*
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Description
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2008 Medicare Base Payment Rates
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029
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Spinal procedures w CC or spinal neurostimulators** |
$15,360
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028
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Spinal procedures w MCC** |
$22,934
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*Most common DRGs for SCS procedures.
CC = complications or comorbid conditions MCC = major complications or comorbid conditions
**There are certain diagnosis that fall into the CC list or MCC list, which can be found on the CMS website in the Acute Inpatient - Files for
Download section (http://www.cms.hhs.gov/AcuteInpatientPPS/FFD/list.asp)
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Peripheral Nerve Stimulation (UB-04) (Site of Service 21)
Effective 10/1/07 thru 9/30/08
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| Implantation of Leads(s) |
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Surgical
Code
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Description
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04.92
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Implantation or replacement, neurostimulator lead(s), peripheral |
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DRG*
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Description
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2008 Medicare Base Payment Rates
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042
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Periph/cranial nerve & other nerv syst proc w/o CC/MCC** |
$10,135
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041
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Periph/cranial nerve & other nerv syst proc w CC or periph neurostim** |
$12,781
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040
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Periph/cranial nerve & other nerv syst proc w MCC** |
$17,631
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| Implantation of Leads(s) |
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Surgical
Code
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Description
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04.92
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Implantation or replacement, neurostimulator lead(s), peripheral |
| With one of the following: |
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86.94
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Insertion or replacement, neurostimulator pulse generator, single array |
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86.95
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Insertion or replacement, neurostimulator pulse generator, dual array |
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86.96
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Insertion or replacement, neurostimulator pulse generator, other |
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86.97
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Insertion or replacement of single array rechargeable neurostimulator pulse generator |
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86.98
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Insertion or replacement of dual array rechargeable neurostimulator pulse generator |
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DRG*
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Description
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2008 Medicare Base Payment Rates
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042
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Peripheral and cranial nerve and other nervous system procedures with CC (Complications or Comorbid Conditions) |
$14,100
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041
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Periph/cranial nerve & other nerv syst proc w CC or periph neurostim** |
$12,781
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040
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Periph/cranial nerve & other nerv syst proc w MCC** |
$17,631
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*Most common DRGs for PNS procedures. CC = complications or comorbid conditions MCC = major complications or comorbid conditions
**There are certain diagnosis that fall into the CC list or MCC list, which can be found on the CMS website in the Acute Inpatient - Files for Download section (http://www.cms.hhs.gov/
AcuteInpatientPPS/FFD/list.asp)
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.
References:
US Dept. of Health and Human Services. 42 CFR Parts 411, 412, 413, and 489. Available at: http://www.cms.hhs.gov/ AcuteInpatientPPS/downloads/CMS-1533-FC.pdf.
Accessed Oct. 26, 2007.
For additional information, please contact:
Advanced Neuromodulation Systems (ANS)
Reimbursement Services Department
6901 Preston Rd. Plano, Texas 75024
800-727-7846
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