Urgent® PC Reimbursement

iStock_000012570594_Small-979608-edited.jpgReimbursement for Urgent PC when used in treating Overactive Bladder symptoms of urge incontinence, urinary frequency and urgency of urination.

Cogentix Medical has compiled this coding information for your convenience. This information is gathered from third-party sources and is subject to change without notice. This information is presented for illustrative purposes only and does not constitute reimbursement or legal advice. It is always the provider’s responsibility to determine medical necessity and submit appropriate codes, modifiers, and charges for services rendered. Please contact your local carrier/payer for interpretation of coding and coverage. Cogentix Medical does not promote the use of its products outside their FDA cleared or approved labeling.

Urgent PC Coverage

Posterior tibial nerve stimulation (PTNS) with Urgent PC is now reimbursed nationally by Medicare. In addition, new private payer policies are being added to the already significant number of national and local policies that cover PTNS. For more information, view the PTNS Coverage Finder.

Urgent PC Billing Codes

PTNS delivered by the Urgent PC Neuromodulation System is indicated for Overactive Bladder (OAB) and associated symptoms of urge incontinence, urinary frequency and urgency of urination.

ICD-10 – Diagnosis Codes

It is the physician's responsibility to select the most accurate diagnosis code(s) to describe a patient's condition. The following diagnosis codes may be applicable for PTNS; however, some medical policies may specify which ICD-10 diagnosis codes support medical necessity.

Description ICD-10
Urge Incontinence N39.41
Urinary Frequency R35.0
Urgency of Urination R39.15
Overactive Bladder N32.81

Physician and Facility Coding

OFFICE - Site of Service 11

CPT® Code2 Total
Non Facility
RVUs3
Medicare
National Allowed Amount3,4
Physician Coding    
64566- Posterior tibial neurostimulation, percutaneous needle electrode, single treatment, includes programming 3.60  $128.90
Medicare allowed amount for 12 treatments*$1,546.80    

OUTPATIENT - Site of Service 22**

CPT® Code Total
Facility
RVUs3
Medicare
National Allowed Amount3,4
Physician Coding    
64566 - Posterior tibial neurostimulation, percutaneous needle electrode, single treatment, includes programming 0.88 $31.51
Medicare allowed amount for 12 treatments* $378.12    
Facility Coding    
64566 - Posterior tibial neurostimulation, percutaneous needle electrode, single treatment, includes programming APC 05441 $233.76
Medicare allowed amount for 12 treatments* $2,685.12    

ASC - Site of Service 24**

CPT® Code Total Facility
RVUs3
Medicare
National Allowed Amount3,4
Physician Coding    
64566 - Posterior tibial neurostimulation, percutaneous needle electrode, single treatment, includes programming 0.88 $31.51
Medicare allowed amount for 12 treatments* $378.12    
Facility Coding    
64566 - Posterior tibial neurostimulation, percutaneous needle electrode, single treatment, includes programming NA $104.95
Medicare allowed amount for 12 treatments* $1,259.40    

* Initial protocol for PTNS is 12 weekly treatments. Patients who respond to the initial protocol typically need a treatment about once per month to maintain their improvements.

**PTNS is generally expected to be delivered in an office setting (site of service 11). Please verify outpatient coverage and payment with the payer.

1. The Urgent PC Neuromodulation System has FDA clearance to treat patients suffering from Overactive Bladder and the associated symptoms of urinary urgency, urinary frequency, and urge incontinence. The FDA does not specify diagnosis codes.

2. CPT® is a trademark of the American Medical Association. Current Procedural Terminology (CPT) is a copyright 2013 American Medical Association. All Rights Reserved. No fee schedules, basic units, relative values, or related listing are included in CPT.

3. 42 CFR Parts 403, 405, 410 et al. Medicare Program; Revisions to Payment Policies Under the Physician Fee Schedule, Clinical Laboratory Fee Schedule, Access to Identifiable Data for the Center for Medicare and Medicaid and Medicaid Innovation Models & Other Revisions to Part B for CY 2015; Final Rule, November 11, 2015.

4. "Allowed Amount" is the payment Medicare determines to be the maximum allowance for any Medicare-covered service. Actual payment will be based on the geographically adjusted maximum allowed amount less any applicable deductible, coinsurance, etc.

5. 42 CFR Parts 405, 410, 412, et al. Medicare  Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs; short hospital stays; Transition For Certain Medicare-Dependent. Small Rural Hospitals Under the Hospital Inpatient Prospective Payment System. Provider Administrative Appeals and Judicial Review; Final Rule, November 13, 2015.