CMS: Providers incorrectly billing HCPCS code for electro-acupuncture devices

Providers need to clean up coding for electro-acupuncture devices, according to CMS. In   Special Edition MLN Matters 20001, the agency noted that some providers are incorrectly coding these devices with HCPCS code L8679 (implantable neurostimulator, pulse generator, any type).

Implantable neurostimulators are surgically implanted in the central nervous system or targeted peripheral nerve. Implantation of these devices is usually performed in an operating room. Therefore, HCPCS code L8679 should be submitted with the appropriate HCPCS/CPT® surgical code. In contrast, electro-acupuncture devices are applied externally behind the ear, have an external battery source, and do not require surgical implantation.

CMS will be making several changes to address inappropriate use of L8679. Starting March 1, Medicare Administrative Contractors (MAC) will reject claims for HCPCS code L8679 submitted without an appropriate HCPCS/CPT surgical procedure code. Claims for HCPCS code L8679 billed with an appropriate HCPCS/CPT surgical code will be suspended for medical review to verify that coverage, coding, and billing rules have been met, according to CMS. In addition, all claims billed with HCPCS code L8679 must be billed with the same date of service as the applicable surgical procedure code.

Organizations should ensure they are correctly billing and coding for these devices. Conduct internal review of claims for both types of devices before March 1 to identify errors, processes that need to be changed, or education needs. Organizations may also contact their MACs with additional questions.