Percutaneous electrical nerve stimulation (PENS), also known as percutaneous neuromodulation therapy (PNT), is considered medically necessary for patients with severe, acute or chronic pain that is significant, constant or frequent when all of the following are met:
1. Patient has tried TENS and failed to obtain pain relief due to the presence of obvious physical barriers to conduction of an electrical stimulus, such as in extremely obese individuals or those with scar tissue at the point of stimulation
2. Patient has been unresponsive to conservative measures and/or has diminished effectiveness or intolerance of medications or has a history of substance abuse
3. Pain limits ability to perform rehabilitation (e.g., exercise programs, physical therapy treatment)
4. Pain relief from temporarily placed peripheral nerve stimulation needles has been documented prior to permanent placement.
5. Treatment is used only as a last resort; other non-surgical treatments have been tried and failed, or are judged to be unsuitable or contraindicated.
Coding Guidelines for CPT code 64555 and 64999
The CPT code 64555, does not describe the procedure of auricular acupuncture stimulation and it should be coded using the NOC CPT code 64999 – unlisted procedure, nervous system.
64555 – Percutaneous implantation of neurostimulator electrode array; peripheral
nerve (excludes sacral nerve)
64999 – Unlisted procedure, nervous system
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Billing of CPT code 64555 and 64999
When billing for auricular peripheral nerve stimulation, use the NOC CPT code 64999 – unlisted procedure, nervous system. The term for the device used for this procedure (e.g. NeuroStim/NSS, P-Stim, ANSiStim, E-Pulse, Electro-Acupuncture) should be reported in the Remarks area of the claim for Part A and the Narrative area of the claim for Part B.
The service for auricular peripheral nerve simulation (CPT code 64999) will be denied as non-covered. This service is not a covered Medicare benefit because acupuncture does not meet the definition of reasonable and necessary under Section 1862(a)(1) of the Act.
While the information given in this article is directed to Neurostim system/NSS, P-Stim, ANSiStim, and E-Pulse, other current or future devices when used for the procedure auricular peripheral nerve stimulation or electro-acupuncture, would also be considered a non-covered service.
Related diagnosis codes
ICD-9 Codes
338.1-338.19 Acute pain
338.2 –338.4 Chronic Pain
ICD-10 Codes
G89.1-G89.8 Acute pain, not elsewhere classified
G89.2-G89.4 Chronic pain, not elsewhere classified
R52 Pain, unspecified
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Related HCPCS code for PENS
A4556 Electrodes (e.g., Apnea monitor), per pair
A4557 Lead wires (e.g., Apnea monitor), per pair
A4595 Electrical stimulator supplies, 2 lead, per month, (eg. TENS,
NMES)
A4630 Replacement batteries for medically necessary transcutaneous
electrical nerve stimulator (TENS) owned by patient
C1787 Patient programmer, neurostimulator
C1816 Receiver and/or transmitter, neurostimulator (implantable)
E0720 Transcutaneous electrical nerve stimulation (TENS) device, two lead, localized stimulation
E0730 Transcutaneous electrical nerve stimulation (TENS) device, four or more leads, for multiple nerve stimulation
E0731 Form-fitting conductive garment for delivery of TENS or NMES (with conductive fibers separated from the patient’s skin by layers of fabric
E0761 Non-thermal pulsed high frequency radiowaves, high peak power electromagnetic energy treatment device
L8680 Implantable neurostimulator electrode, each
L8682 Implantable neurostimulator radiofrequency receiver
L8683 Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver
L8684 Radiofrequency transmitter (external) for use with implantable sacral root neurostimulator receiver for bowel and bladder management replacement
L8685 Implantable neurostimulator pulse generator, single array, rechargeable, includes extension
L8686 Implantable neurostimulator pulse generator, single array, non rechargeable, includes extension
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