New hypoglossal nerve stimulation codes available

August 2016 - Vol. 35, No. 7

In February, the Academy’s CPT team presented a code change proposal at the CPT Editorial Panel meeting requesting the creation of several new Category III codes for the insertion and/or replacement of chest wall sensor for the treatment of obstructive sleep apnea. These codes were approved by the AMA and released and available for reporting on July 1, 2016. CPT Category III codes are a set of temporary codes that allows data collection for emerging technology, services, and procedures. These codes are intended to be used for data collection to substantiate widespread usage or to provide documentation for the Food and Drug Administration (FDA) approval process.

It is important to note that CPT Category III codes are not referred to the AMA/Specialty Society Relative Value Scale Update Committee (RUC) for valuation because no relative value units (RVUs) are assigned to these codes. Payment for these services or procedures is based on the policies of payers and not on a yearly fee schedule.

The new codes, officially implemented by payers on January 1, 2017, but available for reporting on July 1, 2016, for the insertion and/or replacement of chest wall sensor for the treatment of obstructive sleep apnea include:

+●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) (Use 0466T in conjunction with 64568)

●0467T
Revision or replacement of chest wall respiratory sensor electrode or electrode array, including connection to existing pulse generator (Do not report 0467T in conjunction with 0466T, 0468T) (For revision or replacement of cranial nerve [e.g., vagus nerve] neurostimulator electrode array, including connection to existing pulse generator, use 64569)

●0468T
Removal of chest wall respiratory sensor electrode or electrode array (Do not report 0468T in conjunction with 0466T, 0467T) (For removal of cranial  nerve [e.g., vagus nerve]  neurostimulator electrode array and pulse generator, use 64570)

The new code set is used to describe implantation, revision/replacement, or removal of the chest wall sensor(s) attached to a cranial nerve neurostimulator electrode array and pulse generator for the treatment of selected patients with obstructive sleep apnea. With these new codes, as of July 1, 2016, a surgeon is no longer to use CPT 64999 hypoglossal nerve stiumulator implantation.  Instead, surgeons should report both 64560-64570 and the corresponding 0466T-0468T depending for insertion, revision/replacement, and/or removal. For example, de novo insertion of a hypoglossal nerve stimulator with chest wall sensor would be reported with both 64568 and 0466T.  The new Category III codes report the chest wall sensor electrode work only.

Additionally, editorial changes were made to CPT codes 64568, 64569, and 64570 to account for the new codes. In conjunction  with the release of these new codes, the Academy is working with the AMA to develop updated CPT Assistant®, CPT for ENT, and Bulletin articles for the use of CPT code 64568 and the newly created Category III codes. The Academy is in the process of developing and reviewing the guidance in conjunction with the AMA. We do not have a date for publication set at this time, but plan to be able to distribute the information as soon as it is available to the public. Visit the Academy’s Coding Corner at www.entnet.org/content/coding-corner to check for updates on these educational materials and view other Academy coding resources.