About this policy
The information in this article contains billing, coding or other guidelines that complement the Local Coverage Determination (LCD) for Sacral Nerve Stimulation for the Treatment of Urinary and Fecal Incontinence L39543. Note : Components of the Global Surgical Package includes miscellaneous services such as dressing changes; local incisional care; removal of cutaneous sutures and staples, lines, wires, tubes, drains. Note : Minor Surgeries and Endoscopies, separate payment for postoperative visits or services within 10 days of the surgery that are related to recovery from the procedure are not allowed. Services performed for any given diagnosis must meet all of the indications and limitations stated in the related LCD, the general requirements for medical necessity as stated in CMS payment policy manuals, any and all existing CMS NCDs, and all Medicare payment rules.
Codes in this policy
Code numbers and each code’s status as the policy records it. CPT code descriptions are left out of this page, as are the passages that cite CPT codes; the official document has them.
| Code | Code system | Status in this policy |
|---|---|---|
| 0786T | HCPCS | Covered |
| 0787T | HCPCS | Covered |
| 0788T | HCPCS | Covered |
| 0789T | HCPCS | Covered |
| 64561 | HCPCS | Covered |
| 64581 | HCPCS | Covered |
| 64585 | HCPCS | Covered |
| 64590 | HCPCS | Covered |
| 64595 | HCPCS | Covered |
| 64596 | HCPCS | Covered |
| 64597 | HCPCS | Covered |
| 64598 | HCPCS | Covered |
| 95970 | HCPCS | Covered |
| 95971 | HCPCS | Covered |