Chronic pain management (CPM) is among the most formidable challenges in modern medicine. Not only are the chronic pain ailments difficult to treat, but they are also equally difficult to bill. A frequently performed and challenging type of CPM treatment is Spinal Cord Stimulation (SCS).
While there can be many types of SCS treatments, the most commonly performed is billed via CPT code 63650. However, as we said, it is challenging to bill and often ends up in a claim denial.
That’s why our billing experts at MediBillMD have created this detailed guide on what code 63650 is and how to bill it. Let’s start.
CPT Code 63650 – Description
CPT code 63650 is defined as:
“Percutaneous implantation of neurostimulator electrode array, epidural.”
Sounds hard? Let us explain in simpler terms.
63650 is a surgical pain management code and represents a specific type of SCS therapy. But what exactly happens during the procedure? Well, during the procedure, the physician inserts a single specialized electrode into the epidural space of the spinal cord. This is done using a minimally invasive technique. This electrode is connected to a neurostimulator device, which generates small electrical pulses. These electrical pulses stimulate the spinal cord and relieve pain.
However, code 63650 has a very high reimbursement rate. So, healthcare providers cannot use it without proper justification. That’s why in most cases, physicians must perform a trial before implanting the device permanently. The difference between the trial and the actual procedure is that in the trial phase, the electrodes are connected to an external generator rather than an implanted neurostimulator.
If the trial is successful, the patient returns for permanent implantation, where new leads are typically placed and connected to an implanted pulse generator (IPG). An essential point to note here is that CPT code 63650 can be used for billing both trial and actual procedures.
Additionally, the surgery needs fluoroscopy for proper guidance. However, as per the guidelines, fluoroscopic imaging is inherent to 63650, so you cannot bill it separately.
Scenarios Where CPT Code 63650 is Applicable
Spinal cord stimulations are complex and expensive. They are not a first-line therapy. They are only used as a last resort for patients who have tried and failed conservative treatments. CPT code 63650 is most commonly used for treating Failed Back Surgery Syndrome (FBSS), where patients continue to experience debilitating pain despite prior spinal interventions.
However, that’s not the only area of its application. 63650 can be used for several chronic pain conditions. Some common scenarios include:
- Complex Regional Pain Syndrome (CRPS): Types I and II, often affecting limbs after injury.
- Chronic Intractable Pain: Specifically affecting the trunk and/or limbs.
- Radicular Pain Syndrome: Persistent nerve root pain that has not responded to other treatments.
- Diabetic Peripheral Neuropathy: Specifically of the lower extremities, where SCS has shown efficacy in managing painful symptoms.
- Post-Surgical Pain Management: Persistent pain following other surgical procedures.
- Arachnoiditis and Epidural Fibrosis: Scarring or inflammation in the spinal canal causing pain.
- Degenerative Disc Disease: When accompanied by intractable leg and back pain.
Applicable Modifiers for CPT Code 63650
Using the correct modifiers with CPT code 63650 is one of the most important factors in preventing its denials.
Modifier 59 (Distinct Procedural Service) is frequently used with code 63650. The procedure involves the placement of a single lead. However, in many cases, physicians might need to implant two or more electrodes. When a second lead is placed, it must be reported as a separate line item using modifier 59.
A critical mistake that many billers make while filing 63650 claims is to use bilateral modifiers. Please note that the modifier 50 (Bilateral Procedure), RT (Right), and LT (Left) must not be used with 63650 claims.
CPT Code 63650 – Billing & Reimbursement Guidelines
Knowing the definition is essential, but to effectively bill CPT code 63650, you must be aware of vital billing guidelines. The following are some critical points to keep in mind:
Provide Detailed Documentation
Documentation is the shield that protects your revenue during an audit. For CPT 63650, the requirements are extensive. Most importantly, there should be documented proof of at least six months of conservative treatment. Your documentation must include:
- An indication of whether the request is for a trial or permanent placement.
- Physician office notes, including:
- Condition requiring procedure
- Physical evaluation
- Treatments tried and failed, including but not limited to:
- Spine surgery
- Physical therapy
- Medications
- Injections
- Psychological therapy
- Documentation of an appropriate psychological evaluation.
For permanent placement, include all of the above documentation, as well as documentation of pain relief with the temporarily implanted electrode(s).
In addition to base documentation, healthcare providers must also get written prior authorization for CPT code 63650. Medicare requires pre-authorization for implanted spinal neurostimulators if the services are to be performed in a Hospital Outpatient Department (OPD).
If a provider plans to perform both the trial and the permanent implantation, they typically only need to obtain prior approval for the trial. Upon approval, they receive a Unique Tracking Number (UTN). This UTN must be placed on the claim for the permanent implantation to prove that authorization was obtained. Failure to transfer this UTN will result in immediate claim rejection.
Report with Psychological Evaluation
Another critical requirement for code 63650 to be valid is a comprehensive psychological evaluation. The screening typically involves checking for symptoms of depression, anxiety, irritability, other serious mental health disorders, and changes in the patient’s mood in relation to chronic pain.
This psychological evaluation must be performed by a qualified professional (PhD, PsyD, or LCSW). A detailed report of this evaluation should be created. The report must explicitly state that the patient is cleared for spinal cord stimulation and does not have untreated psychological comorbidities.
Do Not Report Bundled Services Separately
As we have mentioned earlier, before a permanent implant, a physician must perform a test trial to check whether the treatment is working or not. However, an additional point to note here is that when code 63650 is used for trials, the removal of electrodes after the test is also covered under the same reimbursement.
Plus, the cost of the device is also covered by 63650, and you cannot file a separate claim for it.
Verify the Medicare Reimbursement Rates
The reimbursement rate for CPT code 63650 varies for each payer and Medicare Administrative Contractor (MAC) locality. However, Medicare’s national average reimbursement amount in non-facility settings is $2,127.11 and $403.68 in facility settings.
You can check the exact amount for your MAC locality via the PFS Lookup Tool. Here’s how the reimbursement is divided among the three components:
Note that the code has a global surgery period of 10 days, so pre- and post-operative services are included in the reimbursement amount.
- Pre-OP: 0.10 (10% of the total payment)
- Intra-OP: 0.80 (80% of total payment)
- Post-OP: 0.10 (10% of the total payment)
Wrapping Up
That is a lot of information to absorb. So, let’s do a quick recap of the most important points.
- CPT code 63650 is a pain management code, used for a neurostimulator electrode implantation.
- It involves the insertion of an electrode array in the epidural space of the spinal cord.
- For multiple lead insertions, use modifier 59.
- Imaging is already included in code 63650 and is not separately reimbursable.
- The device cost is also bundled with 63650.
If you are facing frequent claim denials or can’t improve your revenue collections, we advise consulting certified billing specialists. You can contact our billing professionals at MediBillMD for premium pain management billing services.
