The information in this article contains billing, coding or other guidelines that complement the Local Coverage Determination (LCD) for Spinal Cord Stimulators for Chronic Pain L37632.
Indications
This A/B MAC will reimburse for placement of a maximum of 2 leads or 16 contacts, and for 2 spinal cord stimulator (SCS) trials per anatomic spinal region per patient per lifetime (with exceptions allowed for technical limitations for the initial trials or for use of different modalities of stimulation, including new technology).
If a trial fails, a repeat trial is not appropriate, unless there are extenuating circumstances that lead to trial failure. Appropriate medical documentation to support a repeat trial can be sent on appeal. Generally, electronic analysis services (CPT® codes 95970, 95971 and 95972) are not considered medically necessary, when provided at a frequency more often than once every 30 days. More frequent analysis may be necessary in the first month after implantation.
CPT® code 63650 - 2 temporary SCS trials per anatomic spinal region (2 per date of service (DOS)) or (4 units) per patient per lifetime (with exceptions allowed for technical limitations for the initial trials or for use of different modalities of stimulation, including new technology), in place of service office, ambulatory surgery center (ASC), outpatient hospital, or hospital. Since permanent neurostimulator arrays can also be placed percutaneously, code 63650 can be covered more often in place of service ASC, outpatient hospital, or hospital.
CPT® code 63655 - 1 permanent SCS per patient per lifetime and must be performed in an ASC, outpatient hospital or hospital.
CPT® codes 63661 and 63663 - Will not be reimbursed in the office setting since they are included in 63650.
The CPT®/HCPCS code(s) may be subject to Correct Coding Initiative (CCI) edits. This article does not take precedence over CCI edits. Please refer to the CCI for correct coding guidelines and specific applicable code combinations prior to billing Medicare.
