The generator remains external during a trial implantation. Use CPT code 63650 for the temporary percutaneous epidural implantation of the neurostimulator electrode array.įor permanent implantation, the electrical leads are advanced in the epidural space to a specific level desired. The purpose of the implantation trial is to determine if a spinal cord stimulator will be effective in relieving the pain. A successful trial should be associated with at least a 50 percent reduction of target pain or 50% reduction of analgesic medicationsīest Practices, Documentation Feedback and Tips.For permanent placement, include all of the above documentation, as well as documentation of pain relief with the temporary implanted electrode(s).Documentation of appropriate psychological evaluation.Treatments tried and failed including but are not limited to:.Indicate if request is for a trial or permanent placement.Implantation of spinal neurostimulator electrodes, accessed through the skin When the trial is rendered in a setting other than hospital OPD, providers will need to submit a PAR for CPT 63650, as part of the permanent implantation procedure in the hospital OPD. To avoid a claim denial, providers must place the Unique Tracking Number (UTN) received for the trial procedure on the claim submitted for the trial and permanent implantation procedure. Providers who plan to perform both the trial and permanent implantation procedures using CPT ® code 63650 in the hospital outpatient department (OPD) will only be required to submit a prior authorization request (PAR) for the trial procedure. This is usually completed percutaneously but can be via the surgical approach where the spine is surgically opened to the epidural space, usually performed with a hemilaminectomy. The extension is the insulated wires tunneled under the skin and the “leads” are the exposed electrodes placed in the epidural space. These are the “wires” connected to the generator. Part II: The Electrical Leads (and Extensions) Some descriptions also call this an implantable pulse generator (IPG). A permanent spinal neurostimulator does include the implantation of a generator into the abdomen, flank or buttocks. The spinal cord neurostimulator system consists of four components: the generator (or “pulse generator”), the electrical leads, a remote control and a battery recharger.Ī temporary spinal neurostimulator does not include the implantation of a generator. The Centers for Medicare & Medicaid Services (CMS) covers the implantation of central nervous system stimulators as a therapy for the relief of chronic intractable pain.Ī dorsal column (or spinal cord) neurostimulator is the surgical implantation of neurostimulator electrodes within the dura mater (endodural) or percutaneous insertion of electrodes in the epidural space.
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