CODING FOR FDA APPROVED OR CLEARED INDICATIONS

To ensure that a patient meets the medically necessary policy criteria, or to find out if coverage prior authorization/predetermination is required, please contact the patient’s payer directly. Medtronic provides this information for your convenience only. It is the responsibility of the provider to determine coverage and submit appropriate codes, modifiers, and charges for the services rendered. The information below provides assistance for FDA approved or cleared indications.

The coding includes information on the diagnosis and procedure codes applicable to all sites-of-service to be used when billing, along with Medicare National Average payment rates. For specific coding assistance with your facility, please contact your local Health Economics Manager.

The codes in the documents below are up to date through:

MPFS – 12/31

OPPS and ASC – 12/31

IPPS – 9/30

SACRAL NEUROMODULATION FOR BLADDER AND BOWEL CONTROL

  • ICD-10-CM Diagnosis and Procedure Codes
  • HCPCS Device Codes
  • Device C-codes and Device Edits
  • CPT® Procedure Codes
  • MS-DRG Assignments

Medtronic provides this information for your convenience only. It does not constitute legal advice or a recommendation regarding clinical practice. Information provided is gathered from third-party sources and is subject to change without notice due to frequently changing laws, rules and regulations. The provider has the responsibility to determine medical necessity and to submit appropriate codes and charges for care provided. Medtronic makes no guarantee that the use of this information will prevent differences of opinion or disputes with Medicare or other payers as to the correct form of billing or the amount that will be paid to providers of service. Please contact your Medicare contractor, other payers, reimbursement specialists and/or legal counsel for interpretation of coding, coverage and payment policies. This document provides assistance for FDA approved or cleared indications. Where reimbursement is sought for use of a product that may be inconsistent with, or not expressly specified in, the FDA cleared or approved labeling (e.g., instructions for use, operator’s manual or package insert), consult with your billing advisors or payers on handling such billing issues. Some payers may have policies that make it inappropriate to submit claims for such items or related service.

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