LCD Reference Article Billing and Coding Article

Billing and Coding: Billing Medicare for the SphenoCath® and Other Similar Devices

A55585

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Draft Article
Draft Articles are works in progress and not necessarily a reflection of the current billing and coding practices. Revisions to codes are carefully and thoroughly reviewed and are not intended to change the original intent of the LCD.
NOT AN LCD REFERENCE ARTICLE
This article is not in direct support of an LCD.

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Article Information

General Information

Source Article ID
N/A
Article ID
A55585
Original ICD-9 Article ID
Not Applicable
Article Title
Billing and Coding: Billing Medicare for the SphenoCath® and Other Similar Devices
Article Type
Billing and Coding
Original Effective Date
01/01/2017
Revision Effective Date
01/01/2023
Revision Ending Date
N/A
Retirement Date
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CMS National Coverage Policy

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Article Guidance

Article Text

Noridian is issuing coding guidance for billing the use of Dolor Technologies SphenoCath® device or similar delivery devices. To bill for use of these devices use CPT® 64999 as described in CPT Assistant (July 2014. Volume 24, Issue 7, pages 8-9).

Source:

Internet Only Manual, CMS Pub 100-4 - Medicare Claims Processing Manual, Chapter 12 - Physicians/Nonphysicians Practitioners, Section 50.K:

"If the physician performing the medical or surgical procedure also provides the level of anesthesia lower in intensity than moderate sedation, such as a local or topical anesthesia, then the moderate sedation code should not be reported and no separate payment should be allowed by the A/B MAC (B)."

 

Response To Comments

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Coding Information

Bill Type Codes

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ICD-10-CM Codes that Support Medical Necessity

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ICD-10-CM Codes that DO NOT Support Medical Necessity

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ICD-10-PCS Codes

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Additional ICD-10 Information

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Bill Type Codes

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the article should be assumed to apply equally to all claims.

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Revenue Codes

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the article should be assumed to apply equally to all Revenue Codes.

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Other Coding Information

Group 1

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Group 1 Codes

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Coding Table Information

Excluded CPT/HCPCS Codes - Table Format
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Non-Excluded CPT/HCPCS Ended Codes - Table Format
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Revision History Information

Revision History Date Revision History Number Revision History Explanation
01/01/2023 R4

Updated to indicate this article is not an LCD Reference Article.

01/01/2023 R3

Per 2023 CPT/HCPCS updates, either the long or short description of CPT code 64999 has been updated. 

04/29/2020 R2

Converted to Billing and Coding article and added 64999 to the CPT/HCPCS Coding section. No Change in coverage was made.

01/01/2017 R1

Updated the Article Title, Text and Group 1 Paragraph to allow for other approved devices used for Sphenopalatine Ganglion Blocks and updated the IOM Source and quotation in the Article Text.

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Associated Documents

Medicare BPM Ch 15.50.2 SAD Determinations
Medicare BPM Ch 15.50.2
Related Local Coverage Documents
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Related National Coverage Documents
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SAD Process URL 1
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SAD Process URL 2
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Statutory Requirements URLs
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Rules and Regulations URLs
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CMS Manual Explanations URLs
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Public Versions
Updated On Effective Dates Status
11/08/2023 01/01/2023 - N/A Currently in Effect You are here
12/16/2022 01/01/2023 - N/A Superseded View
Some older versions have been archived. Please visit the MCD Archive Site to retrieve them.

Keywords

  • SphenoCath®
  • Sphenopalatine
  • 64400
  • 64505
  • 64999