Vagus Nerve Stimulation (VNS) CPT Codes 95970, 95974 and 95975 National Coverage Determination (NCD)
States Applicable to Alert: Northern and Southern California
Background Information: When Palmetto GBA implemented the Vagus Nerve Stimulation (VNS) NCD, some procedure codes overlapped. Therefore, claims with Deep Brain Stimulation (DBS) were being denied in error. CPT codes 95970, 95974 and 95975 are being removed from VNS editing.
Applies To Procedure Code(s): 95970, 95974 and 95975
Remark /Reason Codes:
50 - These are non-covered services because this is not deemed a 'medical necessity' by the payer.
N386 - This decision was based on an NCD. An NCD provides a coverage determination as to whether a particular item or service is covered. A copy of this policy is available at www.cms.hhs.gov/mcd/search.asp. If you do not have Web access, you may contact Palmetto GBA to request a copy of the NCD.
MAC Action: CPT codes 95970, 95974 and 95975 are being removed from the VNS editing. When the system is updated, a mass adjustment will be performed to correct the DBS services denied in error.
Provider Action: No Action Required
Date Reported: October 13, 2009
Date Resolved: Open