Codes to use when billing for Neuspera’s integrated SNM device

One of my physicians told me there was just FDA approval for a new sacral neurostimulation device that is put in as 1 piece instead of the usual 2 pieces. Do you know about this, and how it would be billed?

Yes, your physician is correct. The FDA has recently cleared a new sacral neuromodulation device from Neuspera Medical. Unlike traditional systems that consist of separate components—an implanted array and a separate generator or receiver—this device features an ultra-miniaturized, integrated design that combines the array and receiver into a single implant placed at the sacral nerve.

It is intended for the treatment of urinary urge incontinence, offering a less-invasive alternative to conventional 2-piece systems. The device enables precise nerve targeting through a programmable stimulator. Rather than relying on an internal battery, therapy is powered by an external, wearable wireless transmitter—a small disc worn against the lower back that activates the implant.

Coding: As for reporting the work to implant this device, one may be tempted to use one of the currently available sacral neuromodulation CPT codes such as 64561 (Percutaneous implantation of neurostimulator electrode array, sacral nerve [transforaminal placement] including image guidance, if performed) or 64590 (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). However, it would be incorrect to use either of those 2 codes, even if the work appears similar to what is being performed. Rather, unique category III codes that are available for reporting the insertion, replacement, revision, or removal (and programming) of this miniaturized integrated device as follows:

0786T: Insertion or replacement of percutaneous electrode array, sacral, with integrated neurostimulator, including imaging guidance, when performed

0787T: Revision or removal of neurostimulator electrode array, sacral, with integrated neurostimulator

0788T: Electronic analysis with simple programming of implanted integrated neurostimulation system (eg, electrode array and receiver), including contact group(s), amplitude, pulse width, frequency (Hz), on/off cycling, burst, dose lockout, patient-selectable parameters, responsive neurostimulation, detection algorithms, closed-loop parameters, and passive parameters, when performed by physician or other qualified health care professional, spinal cord or sacral nerve, 1-3 parameters

0789T: …, 4 or more parameters

When reporting category III codes, it is important to check with the patient’s insurer to determine their policies and reimbursement for these devices.

Similar to what was mentioned above using unlisted codes, documentation for the use of the device should include a history of the patient’s condition and the reasoning behind the recommendation for the treatment. It is important to include appropriate documentation in the patient record, including diagnostic tests performed, previous therapies, additional testing, and improvements for all patients similar to other devices in this category. It is common for a payer to request patient records when submitting for a service with a category III code. You should also be prepared to develop for both an appropriate charge for the service and obtaining appropriate reimbursement inherent costs and projected or associated costs for the service.A practice will need to consider all of the following; 1) cost of the device (invoice), 2) comparative clinical work efforts (CPT codes with similar work requirements), 3) other direct and indirect costs for providing the service and 4)overhead for the practice.Appeal and follow-up may be required.

As with all medications and services, it is important to check with the patient’s insurer to determine their policy and whether the medication will be covered.

Send coding and reimbursement questions to Jonathan Rubenstein, MD, and Mark Painter c/o Urology Times®, at UTeditors@mjhlifesciences.com.

The information in this column is designed to be authoritative, and every effort has been made to ensure its accuracy at the time it was written. However, readers are encouraged to check with their individual carrier or private payers for updates and to confirm that this information conforms to their specific rules.