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Article Title
Billing and Coding: Billing Medicare for the SphenoCath® and Other Similar Devices
Article Type
Billing and Coding
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CMS National Coverage Policy
N/A
Article Guidance
1
Article Text
Noridian is issuing coding guidance for billing the use of Dolor Technologies SphenoCath® device or similar
delivery devices. To bill for use of these devices use CPT® 64999 as described in CPT Assistant (July 2014.
Volume 24, Issue 7, pages 8-9).
Source:
Internet Only Manual, CMS Pub 100-4 - Medicare Claims Processing Manual, Chapter 12
- Physicians/Nonphysicians Practitioners, Section 50.K:
"If the physician performing the medical or surgical procedure also provides the level of anesthesia lower in
intensity than moderate sedation, such as a local or topical anesthesia, then the moderate sedation code should
not be reported and no separate payment should be allowed by the A/B MAC (B)."
Coding Information
CPT/HCPCS Codes
Group 1
(1 Code)
Group 1 Paragraph
To bill for this service, enter 64999 in the comment field as listed below with the description SphenoCath® or
the name of the delivery device used.
For Part A:
• 2300 loop, NTE segment for the electronic claim
• Form Locator 80 Remarks on the UB04 form
Part B:
• Loop 2400/SV101-7 for the electronic claim or
• Item 19 on the CMS-1500 paper claim form
Do not use CPT® 64400 and/or 64505 to bill for this device.
Group 1 Codes
Code Description
2
64999 UNLISTED PROCEDURE, NERVOUS SYSTEM
CPT/HCPCS Modifiers
N/A
ICD-10-CM Codes that Support Medical Necessity
N/A
ICD-10-CM Codes that DO NOT Support Medical Necessity
N/A
ICD-10-PCS Codes
N/A
Additional ICD-10 Information
N/A
Bill Type Codes
Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this
service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type. Complete
absence of all Bill Types indicates that coverage is not influenced by Bill Type and the article should be
assumed to apply equally to all claims.
Code Description
999x Not Applicable
Revenue Codes
Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to
report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article,
services reported under other Revenue Codes are equally subject to this coverage determination. Complete
absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the article
should be assumed to apply equally to all Revenue Codes.
Code Description
99999 Not Applicable
Other Coding Information
N/A
Revision History Information
Revision Revision
History History
Date Number Revision History Explanation
01/01/2023R3 Per 2023 CPT/HCPCS updates, either the long or short description of CPT code
64999 has been updated.
3
04/29/2020R2 Converted to Billing and Coding article and added 64999 to
the CPT/HCPCS Coding section. No Change in coverage was made.
01/01/2017R1 Updated the Article Title, Text and Group 1 Paragraph to allow for other approved
devices used for Sphenopalatine Ganglion Blocks and updated the IOM Source and
quotation in the Article Text.
Associated Documents
Related Local Coverage Documents
N/A
Related National Coverage Documents
N/A
Statutory Requirements URLs
N/A
Rules and Regulations URLs
N/A
CMS Manual Explanations URLs
N/A
Other URLs
N/A
Public Versions
Updated On Effective Dates Status
12/16/2022 01/01/2023 - N/A Future Effective You are here
