Sacral nerve stimulation procedures are reported using the following Current Procedural Terminology (CPT) codes (with their associated descriptors):

CPT 64561: Percutaneous implantation of neurostimulator electrode array; sacral nerve (transforaminal placement), including image guidance, if performed

CPT 64581: Open implantation of neurostimulator electrode array; sacral nerve (transforaminal placement)

CPT 64585: Revision or removal of peripheral neurostimulator electrode array

CPT 64590: Insertion or replacement of peripheral or gastric neurostimulator pulse generator or receiver, direct or inductive coupling (note: on January 1, 2024, the code descriptor for CPT 64590 will be revised as: Insertion or replacement of peripheral, sacral, or gastric neurostimulator pulse generator or receiver, requiring pocket creation and connection between electrode array and pulse generator or receiver)

CPT 64595: Revision or removal of peripheral or gastric neurostimulator pulse generator or receiver

CPT 95971 and 95972: Electronic analysis of implanted neurostimulator pulse generator/transmitter, with simple (95971) or complex (95972) programming by physician or other qualified health care professional

Instructions for use of the following codes:

Array placement (or replacement): Use CPT code 64561 or 64581. Note: The correct code to report for array placement is based upon on the surgical technique used, not the type of lead placed (temporary or permanent), nor whether the array is tunneled or not.

• Report 64561 for percutaneous placement of an electrode array into a sacral foramen. The CPT codebook specifically states that this code “may be used to report either the temporary or permanent placement of percutaneous electrode arrays” if a percutaneous approach is used. Fluoroscopy and other imaging modalities to help guide placement are included and not separately reportable. If performed bilaterally, append Modifier 50. This code has a 10-day global period. Removal of temporary leads should not be reported, whether performed within the global period or not.
• In contrast, CPT 64581 should be reported for the open placement of an array. The surgical technique describes a midline incision with cutdown to the sacrum and direct placement of the array into the sacral foramen. (Note that the previous ambiguous wording describing “incision for” placement led to confusion and has since been updated to clarify that this is a true open procedure, which was the originally described technique for array placement.) CPT 64581 has a 90-day global period.

Pulse generator placement (or replacement): Use CPT code 64590.

The work includes the creation of a pocket and attachment of the generator or receiver to a separately placed (whether concomitantly or not) electrode array. CPT 64590 has a 10-day global period. Both CPT codes 64561 and 64581 can be reported along with CPT code 64590 when the procedures are performed at the same surgical session. This code should not be used to report placing a generator or receiver without attachment to a separately placed array.

Revision or removal of electrode array: Use CPT code 64585.

CPT code 64585 should not be reported for the removal of temporary (untined) leads, even outside of the global period. CPT 64585 should not be reported for the replacement of leads, which instead would be reported using CPT code 64561 (or 64581 if done open). CPT 64585 is bundled to placement codes 64561 and 64581 if done on the same side. CPT 64585 has a 10-day global period.

Revision or removal of generator/receiver: Use CPT code 64595.

CPT code 64595 would be reported for removal of the generator/receiver, whereas removal and replacement should be reported with CPT 64590. CPT 64595 has a 10-day global period. There is an @NCCI Edit “1” for 64585 with 64561 and 64581, and also 64590 with 64595, meaning if an array is removed from one side and a new array is placed on the contralateral side, both can be reported using the appropriate modifier, and if a generator/receiver is removed from one side and then a new generator/receiver is placed on the contralateral side, then both can be reported using an appropriate modifier.

CPT 95971 and 95972: Electronic analysis of implanted neurostimulator pulse generator/transmitter, with simple (95971) or complex (95972) programming by physician or other qualified health care professional.

Programming may be performed in the operating room, postoperative care unit, inpatient, and/or outpatient setting. Programming a neurostimulator in the operating room is not inherent in the service represented by the implantation code and therefore may be reported by either the implanting surgeon or other qualified health care professional, when performed. If the programming is performed by a device representative then it should not be reported by the physician. Codes 95971 (Simple programming) should be reported for adjustment of 1 to 3 parameter(s), whereas CPT code 95972 (Complex programming) should be reported for adjustment of more than 3 parameters. For purposes of counting the number of parameters being programmed, a single parameter that is adjusted 2 or more times during a programming session counts as 1 parameter.

Code 95970: Electronic analysis of the implanted brain, cranial nerve, spinal cord, peripheral nerve, or sacral nerve neurostimulator pulse generator/transmitter without programming.

Test stimulation to confirm correct target site placement of the electrode array(s) and/or to confirm the functional status of the system is inherent to placement and is not separately reported as electronic analysis or programming of the neurostimulator system so should not be reported with implantation codes (eg, 64561, 64581, 64590, or 64595) or with electronic analysis with programming (CPT codes 95971 or 95972).

CORRECT CPT CODES TO REPORT BASED UPON PROCEDURE PERFORMED

Peripheral nerve evaluation (PNE): CPT code 64561 (appended with modifier 50 if performed bilateral). Test stimulation (CPT code 95970) is included in the placement code so would not be separately reported.

Generator implantation (or replacement): CPT code 64590 (and 95972 if performed by surgeon).

Note: CPT 95972 should be reported for complex programming if performed by the physician or other qualified health care professional, not by a device representative.

Full system implant (array and generator/receiver): CPT codes 64561 and 64590 (and 95972 if programming by surgeon).

CPT code 64581 may be reported in place of CPT code 64561 (only) if the placement is performed in an open cutdown approach using a midline incision, exposure of the sacrum and direct placement of the array into the sacral foramen.

Revision or removal without reimplantation: CPT code 64585 (lead) or 64595 (generator/receiver) or both.

Note: These codes are both bundled to the placement code so should not be used if removal and replacing leads and/or a generator/receiver.

Removal with replacement of generator/receiver: CPT code 64590 (and 95972 if programming by surgeon).

Note: CPT code 64590 includes removal of the previous generator or receiver; one should not additionally report CPT code 64595 for removal if performed on the same side.

Removal with replacement of lead and generator/receiver on the same side: CPT codes 64561 and 64590 (and 95972 if programming performed by surgeon).

Again, CPT code 64581 may be reported in place of CPT code 64561 (only) if the placement is performed in an open cutdown approach using a midline incision, exposure of the sacrum and direct placement of the array into the sacral foramen.

Removal with replacement of lead and generator/receiver on contralateral sides: CPT codes 64561 (or 64581 for open placement with cutdown to sacrum) and 64590 (and 95972 if programming by surgeon), and CPT codes 64585 and 64595 with modifier.