Billing and Coding: Hypoglossal Nerve Stimulation for Treatment of Obstructive
Sleep Apnea

Refer to the Proposed Local Coverage Determination (LCD) L38387, Hypoglossal
Nerve Stimulation for the Treatment of Obstructive Sleep Apnea, for reasonable
and necessary requirements.  
  
The Current Procedural Terminology (CPT)/Healthcare Common Procedure Coding
System (HCPCS) code(s) may be subject to National Correct Coding Initiative
(NCCI) edits. This information does not take precedence over NCCI edits.
Please refer to NCCI for correct coding guidelines and specific applicable
code combinations prior to billing Medicare.  
  
 **Coding Guidelines**

**Effective for dates of service on or after 01/01/2022,** **the following CPT
codes should be used to report insertion, replacement and removal of
hypoglossal nerve neurostimulator:**

**CPT code 64582** should be reported for insertion of hypoglossal nerve
neurostimulator electrode, generator and breathing sensor electrode  
 **CPT code 64583** should be used to report revision or replacement of
hypoglossal nerve neurostimulator electrode and breathing sensor electrode
with connection to existing generator

**Reduced services** -Use modifier 52 for revision or replacement of either
the hypoglossal nerve stimulator electrode array or distal respiratory sensor,
and bill at a reduced rate.

**CPT code 64854** should be used to report removal of hypoglossal nerve
neurostimulator electrode and generator and breathing sensor electrode

**Reduced services** \- Use modifier 52 for removal of one or two components
of the hypoglossal nerve stimulator electrode array, pulse generator, or
distal respiratory sensor, and bill at a reduced rate.

**For dates of service prior to 01/01/2022:**

**Implantation** of a Hypoglossal Nerve Stimulator (HSN) for treatment of OSA
utilizes 2 CPT codes:

  * **CPT code 64568** \- Incision for implantation of cranial nerve (eg: vagus nerve) neurostimulator electrode array and pulse generator
  * **CPT code +0466T** \- Insertion of chest wall respiratory sensor electrode or electrode array, including connection to pulse generator (list separately in addition to code for primary procedure)

* **Note** : Per AMA CPT, use 0466T in conjunction with 64568  
  
 **Revision or replacement** of HSN for treatment of OSA is reported with:

  * **CPT code 0467T** \- Revision or replacement of chest wall respiratory sensor electrode or electrode array, including connection to existing pulse generator

**Removal** of HSN for treatment of OSA is reported with:

  * **CPT code 0468T** \- Removal of chest wall respiratory sensor electrode or electrode array

**Coding Information**

**For dates of service on or after 01/01/2022,** CPT codes 64582, 64853 and
64584 should be used to report hypoglossal nerve neurostimulation.

**For dates of service prior to 01/01/2022:**

  * **CPT** code **64568** is for both the neurostimulator and its corresponding electrode array
  * **CPT** codes **0466T, 0467T, and 0468T** are codes for the insertion, revision or replacement, and removal respectively

**Documentation Requirements**

  1. All documentation must be maintained in the patient's medical record and made available to the contractor upon request.
  2. Every page of the record must be legible and include appropriate patient identification information (e.g., complete name, dates of service[s]). The documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing the care to the patient.
  3. The submitted medical record must support the use of the selected diagnosis code(s).