# Stim Trial Leads



## kelliricks (Mar 12, 2015)

Our office billed 63650, 63650-59 and C1778. Ins denied C1778. Paid 63650 than denied 63650-59 as not being a separate procedure. This was a 2 lead total of 16 contacts (8 each side) as far as I can read on the note. I am new to this so I am not understanding if this was coded wrong. I have tried looking this up on CMS and other sites and am not understanding any of the information I am finding.  Any help is appreciated.


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## MLITE2113 (Mar 12, 2015)

The Code C1778 does bundle into the 63650 unfortunately. You should be paid for 2 leads with 8 electrodes as billed 63650,63650-59. My office used to bill for L8680 and this is not separately payable as of 1/1/14. Your best bet is to go to your SCS rep and ask them. They usually have websites that can help with coding too. Ask your physician what SCS company they use believe me they will be happy to help or just go to their website. 
Hope that helps!


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## dwaldman (Mar 12, 2015)

I would bill CPT 63650 with quantity 2 to represent a spinal cord stimulator trial  with dual lead placement.

Below is from Boston Scientific, you appear to be coding for office SCS trial so the below information could be helpful:

http://www.bostonscientific.com/en-US/reimbursement/neuromodulation/physicians.html


On November 27th, the Centers for Medicare & Medicaid Services (CMS) released the 2014 Final Rules for the Physician Fee Schedule; payment rates will become effective January 1st, 2014.  
Coding and Payment Policy Changes for Spinal Cord Stimulation (SCS) Trials in the Physician Office Setting: 
For 2014, CMS has included non-facility practice expense relative value units (site of service differential payment) for CPT1 code 63650 Percutaneous implantation of neurostimulator electrode array, epidural when performed in the office setting. The 2014 Medicare National Average Payment Rate2 for CPT code 63650 is shown below.  
Because of the uncertainty regarding the projected 2014 Sustainable Growth Rate reduction, Medicare?s 2014 national average payment rates in this document are calculated using two different conversion factors (CF): a) the 2013 CF of 34.023 and b) the 2014 CF of 35.6446 used by CMS to adjust for budget neutrality. Rates are subject to change and do not reflect the projected 2014 Sustainable Growth Rate reduction of 20.1% that would occur unless Congress intervenes. 
The payment for trial lead(s) are now included in the non-facility practice expense relative value unit. It is expected that L8680 Implantable neurostimulator electrode, each will no longer be paid separately by Medicare. More information on L8680 and this payment policy will be released by Medicare later this year.   
The multiple procedure payment reduction will apply to CPT code 63650. Payments for additional quantities of CPT code 63650 will be reduced by 50% thus a dual lead trial in the office setting will be paid $1,922-$2,014. 
Why did CMS implement this change? 
Medicare carriers flagged L8680 Implantable neurostimulator electrode, each as a potential overpayment concern. Medicare worked with the American Medical Association and physician societies to develop appropriate office based payment rates based on the cost of the trial lead and the office practice expenses when the procedure is performed in the office.  How should I code a percutaneous lead trial?  CPT code 63650 should still be used to code for a percutaneous lead trial. The only change expected for 2014 is that L8680 would no longer be billable in the office for Medicare as the non-facility practice expenses (e.g. lead, supplies, and equipment costs) are already included in the procedure payment. For more guidance on coding for SCS procedures, please refer to the Precision SpectraTM Spinal Cord Stimulation System Frequently Asked Questions which may be accessed through http://hcp.controlyourpain.com/support_for_physicians/reimbursement.html  Does the Multiple Procedure Payment Reduction Rule still apply to the 2nd, 3rd and 4th leads if applicable? Yes, the Multiple Procedure Payment Reduction Rule applies to CPT code 63650. Per this rule, up to 4 additional units may be paid at 50% of the Medicare allowable provided medical necessity is substantiated. MUE (Medically unlikely Edit) limits of 2 units also still apply to CTP 63650.  Will Non-Medicare payers still utilize L8680? The changes outlined in the physician final rule apply to procedures performed on Medicare beneficiaries in the office setting. Boston Scientific encourages physicians to contact their non-Medicare payers for guidance on appropriate coding and payment information for SCS trials.  When will this change take effect? This change will take effect January 1, 2014.  
Will there be a comment period for this Final Rule? Yes, comments for this interim final rule are accepted until January 27, 2014. Instructions on how to submit comments are listed on www.regulations.gov , follow the instructions for ?submitting a comment.? Where can I get more information on this policy change? The full text to this Final Rule may be accessed through http://www.cms.gov/Medicare/Medicare-Fee-forService-Payment/PhysicianFeeSched/index.html .


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## kelliricks (Mar 13, 2015)

*Thank you*

Thank you so much. That really helps.


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