Billing and Coding: Auricular Peripheral Nerve Stimulation (Electro-
Acupuncture Device)

It has come to Novitas' attention 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).

**Coding Guidance  
  
Notice**: 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.  
  
 **Background:**  
  
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.

For additional information, please refer to National Coverage Determination
(NCD) 30.3 for Acupuncture.  
  
**Coding Guidelines:**  
  
The CPT code 64555, does not describe the procedure of auricular acupuncture
stimulation and it should be coded using the NOC CPT code 64999 - unlisted
procedure, nervous system.  
  
 **Reporting:**  
  
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.

**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 ICD-10-CM code(s). The submitted CPT/HCPCS code must describe the service performed.