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Medicare Advantage Prior Authorization
Implantable Neurostimulators

last updated 06/04/2013garcarl

61850 Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical 
61860 Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical 
61863 Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostimulator electrode array in subcortical site (eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array 
61864 Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostimulator electrode array in subcortical site (eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; each additional array (List separately in addition to primary procedure) 
61867 Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostimulator electrode array in subcortical site (eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array 
61868 Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostimulator electrode array in subcortical site (eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; each additional array (List separately in addition to primary procedure) 
61870 Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical
61875 Craniectomy for implantation of neurostimulator electrodes, cerebellar; subcortical 
61885 Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array
61886 Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to 2 or more electrode arrays 
61888 Revision or removal of cranial neurostimulator pulse generator or receiver 
63650 Percutaneous implantation of neurostimulator electrode array, epidural
63655 Laminectomy for implantation of neurostimulator electrodes, plate/paddle, epidural
63685 Insertion or replacement of spinal neurostimulator pulse generator or receiver, direct or inductive coupling
63688 Revision or removal or implanted spinal neurostimulator pulse generator or receiver
64553 Percutaneous implantation of neurostimulator electrodes; cranial nerve 
64555 Percutaneous implantation of neurostimulator electrodes; peripheral nerve (excludes sacral nerve)
64561 Percutaneous implantation of neurostimulator electrodes; sacral nerve (transforaminal placement)
64565 Percutaneous implantation of neurostimulator electrodes; neuromuscular
64568 Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator
64575 Incision for implantation of neurostimulator electrodes; peripheral nerve (excludes sacral nerve)
64580 Incision for implantation of neurostimulator electrodes; neuromuscular
64581 Incision for implantation of neurostimulator electrodes; sacral nerve (transforaminal placement)
0160T Therapeutic repetitive transcranial magnetic stimulation treatment planning
0161T Therapeutic repetitive transcranial magnetic stimulation treatment delivery and management, per session 
L8680 Implantable neurostimulator electrode, each
C1778 Lead, neurostimulator (implantable)
C1897 Lead, neurostimulator test kit (implantable)

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