Sacral Nerve Stimulation
A sacral nerve stimulator is a pulse generator that transmits electrical impulses to the sacral nerves through an implanted wire. These impulses cause the bladder muscles to contract, which gives the patient ability to void more properly.
Healthcare Common Procedural Coding System (HCPCS)
64590 - Incision and subcutaneous placement of peripheral neurostimulator pulse generator or receiver, direct or inductive coupling
64561 - Percutaneous implantation of neurostimulator electrodes; sacral nerve (transforaminal placement)
64581 - Incision for implantation of neurostimulator electrodes; sacral nerve (transforaminal placement)
64585 - Revision or removal of peripheral neurostimulator electrodes
64595 - Revision or removal of peripheral neurostimulator pulse generator or receiver
A4290 - Sacral nerve stimulation test lead, each
E0752 - Implantable neurostimulator electrodes, each
E0756 - Implantable neurostimulator pulse generator
C1767 - Generator, neurostimulator (implantable)
C1778 - Lead, neurostimulator (implantable)
C1883 - Adaptor/extension, pacing lead or neurostimulator lead (implantable)
C1897 - Lead, neurostimulator test kit (implantable)
Providers are reminded to refer to the long descriptors of the CPT codes in their CPT book. The American Medical Association (AMA) and the Centers for Medicare & Medicaid Services (CMS) require the use of short CPT descriptors in policies published on the Web.
Sacral nerve stimulation test lead, each (Part B only)
Implt neurostim elctr each (Part B only)
Payment is as follows:
• Hospital outpatient departments – OPPS
• Critical access hospital (CAH) - Reasonable cost
• Comprehensive outpatient rehabilitation facility - Medicare physician fee schedule (MPFS)
• Rural health clinics/federally qualified health centers (RHCs/FQHCs) - All inclusive rate, professional component only. The technical component is outside the scope of the RHC/FQHC benefit. Therefore, the provider of that technical service bills theirMedicare using the ASC X12 837 professional claim format or Form CMS-1500 and payment is made under the MPFS. For provider-based RHCs/FQHCs payment for the technical component is made as indicated above based on the type of provider the RHC/FQHC is based with.
Low bladder compliance
Detrusor sphincter dyssynergia
Retention of urine
Other specified retention of urine
Functional urinary incontinence
Other symptoms involving urinary system
Deductible and coinsurance apply.
Payment Requirements for Device Codes A4290, E0752 and E0756
Payment is made on a reasonable cost basis when these devices are implanted in a CAH.
Payment Requirements for Codes C1767, C1778, C1883 and C1897
Only hospital outpatient departments report these codes. Payment is made under OPPS.