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The rules say that plans must pay for a medical service or item if regular Medicare would pay for it in this case. 
You can find this rule at 42 Code of Federal Regulations (CFR) Section 422.101. 
 
The rules say that auricular peripheral nerve stimulation has been billed to Medicare using the CPT code 
64555. CPT code 64555 is described as: Percutaneous implantation of Neurostimulator electrode array; 
peripheral nerve (excludes sacral nerve). It is not appropriate to bill Medicare for services that are not covered 
as if they are covered. When billing for non-covered services, use the appropriate modifier. 
 
The following devices are listed under the Food and Drug Administration (FDA) approval documents as 
electro-acupuncture devices used for stimulation of auricular acupuncture points and as such are non-covered. 
Acupuncture for stimulation of auricular points is not a covered Medicare benefit. 
 
    NeuroStim system/NSS 
    P-Stim 
    ANSiStim 
    E-Pulse 
 
The following device is FDA classified as a percutaneous nerve stimulator for substance use disorders; Class II 
device: 
 
    NSS-2 Bridge 
 
This device is an electrical nerve stimulator (percutaneous nerve field stimulator [PNFS] system) that is placed 
behind the patient's ear (auricular). The NSS-2 Bridge is described as nearly identical to the Electronic 
Auricular Device (EAD) for a different intended use (to aid in the reduction of opioid withdrawal symptoms). 
This device is non-covered by Medicare when used for acupuncture (stimulation of auricular acupuncture 
points) for any indication. 
 
When billing for auricular peripheral nerve stimulation, use the NOC CPT code 64999 - unlisted procedure, 
nervous system. The term for the device used for this procedure (e.g., NeuroStim/NSS, P-Stim, ANSiStim, E-
Pulse, Electro-Acupuncture, NSS-2 Bridge) should be reported in the Remarks area of the claim for Part A and 
the Narrative area of the claim for Part B. The service for auricular peripheral nerve stimulation (CPT code 64999) will be denied as non-covered. This service is not a covered Medicare benefit because acupuncture for auricular stimulation does not meet the definition of reasonable and necessary under Section 1862(a)(1) of the Act. 
 
While the information given in this article is directed to Neurostim system/NSS, P-Stim, ANSiStim, E-Pulse, 
and NSS-2 Bridge, other current or future devices when used for the procedure auricular peripheral nerve 
stimulation or electro-acupuncture, would also be considered a non-covered service. You can find these rules in 
the Local Coverage Article Billing and Coding Billing and Coding: Auricular Peripheral Nerve Stimulation 
(Electro-Acupuncture Device) A55240. 
 
The rules say that payment may be made under the prosthetic device benefit for implanted peripheral nerve 
stimulators. Use of this stimulator involves implantation of electrodes around a selected peripheral nerve. The 
stimulating electrode is connected by an insulated lead to a receiver unit which is implanted under the skin at a 
depth not greater than 1/2 inch. 
 
Stimulation is induced by a generator connected to an antenna unit which is attached to the skin surface over 
the receiver unit. Implantation of electrodes requires surgery and usually necessitates an operating room. 
 
NOTE: Peripheral nerve stimulators may also be employed to assess a patient's suitability for continued 
treatment with an electric nerve stimulator. As explained in 160.7.1, such use of the stimulator is covered as 
part of the total diagnostic service furnished to the beneficiary rather than as a prosthesis. You can find these 
rules in the National Coverage Determination (NCD) Electrical Nerve Stimulators 160.7. 
 
If you want to read these Medicare rules, you can go to this website www.medicareappeal.com. 
 
The Plan contract says that the Plan covers items and services in accordance with Medicare rules.