|
L8679 |
 |
Implantable neurostimulator, pulse generator, any type
| short | Imp neurosti pls gn any type |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 1.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 3.0 | 3 Date of Service Edit: Clinical | Clinical: Data |
|
|
|
|
L8680 |
|
Implantable neurostimulator electrode, each
| short | Implt neurostim elctr each |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
L8681 |
|
Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only
| short | Pt prgrm for implt neurostim |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 1.0 | 3 Date of Service Edit: Clinical | Nature of Equipment | | OPH | 1.0 | 3 Date of Service Edit: Clinical | Nature of Equipment | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
L8682 |
|
Implantable neurostimulator radiofrequency receiver
| short | Implt neurostim radiofq rec |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 2.0 | 3 Date of Service Edit: Clinical | Nature of Equipment | | OPH | 2.0 | 3 Date of Service Edit: Clinical | Nature of Equipment | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
L8683 |
|
Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver
| short | Radiofq trsmtr for implt neu |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 1.0 | 3 Date of Service Edit: Clinical | Nature of Equipment | | OPH | 1.0 | 3 Date of Service Edit: Clinical | Nature of Equipment | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
L8684 |
|
Radiofrequency transmitter (external) for use with implantable sacral root neurostimulator receiver for bowel and bladder management, replacement
| short | Radiof trsmtr implt scrl neu |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 1.0 | 3 Date of Service Edit: Clinical | Nature of Equipment | | OPH | 1.0 | 3 Date of Service Edit: Clinical | Nature of Equipment | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
L8685 |
|
Implantable neurostimulator pulse generator, single array, rechargeable, includes extension
| short | Implt nrostm pls gen sng rec |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 1.0 | 3 Date of Service Edit: Clinical | Nature of Equipment | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
L8686 |
|
Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension
| short | Implt nrostm pls gen sng non |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 2.0 | 3 Date of Service Edit: Clinical | Nature of Equipment | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
L8687 |
|
Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension
| short | Implt nrostm pls gen dua rec |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 1.0 | 3 Date of Service Edit: Clinical | Nature of Equipment | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
L8688 |
|
Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension
| short | Implt nrostm pls gen dua non |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 1.0 | 3 Date of Service Edit: Clinical | Nature of Equipment | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
L8689 |
|
External recharging system for battery (internal) for use with implantable neurostimulator, replacement only
| short | External recharg sys intern |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 1.0 | 3 Date of Service Edit: Clinical | Nature of Equipment | | OPH | 1.0 | 3 Date of Service Edit: Clinical | Nature of Equipment | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|