Description
Hypoglossal nerve stimulation (HNS) is reasonable and necessary for the treatment of moderate to severe obstructive sleep apnea (OSA) when coverage criteria are met. Documentation will be reviewed to determine if HNS meets Medicare coverage criteria, applicable coding guidelines, and/or are medically reasonable and necessary.
Affected Code(s)
CPT 64582
Applicable Policy References
1. Social Security Act (SSA), Title XVIII- Health Insurance for the Aged and Disabled, §1862(a)(1)(A)- Exclusions from Coverage and Medicare as a Secondary Payer
2. SSA, Title XVIII- Health Insurance for the Aged and Disabled, §1833(e)- Payment of Benefits
3. 42 CFR §405.929- Post-Payment Review
4. 42 CFR §405.930- Failure to Respond to Additional Documentation Request
5. 42 CFR §405.980- Reopening of Initial Determinations, Redeterminations, Reconsiderations, Decisions, and Reviews, (b)- Timeframes and Requirements for Reopening Initial Determinations and Redeterminations Initiated by a Contractor; and (c)- Timeframes and Requirements for Reopening Initial Determinations and Redeterminations Requested by a Party
6. 42 CFR §405.986- Good Cause for Reopening
7. Medicare National Coverage Determinations (NCD) Manual, Chapter 1, Part 4, Section 240.4.1 Sleep Testing for Obstructive Sleep Apnea (OSA)
8. Medicare Program Integrity Manual, Chapter 3- Verifying Potential Errors and Taking Corrective Actions, §§3.1- 3.6.6
9. Palmetto GBA, LCD L38276- Hypoglossal Nerve Stimulation for Obstructive Sleep Apnea, Effective 06/21/2020, Revised 04/13/2023
10. Palmetto GBA, LCA A58075- Billing and Coding: Hypoglossal Nerve Stimulation for Obstructive Sleep Apnea, Effective 06/21/2020; Revised 01/01/2022
11. First Coast Service Options, Inc., LCD L38398- Hypoglossal Nerve Stimulation for the Treatment of Obstructive Sleep Apnea, Effective 03/15/2020
12. First Coast Service Options, Inc., LCA A56953 - Billing and Coding: Hypoglossal Nerve Stimulation for the Treatment of Obstructive Sleep Apnea, Effective 03/16/2020; Revised 01/01/2022
13. Novitas Solutions, Inc., LCD L38385- Hypoglossal Nerve Stimulation for the Treatment of Obstructive Sleep Apnea, Effective 03/15/2020
14. Novitas Solutions, Inc., LCA A56938- Billing and Coding: Hypoglossal Nerve Stimulation for the Treatment of Obstructive Sleep Apnea, Effective 03/15/2020; Revised 01/01/2022
15. National Government Services, Inc., LCD L38387-Hypoglossal Nerve Stimulation for the Treatment of Obstructive Sleep Apnea, Effective 04/01/2020; Revised 04/01/2020
16. National Government Services, Inc., LCA A57092- Billing and Coding: Hypoglossal Nerve Stimulation for Treatment of Obstructive Sleep Apnea, Effective 04/01/2020; Revised 01/01/2022
17. Wisconsin Physicians Service Insurance Corporation, LCD L38528- Hypoglossal Nerve Stimulation for the Treatment of Obstructive Sleep Apnea, Effective 06/14/2020, Revised 04/28/2022
18. Wisconsin Physicians Service Insurance Corporation, LCA A57944-Billing and Coding: Hypoglossal Nerve Stimulation for the Treatment of Obstructive Sleep Apnea, Effective 06/14/2020; Revised 04/28/2022
19. Noridian Healthcare Solutions, LLC, LCD L38310(JE)- Hypoglossal Nerve Stimulation for the Treatment of Obstructive Sleep Apnea, Effective 03/15/2020
20. Noridian Healthcare Solutions, LLC, LCD L38312(JF)- Hypoglossal Nerve Stimulation for the Treatment of Obstructive Sleep Apnea, Effective 03/15/2020
21. Noridian Healthcare Solutions, LLC, LCA A57948(JE)- Billing and Coding: Hypoglossal Nerve Stimulation for the Treatment of Obstructive Sleep Apnea, Effective 03/15/2020; Revised 01/01/2022
22. Noridian Healthcare Solutions, LLC, LCA A57949(JF)- Billing and Coding: Hypoglossal Nerve Stimulation for the Treatment of Obstructive Sleep Apnea, Effective 03/15/2020; Revised 01/01/2022
23. CGS Administrators, LLC, LCD L38307- Hypoglossal Nerve Stimulation for the Treatment of Obstructive Sleep Apnea, Effective 04/01/2020; Revised 03/07/2024
24. CGS Administrators, LLC, LCA A57149- Billing and Coding: Hypoglossal Nerve Stimulation for Treatment of Obstructive Sleep Apnea, Effective 04/01/2020; Revised 03/07/2024
25. American Hospital Association (AHA) Coding Clinic for HCPCS- Volume 22, Number 2, Second Quarter 2022, Page 1-2, New CPT code for drug-induced sleep endoscopy
26. AMA CPT Assistant, March 2022, Volume 32, Issues 3, Page 7, Reporting Hypoglossal Nerve Stimulator Services
27. AMA CPT Codebook