Pain Management Coding Alert

Question: Does the stimulator trial lead (L8680) now get included in the implantation (63650) when the service is performed in an office setting? Our representative had some paperwork regarding Medicare’s fee schedule for 2014 raising the RVU on implementation to include the leads, but I haven’t found anything about it on our local carrier’s website.

Colorado Subscriber 

Answer: Medicare does plan to make changes in payments for spinal cord stimulator trial placements in 2014. According to the OPPS Final Rule released in November, CMS is working with the American Medical Association to incorporate the cost of the leads currently billed through HCPCS code L8680 (Implantable neurostimulator electrode, each), into CPT® code 63650 (Percutaneous implantation of neurostimulator electrode array, epidural) for CY2014.

This change was part of the process of establishing a non-facility site of service differential for 63650. The additional practice expenses in the non-facility (office) setting include all supplies, equipment, etc. Medicare determined that the trial lead kit and trial lead array should be included in the practice expense RVUs established for the 2014 Medicare Physician Fee Schedule.