# 95972 - stimulator programming billing????



## sarthur (Nov 5, 2015)

We have been having a discussion on how to bill for spinal cord stimulator programming services in our office. The rep does the actual reprogramming, so I understand we cannot bill 95972 since the physician did not provide that service. But is there something we can bill for the loss of office space/equipment for that time frame? When is 95972 appropriate to bill??


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## dwaldman (Nov 7, 2015)

"From a CPT coding perspective, based on the information available in your inquiry, and in answer to your question, CPT is a set of codes, descriptions, and guidelines intended to describe procedures and services performed by physicians and other health care providers, therefore, it would not be appropriate to report this code if performed by a manufacturer's representative."
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 Above is a part of response I received from the AMA CPT Network in regards to 95971/95972 from November 2010. 

 Below is from the Medtronic's PDF for Spinal Cord Stimulation 

http://professional.medtronic.com/pt...m-pm/index.htm


 Analysis/ Programming
 Note: In the office, analysis and programming may be furnished by a physician, practitioner  with an incident to? benefit, or auxiliary personnel under the direct supervision of the  physician (or other practitioner), with or without support from a manufacturer representative. The patient or payer should not be billed for services rendered solely by the manufacturer representative. Contact your local carrier or payer for interpretation of applicable policies.

 Below is from the Boston Scientific PDF for Spinal Cord Stimulation

http://www.controlyourpain.com/profe.../physician.cfm


 "A physician should not bill if the service is performed entirely by, or under the direction of, a manufacturer representative without payer consent. If the service is performed in part by a physician or physician-supervised personnel (in accordance with the Medicare incident to requirements) and in part by a manufacturer representative, the physician should contact the payer and/or a reimbursement consultant before billing the service"

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I would agree if the manufacturer's representative performed the reprogramming there would not be a charge from the provider for  the service. You asked when would CPT 95971/95972 be reported, I guess that is where the provider has been trained by the manufacturer rep previously to use the manufacturer's equipment to personally provide the programming themselves. I don't know the SCS manufacturer's policy on providers using their equipment and if there is some type of training that they would have to complete to demonstrate they properly  know how to use the equipment. I don't believe there is a separate CPT code for use of office suite and potentially a service recognized as part of costs incurred when the provider has patients with these types of devices. There may be instances where this is the only service provided and there is no charge or there could be times where the provider provides a separately identifiable evaluation and management service with regards to medications and patient with a new complaint or required referral for additional care.


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