Vagus Nerve Stimulation (VNS) therapy is provided to reduce the frequency of seizures in adults and children with partial onset seizures that are refractory (intractable) to anti-epileptic medications and for which surgery has failed or is not recommended. The VNS therapy system consists of a medical device that may be surgically implanted in a hospital setting or an ambulatory surgical center.
Effective June 1, 2020, Staywell Health Plan and Children’s Medical Services Health Plan will begin reimbursing eligible facilities a maximum fee of $16,200 for the complete device or $8,100 for a partial replacement of the device, in addition to the surgical rate for Enhanced Ambulatory Patient Grouping (EAPG) or Diagnosis Related Group (DRG) payments. The physician who implants the device will only receive reimbursement from Staywell or CMS Health Plan at the facility rate listed on Florida Medicaid Practitioner Fee Schedule.
Device Billing Information
|
Provider |
Claim Type |
New or Full Replacement Device |
Partial Replacement |
Unit Limit |
Prior Authorization |
Additional Information |
|---|---|---|---|---|---|---|
|
Inpatient Hospital |
UB-04 or 837I |
Revenue Code: 0278 – Other Implants
CPT Code(s): L8679 – Implantable neurostimulator, pulse generator, any type
|
Revenue Code: 0278 – Other Implants
CPT Code(s): L8679 SC** – Implantable neurostimulator, pulse generator, any type
(Note: Modifier SC is required for partial replacement of vagus nerve stimulators.)
** Must be only modifier on claim line |
1 per date of service |
No prior authorization is required for the device. However, authorization for the Inpatient stay is still required. |
The claim line with L8679 will pay independent of the Diagnosis Related Group (DRG) payment for the surgery. *Provider should bill the appropriate revenue code for each CPT code. |
|
Outpatient Hospital |
UB-04 or 837I |
Claim Line 1:
Revenue Code: 0360 – General Surgery* CPT Code(s): 64568– Incision for Implantation of Cranial Nerve (eg, Vagus Nerve) Neurostimulator Electrode Array and Pulse Generator* *Both are required
Claim Line 2:
Revenue Code: 0278 – Other Implants CPT Code(s): L8679 – Implantable neurostimulator, pulse generator, any type*
*Both are required
|
Claim Line 1:
Revenue Code: 0360 – General Surgery* CPT Code(s): 64569– Revision or Replacement of Cranial Nerve (eg, Vagus Nerve) Neurostimulator Electrode Array, including connection to existing pulse generator*
*Both are required
Claim Line 2:
Revenue Code: 0278 – Other Implants CPT Code(s): L8679 SC** – Implantable neurostimulator, pulse generator, any type*
*Both are required
**Must be only modifier on claim line |
1 per date of service |
No prior authorization is required for this claim line. Prior authorization or other services billed on the same claim may still apply.
|
The device is reimbursed in addition to the Enhanced Ambulatory Patient Grouping payment for the surgery. *Provider should bill the appropriate revenue code for each CPT code. |
|
Ambulatory Surgical Center |
UB-04 or 837I |
Claim Line 1:
Revenue Code: 0360 – General Surgery* CPT Code(s): 64568– Incision for Implantation of Cranial Nerve (e.g., Vagus Nerve) Neurostimulator Electrode Array and Pulse Generator
Claim Line 2:
Revenue Code: 0278 – Other Implants CPT Code(s): L8679 – Implantable neurostimulator, pulse generator, any type |
Claim Line 1:
CPT Code(s): 64569– Revision or Replacement of Cranial Nerve (e.g., VagusNerve) Neurostimulator Electrode Array, including connection to existing pulse generator
Claim Line 2:
CPT Code(s): L8679 SC** –Implantable neurostimulator, pulse generator, any type
**Must be only modifier on claim line
|
1 per date of service |
No prior authorization is required for this claim line. However, prior authorization or other services billed on the same claim may still require an authorization.
|
The device is reimbursed in addition to the Enhanced Ambulatory Patient Grouping payment for the surgery. *Provider should bill the appropriate revenue code for each CPT code. |
PRO_56120E Internal Approved 06112020 FL0PROLTR56120E_0000
