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70551 | MRI scan of brain without contrast | HCPCS | An UpToDate review on “Attention deficit hyperactivity disorder in children and adolescents: Treatment with medications” (Krull, 2015b) does not mention bupropion, reboxetine, desipramine and nortriptyline as therapeutic options. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|CPT codes covered if selection criteria are met:|
|90791||Psychiatric diagnostic evaluation|
|90792||Psychiatric diagnostic evaluation with medical services|
|96150||Health and behavior assessment (e.g., health-focused clinical interview, behavioral observations, psychophysiological monitoring, health-oriented questionnaires), each 15 minutes face-to-face with the patient; initial assessment|
|96152||Health and behavior intervention, each 15 minutes, face-to-face; individual|
|96153||group (2 or more patients)|
|96154||family (with the patient present)|
|CPT codes not covered for indications listed in the CPB:|
|0333T||Visual evoked potential, screening of visual acuity, automated|
|0359T - 0374T||Adaptive behavior assessments and treatments|
|70450||Computed tomography, head or brain; without contrast material|
|70460||with contrast material(s)|
|70470||without contrast material, followed by contrast material(s) and further sections|
|70496||Computed tomographic angiography, head, with contrast material(s), including noncontrast images, if performed, and image post-processing|
|70544||Magnetic resonance angiography, head; without contrast material(s)|
|70545||with contrast material(s)|
|70546||without contrast material(s), followed by contrast material(s) and further sequences|
|70551||Magnetic resonance (e.g., proton) imaging, brain (including brain stem); without contrast material|
|70552||with contrast material(s)|
|70553||without contrast material, followed by contrast material(s) and further sequences|
|70554||Magnetic resonance imaging, brain, functional MRI; including test selection and administration of repetitive body part movement and/or visual stimulation, not requiring physician or psychologist administration|
|70555||requiring physician or psychologist administration of entire neurofunctional testing|
|76390||Magnetic resonance spectroscopy|
|78600||Brain imaging, less than 4 static views|
|78601||with vascular flow|
|78605||Brain imaging, minimum 4 static views|
|78606||with vascular flow|
|78607||Brain imaging, tomographic (SPECT)|
|78608||Brain imaging, positron emission tomography (PET); metabolic evaluation|
|82784||Gammaglobulin (immunoglobulin); IgA, IgD, IgG, IgM, each [assessment test for prescription of diet]|
|82787||Immunoglbulin subclasses (ed, IgG1, 2, 3, or 4), each [assessment test for prescription of diet]|
|86001||Allergen specific IgG quantitative or semiquantitative, each allergen [assessment test for prescription of diet]|
|88318||Determinative histochemistry to identify chemical components (e.g., copper, zinc)|
|90832||Psychotherapy, 30 minutes with patient and/or family member|
|90833||Psychotherapy, 30 minutes with patient and/or family member when performed with an evaluation and management service|
|90834||Psychotherapy, 45 minutes with patient and/or family|
|90836||Psychotherapy, 45 minutes with patient and/or family member when performed with an evaluation and management service|
|90837||Psychotherapy, 60 minutes with patient and/or family member|
|90838||Psychotherapy, 60 minutes with patient and/or family member when performed with an evaluation and management service|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|90869||subsequent motor threshold re-determination with delivery and management|
|90875||Individual psychophysiological therapy incorporating biofeedback training by any modality (face-to-face with the patient), with psychotherapy (eg, insight oriented, behavior modifying or supportive psychotherapy); 30 minutes|
|92065||Orthoptic and/or pleoptic training, with continuing medical direction and evaluation|
|92537 - 92538||Caloric vestibular test with recording, bilateral; bithermal or monothermal|
|92540||Basic vestibular evaluation, includes spontaneous nystagmus test with eccentric gaze fixation nystagmus, with recording, positional nystagmus test, minimum of 4 positions, with recording, optokinetic nystagmust test, bidirectional foveal and peripheral stimulation, with recording, and oscillating tracking test, with recording|
|92541||Spontaneous nystagmus test, including gaze and fixation nystagmus, with recording|
|92542||Positional nystagmus test, minimum of 4 positions, with recording|
|92544||Optokinetic nystagmus test, bidirectional, foveal or peripheral stimulation, with recording|
|92545||Oscillating tracking test, with recording|
|92546||Sinusoidal vertical axis rotational testing|
|+ 92547||Use of vertical electrodes (List separately in addition to code for primary procedure)|
|92548||Computerized dynamic posturography|
|92550||Tympanometry and reflex threshold measurements|
|92558||Evoked otoacoustic emissions, screening (qualutative measurement of distortion product or transient evoked otoacoustic emissions), automated analysis|
|92567||Tympanometry (impedance testing)|
|92568 - 92569||Acoustic reflex testing|
|92570||Acoustic immittance testing, includes typanometry (impedance testing), acoustic reflex threshold testing, and acoustic reflex decay testing|
|92585||Auditory evoked potentials for evoked response audiometry and/or testing of the central nervous system; comprehensive|
|92587||Evoked otoacoustic emissions; limited (single stimulus level, either transient or distortion products)|
|92588||comprehensive or diagnostic evaluation (comparison of transient and/or distortion product otoacoustic emissions at multiple levels and frequencies|
|95803||Actigraphy testing, recording, analysis, interpretation, and report (minimum of 72 hours to 14 consecutive days of recording)|
|95812||Electroencephalogram (EEG) extended monitoring; 41-60 minutes [covered only for persons with signs of seizure disorder or degenerative neurological condition]|
|95813||greater than 1 hour [covered only for persons with signs of seizure disorder or degenerative neurological condition]|
|95816||Electroencephalogram (EEG); including recording awake and drowsy [covered only for persons with signs of seizure disorder or degenerative neurological condition]|
|95819||including recording awake and asleep [covered only for persons with signs of seizure disorder or degenerative neurological condition]|
|95925||Short-latency somatosensory evoked potential study, stimulation of any/all peripheral nerves or skin sites, recording from the central nervous system; in upper limbs|
|95926||in lower limbs|
|95927||in the trunk or head|
|95928||Central motor evoked potential study (transcranial motor stimulation); upper limbs|
|95930||Visual evoked potential (VEP) testing central nervous system, checkerboard or flash|
|95954||Pharmacological or physical activation requiring physician attendance during EEG recording of activation phase (eg, thiopental activation test)|
|95957||Digital analysis of electroencephalogram (EEG) (eg, for epileptic spike analysis) [neuropsychiatric EEG based assessment aid (NEBA)]|
|96020||Neurofunctional testing selection and administration during noninvasive imaging functional brain mapping, with test administered entirely by a physician or other qualified health care professional (ie, psychologist), with review of test results and report|
|96101 - 96103||Psychological testing|
|96105||Assessment of aphasia (includes assessment of expressive and receptive speech and language function, language comprehension, speech production ability, reading, spelling, writing, e.g., by Boston Diagnostic Aphasia Examination) with interpretation and report, per hour|
|96116 - 96125||Neuropsychological testing|
|96902||Microscopic examination of hairs plucked or clipped by the examiner (excluding hair collected by the patient) to determine telogen and anagen counts, or structural hair shaft abnormality|
|97530||Therapeutic activities, direct (one-on-one) patient contact (use of dynamic activities to improve functional performance), each 15 minutes|
|97532||Development of cognitive skills to improve attention, memory, problem solving (includes compensatory training), direct (one-on-one) patient contact, each 15 minutes|
|97533||Sensory integrative techniques to enhance sensory processing and promote adaptive responses to environmental demands, direct (one-on-one) patient contact by the provider, each 15 minutes|
|98940||Chiropractic manipulative treatment (CMT); spinal, 1-2 regions|
|98941||spinal, 3-4 regions|
|98942||spinal, 5 regions|
|98943||extraspinal, 1 or more regions|
|Other CPT codes related to the CPB:|
|96127||Brief emotional/behavioral assessment (eg, depression inventory, attention-deficit/hyperactivity disorder [ADHD] scale), with scoring and documentation, per standardized instrument|
|96365 - 96368||Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug)|
|HCPCS codes not covered for indications listed in the CPB:|
|A9583||Injection, Gadofosveset Trisodium, 1 ml [Ablavar, Vasovist]|
|A9585||Injection, gadobutrol, 0.1 ml|
|G0176||Activity therapy, such as music, dance, art or play therapies not for recreation, related to the care and treatment of patient's disabling mental health problems, per session (45 minutes or more)|
|G0295||Electromagnetic therapy, to one or more areas|
|H1010||Non-medical family planning education, per session|
|H1011||Family assessment by licensed behavioral health professional for state defined purposes|
|J0470||Injection, dimercaprol, per 100 mg|
|J0600||Injection, edetate calcium disodium, up to 1,000 mg|
|J0895||Injection, deferoxamine mesylate, 500 mg|
|J3520||Edetate disodium, per 150 mg|
|M0300||IV chelation therapy (chemical endarterectomy)|
|P2031||Hair analysis (excluding arsenic)|
|S8035||Magnetic source imaging|
|S8040||Topographic brain mapping|
|S9355||Home infusion, chelation therapy; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem|
|S9445||Patient education, not otherwise classified, non-physician provider, individual, per session|
|S9446||Patient education, not otherwise classified, non-physician provider, group, per session|
|T1018||School-based individualized education program (IEP) services, bundled|
|ICD-10 codes covered if selection criteria are met:|
|F90.0 - F90.9||Attention-deficit hyperactivity disorder| |
92132 | PR CMPTR OPHTHALMIC DX IMG ANT SEGMT W/I&R UNI/BI | HCPCS | Currently, there are no data that demonstrate improved outcomes using this technology. Thus, AS-OCT is a promising technology; but its clinical value remains to be ascertained by well-designed studies that show improved outcomes. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015:|
|CPT codes not covered for indications listed in the CPB:|
|92132||Scanning computerized ophthalmic diagnostic imaging, anterior segment, with interpretation and report, unilateral or bilateral| |
92132 | PR CMPTR OPHTHALMIC DX IMG ANT SEGMT W/I&R UNI/BI | HCPCS | Thus, AS-OCT is a promising technology; but its clinical value remains to be ascertained by well-designed studies that show improved outcomes. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015:|
|CPT codes not covered for indications listed in the CPB:|
|92132||Scanning computerized ophthalmic diagnostic imaging, anterior segment, with interpretation and report, unilateral or bilateral| |
15878 | Suction lipectomy upr extrem | HCPCS | changed from investigational to medically necessary as follows: "Treatment of severe primary axillary hyperhidrosis with botulinum toxin is considered medically necessary after failed treatment using topical agents. "; "The treatment of axillary hyperhidrosis is considered cosmetic and therefore not eligible for coverage." deleted, Code Reference section updated, ICD-9 diagnosis code 780.8 description revised and "Note" added covered table, HCPCS J0585 added covered table, non-covered table added, CPT code 15878, 17999, 97033 added non-covered table, ICD-9 procedure code 86.3, 86.83, 99.27 added non-covered table
11/18/2004: Reviewed by MPAC, Treatment of severe primary axillary hyperhidrosis with botulinum toxin is considered medically necessary after failed treatment using topical agents, consultation with a dermatologist, and prior authorization. Sources updated
5/5/2005: Code Reference section updated, ICD-9 diagnosis code 705.21 added with Note: "Use code 780.8 to report all forms of hyperhidrosis for dates of service prior to 10/1/2004. See POLICY statement for coverage information regarding the various forms of hyperhidrosis." |
97033 | SBT PTA IONTOPHORESIS EACH 15 MIN | HCPCS | changed from investigational to medically necessary as follows: "Treatment of severe primary axillary hyperhidrosis with botulinum toxin is considered medically necessary after failed treatment using topical agents. "; "The treatment of axillary hyperhidrosis is considered cosmetic and therefore not eligible for coverage." deleted, Code Reference section updated, ICD-9 diagnosis code 780.8 description revised and "Note" added covered table, HCPCS J0585 added covered table, non-covered table added, CPT code 15878, 17999, 97033 added non-covered table, ICD-9 procedure code 86.3, 86.83, 99.27 added non-covered table
11/18/2004: Reviewed by MPAC, Treatment of severe primary axillary hyperhidrosis with botulinum toxin is considered medically necessary after failed treatment using topical agents, consultation with a dermatologist, and prior authorization. Sources updated
5/5/2005: Code Reference section updated, ICD-9 diagnosis code 705.21 added with Note: "Use code 780.8 to report all forms of hyperhidrosis for dates of service prior to 10/1/2004. See POLICY statement for coverage information regarding the various forms of hyperhidrosis." |
J0585 | PR INJECTION,ONABOTULINUMTOXINA 1 UNITS | HCPCS | changed from investigational to medically necessary as follows: "Treatment of severe primary axillary hyperhidrosis with botulinum toxin is considered medically necessary after failed treatment using topical agents. "; "The treatment of axillary hyperhidrosis is considered cosmetic and therefore not eligible for coverage." deleted, Code Reference section updated, ICD-9 diagnosis code 780.8 description revised and "Note" added covered table, HCPCS J0585 added covered table, non-covered table added, CPT code 15878, 17999, 97033 added non-covered table, ICD-9 procedure code 86.3, 86.83, 99.27 added non-covered table
11/18/2004: Reviewed by MPAC, Treatment of severe primary axillary hyperhidrosis with botulinum toxin is considered medically necessary after failed treatment using topical agents, consultation with a dermatologist, and prior authorization. Sources updated
5/5/2005: Code Reference section updated, ICD-9 diagnosis code 705.21 added with Note: "Use code 780.8 to report all forms of hyperhidrosis for dates of service prior to 10/1/2004. See POLICY statement for coverage information regarding the various forms of hyperhidrosis." |
17999 | UNLISTED PROC SKIN SUBQ | HCPCS | changed from investigational to medically necessary as follows: "Treatment of severe primary axillary hyperhidrosis with botulinum toxin is considered medically necessary after failed treatment using topical agents. "; "The treatment of axillary hyperhidrosis is considered cosmetic and therefore not eligible for coverage." deleted, Code Reference section updated, ICD-9 diagnosis code 780.8 description revised and "Note" added covered table, HCPCS J0585 added covered table, non-covered table added, CPT code 15878, 17999, 97033 added non-covered table, ICD-9 procedure code 86.3, 86.83, 99.27 added non-covered table
11/18/2004: Reviewed by MPAC, Treatment of severe primary axillary hyperhidrosis with botulinum toxin is considered medically necessary after failed treatment using topical agents, consultation with a dermatologist, and prior authorization. Sources updated
5/5/2005: Code Reference section updated, ICD-9 diagnosis code 705.21 added with Note: "Use code 780.8 to report all forms of hyperhidrosis for dates of service prior to 10/1/2004. See POLICY statement for coverage information regarding the various forms of hyperhidrosis." |
J0585 | PR INJECTION,ONABOTULINUMTOXINA 1 UNITS | HCPCS | 01/01/2009: Accredo preferred provider information removed. BCBSMS information added. 07/27/2009: Policy Description section updated for a clearer understanding of primary and secondary hyperhidrosis symptoms and treatments, Policy Statement section revised to add table with treatments considered medically necessary per region and treatments considered investigational per region for a clearer understanding of the intent of the policy, Policy Guidelines section updated to add features of hyperhidrosis, note added to HCPCS code J0585 under covered table, HCPCS code J0587 added to non covered table. 08/03/2010: Policy description updated to add new FDA information about the safety evaluation of botulinum toxin products and the new drug names established to reinforce individual potencies and prevent medication errors. Botulinum type A and botulinum B were changed to OnabotulinumtoxinA and RimabotulinumtoxinB, respectively, throughout the policy. |
J0587 | rimabotulinumtoxinB 5,000 unit/mL solution 1 mL Vial | HCPCS | 01/01/2009: Accredo preferred provider information removed. BCBSMS information added. 07/27/2009: Policy Description section updated for a clearer understanding of primary and secondary hyperhidrosis symptoms and treatments, Policy Statement section revised to add table with treatments considered medically necessary per region and treatments considered investigational per region for a clearer understanding of the intent of the policy, Policy Guidelines section updated to add features of hyperhidrosis, note added to HCPCS code J0585 under covered table, HCPCS code J0587 added to non covered table. 08/03/2010: Policy description updated to add new FDA information about the safety evaluation of botulinum toxin products and the new drug names established to reinforce individual potencies and prevent medication errors. Botulinum type A and botulinum B were changed to OnabotulinumtoxinA and RimabotulinumtoxinB, respectively, throughout the policy. |
J0585 | PR INJECTION,ONABOTULINUMTOXINA 1 UNITS | HCPCS | BCBSMS information added. 07/27/2009: Policy Description section updated for a clearer understanding of primary and secondary hyperhidrosis symptoms and treatments, Policy Statement section revised to add table with treatments considered medically necessary per region and treatments considered investigational per region for a clearer understanding of the intent of the policy, Policy Guidelines section updated to add features of hyperhidrosis, note added to HCPCS code J0585 under covered table, HCPCS code J0587 added to non covered table. 08/03/2010: Policy description updated to add new FDA information about the safety evaluation of botulinum toxin products and the new drug names established to reinforce individual potencies and prevent medication errors. Botulinum type A and botulinum B were changed to OnabotulinumtoxinA and RimabotulinumtoxinB, respectively, throughout the policy. Added links to related medical policy. |
J0587 | rimabotulinumtoxinB 5,000 unit/mL solution 1 mL Vial | HCPCS | BCBSMS information added. 07/27/2009: Policy Description section updated for a clearer understanding of primary and secondary hyperhidrosis symptoms and treatments, Policy Statement section revised to add table with treatments considered medically necessary per region and treatments considered investigational per region for a clearer understanding of the intent of the policy, Policy Guidelines section updated to add features of hyperhidrosis, note added to HCPCS code J0585 under covered table, HCPCS code J0587 added to non covered table. 08/03/2010: Policy description updated to add new FDA information about the safety evaluation of botulinum toxin products and the new drug names established to reinforce individual potencies and prevent medication errors. Botulinum type A and botulinum B were changed to OnabotulinumtoxinA and RimabotulinumtoxinB, respectively, throughout the policy. Added links to related medical policy. |
61867 | PR STRTCTC IMPLTJ NSTIM ELTRD W/RECORD 1ST ARRAY | HCPCS | No side effects were observed during the treatment period. The authors concluded that the combined use of sulodexide and melatonin confirmed to an important and promising therapeutically option in the tinnitus management. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|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|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
G0329 | PR ELECTROMAGNTIC TX FOR ULCERS | HCPCS | No side effects were observed during the treatment period. The authors concluded that the combined use of sulodexide and melatonin confirmed to an important and promising therapeutically option in the tinnitus management. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|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|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
L8614 | SYS IMPLANT COCHLEAR BONEBRIDGE | HCPCS | No side effects were observed during the treatment period. The authors concluded that the combined use of sulodexide and melatonin confirmed to an important and promising therapeutically option in the tinnitus management. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|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|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
95970 | PR ELEC ALYS IMPLT NPGT PHYS/QHP W/O PROGRAMMING | HCPCS | No side effects were observed during the treatment period. The authors concluded that the combined use of sulodexide and melatonin confirmed to an important and promising therapeutically option in the tinnitus management. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|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|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
C1883 | XTN NRSTM PERC 2.16MM | HCPCS | No side effects were observed during the treatment period. The authors concluded that the combined use of sulodexide and melatonin confirmed to an important and promising therapeutically option in the tinnitus management. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|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|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
L8629 | Transmitting coil and cable, integrated, for use with cochlear implant device, replacement | HCPCS | No side effects were observed during the treatment period. The authors concluded that the combined use of sulodexide and melatonin confirmed to an important and promising therapeutically option in the tinnitus management. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|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|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
L8682 | Implt neurostim radiofq rec | HCPCS | No side effects were observed during the treatment period. The authors concluded that the combined use of sulodexide and melatonin confirmed to an important and promising therapeutically option in the tinnitus management. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|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|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
99183 | PR PHYS/QHP ATTN&SUPVJ HYPRBARIC OXYGEN TX/SESSION | HCPCS | No side effects were observed during the treatment period. The authors concluded that the combined use of sulodexide and melatonin confirmed to an important and promising therapeutically option in the tinnitus management. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|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|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
E0720 | Transcutaneous electrical nerve stimulation (tens) device, two lead, localized stimulation | HCPCS | No side effects were observed during the treatment period. The authors concluded that the combined use of sulodexide and melatonin confirmed to an important and promising therapeutically option in the tinnitus management. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|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|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
61868 | PR STRTCTC IMPLTJ NSTIM ELTRD W/RECORD EA ARRAY | HCPCS | No side effects were observed during the treatment period. The authors concluded that the combined use of sulodexide and melatonin confirmed to an important and promising therapeutically option in the tinnitus management. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|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|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
95975 | Cranial neurostim complex | HCPCS | No side effects were observed during the treatment period. The authors concluded that the combined use of sulodexide and melatonin confirmed to an important and promising therapeutically option in the tinnitus management. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|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|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
95979 | Analyz neurostim brain addon | HCPCS | No side effects were observed during the treatment period. The authors concluded that the combined use of sulodexide and melatonin confirmed to an important and promising therapeutically option in the tinnitus management. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|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|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
L8685 | Implt nrostm pls gen sng rec | HCPCS | No side effects were observed during the treatment period. The authors concluded that the combined use of sulodexide and melatonin confirmed to an important and promising therapeutically option in the tinnitus management. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|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|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
92590 | HC HEARING AID EXAMINATION AND SELECTION; MONAURAL | HCPCS | No side effects were observed during the treatment period. The authors concluded that the combined use of sulodexide and melatonin confirmed to an important and promising therapeutically option in the tinnitus management. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|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|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
61888 | Revise/remove neuroreceiver | HCPCS | No side effects were observed during the treatment period. The authors concluded that the combined use of sulodexide and melatonin confirmed to an important and promising therapeutically option in the tinnitus management. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|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|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
69930 | PR COCHLEAR DEVICE IMPLANTATION W/WO MASTOIDECTOMY | HCPCS | No side effects were observed during the treatment period. The authors concluded that the combined use of sulodexide and melatonin confirmed to an important and promising therapeutically option in the tinnitus management. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|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|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
L8689 | SYSTEM CHARGING AXONICS WRELS | HCPCS | No side effects were observed during the treatment period. The authors concluded that the combined use of sulodexide and melatonin confirmed to an important and promising therapeutically option in the tinnitus management. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|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|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
V5298 | Hearing aid noc | HCPCS | No side effects were observed during the treatment period. The authors concluded that the combined use of sulodexide and melatonin confirmed to an important and promising therapeutically option in the tinnitus management. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|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|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
90867 | PR REPET TMS TX INITIAL W/MAP/MOTR THRESHLD/DEL&M | HCPCS | No side effects were observed during the treatment period. The authors concluded that the combined use of sulodexide and melatonin confirmed to an important and promising therapeutically option in the tinnitus management. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|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|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
90868 | PR THERAP REPETITIVE TMS TX SUBSEQ DELIVERY & MNG | HCPCS | No side effects were observed during the treatment period. The authors concluded that the combined use of sulodexide and melatonin confirmed to an important and promising therapeutically option in the tinnitus management. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|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|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
L8681 | REMOTE SLEEP | HCPCS | No side effects were observed during the treatment period. The authors concluded that the combined use of sulodexide and melatonin confirmed to an important and promising therapeutically option in the tinnitus management. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|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|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
61860 | PR CRNEC/CRX IMPLTJ NSTIM ELTRD CERE CORTICAL | HCPCS | No side effects were observed during the treatment period. The authors concluded that the combined use of sulodexide and melatonin confirmed to an important and promising therapeutically option in the tinnitus management. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|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|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
J2001 | Xylocaine 2% SYRINGE 100mg (Lidocaine) | HCPCS | No side effects were observed during the treatment period. The authors concluded that the combined use of sulodexide and melatonin confirmed to an important and promising therapeutically option in the tinnitus management. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|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|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
L8688 | Implt nrostm pls gen dua non | HCPCS | No side effects were observed during the treatment period. The authors concluded that the combined use of sulodexide and melatonin confirmed to an important and promising therapeutically option in the tinnitus management. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|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|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
V5010 | HC ASSESSMENT HEARING AID | HCPCS | No side effects were observed during the treatment period. The authors concluded that the combined use of sulodexide and melatonin confirmed to an important and promising therapeutically option in the tinnitus management. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|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|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
E0730 | Transcutaneous electrical nerve stimulation (tens) device, four or more leads, for multiple nerve stimulation | HCPCS | No side effects were observed during the treatment period. The authors concluded that the combined use of sulodexide and melatonin confirmed to an important and promising therapeutically option in the tinnitus management. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|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|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
G0277 | PR HBOT, FULL BODY CHAMBER, 30M | HCPCS | No side effects were observed during the treatment period. The authors concluded that the combined use of sulodexide and melatonin confirmed to an important and promising therapeutically option in the tinnitus management. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|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|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
64550 | SBT PTA TENS APPLICATION UNATTENDED | HCPCS | No side effects were observed during the treatment period. The authors concluded that the combined use of sulodexide and melatonin confirmed to an important and promising therapeutically option in the tinnitus management. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|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|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
L8695 | External recharg sys extern | HCPCS | No side effects were observed during the treatment period. The authors concluded that the combined use of sulodexide and melatonin confirmed to an important and promising therapeutically option in the tinnitus management. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|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|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
61864 | PR STRTCTC IMPLTJ NSTIM ELTRD W/O RECORD EA ARRAY | HCPCS | No side effects were observed during the treatment period. The authors concluded that the combined use of sulodexide and melatonin confirmed to an important and promising therapeutically option in the tinnitus management. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|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|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
L8683 | TRANSMITTER SGL | HCPCS | No side effects were observed during the treatment period. The authors concluded that the combined use of sulodexide and melatonin confirmed to an important and promising therapeutically option in the tinnitus management. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|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|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
92601 | PR ANALYSIS COCHLEAR IMPLT PT <7 YR PRGRMG | HCPCS | No side effects were observed during the treatment period. The authors concluded that the combined use of sulodexide and melatonin confirmed to an important and promising therapeutically option in the tinnitus management. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|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|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
L8686 | Implt nrostm pls gen sng non | HCPCS | No side effects were observed during the treatment period. The authors concluded that the combined use of sulodexide and melatonin confirmed to an important and promising therapeutically option in the tinnitus management. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|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|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
61880 | Revise/remove neuroelectrode | HCPCS | No side effects were observed during the treatment period. The authors concluded that the combined use of sulodexide and melatonin confirmed to an important and promising therapeutically option in the tinnitus management. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|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|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
92604 | Reprogram cochlear implt 7/> | HCPCS | No side effects were observed during the treatment period. The authors concluded that the combined use of sulodexide and melatonin confirmed to an important and promising therapeutically option in the tinnitus management. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|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|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
64568 | PR OPEN IMPLANTATION CRANIAL NERVE NEA & PULSE GEN | HCPCS | No side effects were observed during the treatment period. The authors concluded that the combined use of sulodexide and melatonin confirmed to an important and promising therapeutically option in the tinnitus management. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|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|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
61863 | PR STRTCTC IMPLTJ NSTIM ELTRD W/O RECORD 1ST ARRAY | HCPCS | No side effects were observed during the treatment period. The authors concluded that the combined use of sulodexide and melatonin confirmed to an important and promising therapeutically option in the tinnitus management. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|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|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
95974 | Cranial neurostim complex | HCPCS | No side effects were observed during the treatment period. The authors concluded that the combined use of sulodexide and melatonin confirmed to an important and promising therapeutically option in the tinnitus management. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|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|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
64569 | Revise/repl vagus n eltrd | HCPCS | No side effects were observed during the treatment period. The authors concluded that the combined use of sulodexide and melatonin confirmed to an important and promising therapeutically option in the tinnitus management. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|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|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
C1778 | VNS THERAPY PERENNIAL FLEX | HCPCS | No side effects were observed during the treatment period. The authors concluded that the combined use of sulodexide and melatonin confirmed to an important and promising therapeutically option in the tinnitus management. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|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|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
C1816 | USER KIT - NALU MEDICAL | HCPCS | No side effects were observed during the treatment period. The authors concluded that the combined use of sulodexide and melatonin confirmed to an important and promising therapeutically option in the tinnitus management. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|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|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
G0295 | Electromagnetic therapy onc | HCPCS | No side effects were observed during the treatment period. The authors concluded that the combined use of sulodexide and melatonin confirmed to an important and promising therapeutically option in the tinnitus management. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|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|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
V5275 | HC EARMOLD IMPRESSIONS EACH | HCPCS | No side effects were observed during the treatment period. The authors concluded that the combined use of sulodexide and melatonin confirmed to an important and promising therapeutically option in the tinnitus management. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|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|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
61850 | PR TWIST/BURR HOLE IMPLTJ NSTIM ELTRD CORTICAL | HCPCS | No side effects were observed during the treatment period. The authors concluded that the combined use of sulodexide and melatonin confirmed to an important and promising therapeutically option in the tinnitus management. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|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|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
61870 | Implant neuroelectrodes | HCPCS | No side effects were observed during the treatment period. The authors concluded that the combined use of sulodexide and melatonin confirmed to an important and promising therapeutically option in the tinnitus management. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|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|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
61885 | PR INSJ/RPLCMT CRANIAL NEUROSTIM PULSE GENERATOR | HCPCS | No side effects were observed during the treatment period. The authors concluded that the combined use of sulodexide and melatonin confirmed to an important and promising therapeutically option in the tinnitus management. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|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|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
61886 | PR INSJ/RPLCMT CRANIAL NEUROSTIM GENER 2/> ELTRDS | HCPCS | No side effects were observed during the treatment period. The authors concluded that the combined use of sulodexide and melatonin confirmed to an important and promising therapeutically option in the tinnitus management. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|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|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
V5267 | Hearing aid sup/access/dev | HCPCS | No side effects were observed during the treatment period. The authors concluded that the combined use of sulodexide and melatonin confirmed to an important and promising therapeutically option in the tinnitus management. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|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|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
L8687 | KIT NEUROSTIMULATOR SENZA IPG STERILE LATEX FREE DISPOSABLE | HCPCS | No side effects were observed during the treatment period. The authors concluded that the combined use of sulodexide and melatonin confirmed to an important and promising therapeutically option in the tinnitus management. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|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|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
C1767 | VERCISE GENUS R16 IPG KIT | HCPCS | No side effects were observed during the treatment period. The authors concluded that the combined use of sulodexide and melatonin confirmed to an important and promising therapeutically option in the tinnitus management. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|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|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
A4595 | TENS suppl 2 lead per month | HCPCS | No side effects were observed during the treatment period. The authors concluded that the combined use of sulodexide and melatonin confirmed to an important and promising therapeutically option in the tinnitus management. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|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|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
61867 | PR STRTCTC IMPLTJ NSTIM ELTRD W/RECORD 1ST ARRAY | HCPCS | The authors concluded that the combined use of sulodexide and melatonin confirmed to an important and promising therapeutically option in the tinnitus management. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|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|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
G0329 | PR ELECTROMAGNTIC TX FOR ULCERS | HCPCS | The authors concluded that the combined use of sulodexide and melatonin confirmed to an important and promising therapeutically option in the tinnitus management. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|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|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
L8614 | SYS IMPLANT COCHLEAR BONEBRIDGE | HCPCS | The authors concluded that the combined use of sulodexide and melatonin confirmed to an important and promising therapeutically option in the tinnitus management. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|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|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
95970 | PR ELEC ALYS IMPLT NPGT PHYS/QHP W/O PROGRAMMING | HCPCS | The authors concluded that the combined use of sulodexide and melatonin confirmed to an important and promising therapeutically option in the tinnitus management. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|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|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
C1883 | XTN NRSTM PERC 2.16MM | HCPCS | The authors concluded that the combined use of sulodexide and melatonin confirmed to an important and promising therapeutically option in the tinnitus management. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|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|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
L8629 | Transmitting coil and cable, integrated, for use with cochlear implant device, replacement | HCPCS | The authors concluded that the combined use of sulodexide and melatonin confirmed to an important and promising therapeutically option in the tinnitus management. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|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|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
L8682 | Implt neurostim radiofq rec | HCPCS | The authors concluded that the combined use of sulodexide and melatonin confirmed to an important and promising therapeutically option in the tinnitus management. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|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|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
99183 | PR PHYS/QHP ATTN&SUPVJ HYPRBARIC OXYGEN TX/SESSION | HCPCS | The authors concluded that the combined use of sulodexide and melatonin confirmed to an important and promising therapeutically option in the tinnitus management. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|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|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
E0720 | Transcutaneous electrical nerve stimulation (tens) device, two lead, localized stimulation | HCPCS | The authors concluded that the combined use of sulodexide and melatonin confirmed to an important and promising therapeutically option in the tinnitus management. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|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|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
61868 | PR STRTCTC IMPLTJ NSTIM ELTRD W/RECORD EA ARRAY | HCPCS | The authors concluded that the combined use of sulodexide and melatonin confirmed to an important and promising therapeutically option in the tinnitus management. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|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|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
95975 | Cranial neurostim complex | HCPCS | The authors concluded that the combined use of sulodexide and melatonin confirmed to an important and promising therapeutically option in the tinnitus management. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|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|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
95979 | Analyz neurostim brain addon | HCPCS | The authors concluded that the combined use of sulodexide and melatonin confirmed to an important and promising therapeutically option in the tinnitus management. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|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|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
L8685 | Implt nrostm pls gen sng rec | HCPCS | The authors concluded that the combined use of sulodexide and melatonin confirmed to an important and promising therapeutically option in the tinnitus management. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|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|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
92590 | HC HEARING AID EXAMINATION AND SELECTION; MONAURAL | HCPCS | The authors concluded that the combined use of sulodexide and melatonin confirmed to an important and promising therapeutically option in the tinnitus management. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|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|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
61888 | Revise/remove neuroreceiver | HCPCS | The authors concluded that the combined use of sulodexide and melatonin confirmed to an important and promising therapeutically option in the tinnitus management. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|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|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
69930 | PR COCHLEAR DEVICE IMPLANTATION W/WO MASTOIDECTOMY | HCPCS | The authors concluded that the combined use of sulodexide and melatonin confirmed to an important and promising therapeutically option in the tinnitus management. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|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|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
L8689 | SYSTEM CHARGING AXONICS WRELS | HCPCS | The authors concluded that the combined use of sulodexide and melatonin confirmed to an important and promising therapeutically option in the tinnitus management. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|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|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
V5298 | Hearing aid noc | HCPCS | The authors concluded that the combined use of sulodexide and melatonin confirmed to an important and promising therapeutically option in the tinnitus management. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|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|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
90867 | PR REPET TMS TX INITIAL W/MAP/MOTR THRESHLD/DEL&M | HCPCS | The authors concluded that the combined use of sulodexide and melatonin confirmed to an important and promising therapeutically option in the tinnitus management. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|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|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
90868 | PR THERAP REPETITIVE TMS TX SUBSEQ DELIVERY & MNG | HCPCS | The authors concluded that the combined use of sulodexide and melatonin confirmed to an important and promising therapeutically option in the tinnitus management. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|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|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
L8681 | REMOTE SLEEP | HCPCS | The authors concluded that the combined use of sulodexide and melatonin confirmed to an important and promising therapeutically option in the tinnitus management. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|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|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
61860 | PR CRNEC/CRX IMPLTJ NSTIM ELTRD CERE CORTICAL | HCPCS | The authors concluded that the combined use of sulodexide and melatonin confirmed to an important and promising therapeutically option in the tinnitus management. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|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|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
J2001 | Xylocaine 2% SYRINGE 100mg (Lidocaine) | HCPCS | The authors concluded that the combined use of sulodexide and melatonin confirmed to an important and promising therapeutically option in the tinnitus management. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|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|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
L8688 | Implt nrostm pls gen dua non | HCPCS | The authors concluded that the combined use of sulodexide and melatonin confirmed to an important and promising therapeutically option in the tinnitus management. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|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|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
V5010 | HC ASSESSMENT HEARING AID | HCPCS | The authors concluded that the combined use of sulodexide and melatonin confirmed to an important and promising therapeutically option in the tinnitus management. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|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|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
E0730 | Transcutaneous electrical nerve stimulation (tens) device, four or more leads, for multiple nerve stimulation | HCPCS | The authors concluded that the combined use of sulodexide and melatonin confirmed to an important and promising therapeutically option in the tinnitus management. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|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|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
G0277 | PR HBOT, FULL BODY CHAMBER, 30M | HCPCS | The authors concluded that the combined use of sulodexide and melatonin confirmed to an important and promising therapeutically option in the tinnitus management. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|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|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
64550 | SBT PTA TENS APPLICATION UNATTENDED | HCPCS | The authors concluded that the combined use of sulodexide and melatonin confirmed to an important and promising therapeutically option in the tinnitus management. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|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|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
L8695 | External recharg sys extern | HCPCS | The authors concluded that the combined use of sulodexide and melatonin confirmed to an important and promising therapeutically option in the tinnitus management. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|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|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
61864 | PR STRTCTC IMPLTJ NSTIM ELTRD W/O RECORD EA ARRAY | HCPCS | The authors concluded that the combined use of sulodexide and melatonin confirmed to an important and promising therapeutically option in the tinnitus management. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|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|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
L8683 | TRANSMITTER SGL | HCPCS | The authors concluded that the combined use of sulodexide and melatonin confirmed to an important and promising therapeutically option in the tinnitus management. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|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|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
92601 | PR ANALYSIS COCHLEAR IMPLT PT <7 YR PRGRMG | HCPCS | The authors concluded that the combined use of sulodexide and melatonin confirmed to an important and promising therapeutically option in the tinnitus management. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|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|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
L8686 | Implt nrostm pls gen sng non | HCPCS | The authors concluded that the combined use of sulodexide and melatonin confirmed to an important and promising therapeutically option in the tinnitus management. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|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|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
61880 | Revise/remove neuroelectrode | HCPCS | The authors concluded that the combined use of sulodexide and melatonin confirmed to an important and promising therapeutically option in the tinnitus management. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|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|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
92604 | Reprogram cochlear implt 7/> | HCPCS | The authors concluded that the combined use of sulodexide and melatonin confirmed to an important and promising therapeutically option in the tinnitus management. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|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|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
64568 | PR OPEN IMPLANTATION CRANIAL NERVE NEA & PULSE GEN | HCPCS | The authors concluded that the combined use of sulodexide and melatonin confirmed to an important and promising therapeutically option in the tinnitus management. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|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|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
61863 | PR STRTCTC IMPLTJ NSTIM ELTRD W/O RECORD 1ST ARRAY | HCPCS | The authors concluded that the combined use of sulodexide and melatonin confirmed to an important and promising therapeutically option in the tinnitus management. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|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|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
95974 | Cranial neurostim complex | HCPCS | The authors concluded that the combined use of sulodexide and melatonin confirmed to an important and promising therapeutically option in the tinnitus management. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|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|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
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