2025 CPT code 61864
(Active) Effective Date: N/A Revision Date: N/A Surgery - Neurostimulators (Intracranial) Surgical Procedures on the Nervous System Feed
Placement of an additional neurostimulator electrode array in a subcortical site, without intraoperative microelectrode recording.
Modifiers may apply depending on the circumstances of the procedure. Consult the latest CPT guidelines and NCCI edits.
The medical necessity for this procedure is determined by the patient's symptoms and response to less invasive treatment options.Documentation should demonstrate the presence of medically refractory movement disorders such as Parkinson's disease, essential tremor, or dystonia, resistant to medication management.
The neurosurgeon or a qualified specialist is responsible for planning, performing, and documenting the procedure. This includes pre-operative imaging review, intra-operative targeting and placement of the electrode array, and post-operative follow-up to assess the device's function and patient's response.
- Surgical Procedures on the Nervous System
- Surgical Procedures on the Nervous System > Neurostimulators (Intracranial)
In simple words: This code describes adding another electrode to the brain during a surgery to help treat movement disorders like tremors or Parkinson's disease. The doctor uses a computer to guide the placement of the electrode precisely, without using a special type of recording during the procedure. This is done after an initial electrode has already been placed in the same session.
This CPT code 61864 represents the addition of a neurostimulator electrode array in a subcortical site (e.g., thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray) following the initial array placement during the same operative session.The procedure involves the use of stereotactic techniques (three-dimensional coordinate system for targeting) to guide electrode placement, without the use of intraoperative microelectrode recording.It's an add-on code and requires a primary procedure code representing the initial array placement (typically 61863).A craniectomy, craniotomy, burr hole, or twist drill may be necessary to access the target site.
Example 1: A patient with Parkinson's disease undergoes deep brain stimulation surgery. An initial electrode array is placed, and after testing, a second array is added via code 61864 to optimize therapeutic effect., A patient with essential tremor undergoes deep brain stimulation.The surgeon implants an initial electrode array and, after testing, decides to add a second array using 61864 to target a different area of the thalamus for better symptom control., A patient with dystonia undergoes surgery for deep brain stimulation.The initial electrode is placed, and due to persistent symptoms, an additional electrode array is added, coded with 61864, during the same surgical session to improve symptom control.
Pre-operative imaging (MRI or CT), operative notes detailing the placement of each array, including coordinates, intraoperative imaging (if used), post-operative imaging to confirm placement, and neurophysiological testing results to assess the efficacy of stimulation.
** This code should only be used when an additional array is implanted during the same operative session as the initial array and the intraoperative microelectrode recording is not performed.The subcortical target site should be clearly specified in the operative report.
- Payment Status: Active
- Modifier TC rule: Not applicable; this is not a procedure that typically uses TC modifiers.
- Specialties:Neurosurgery
- Place of Service:Inpatient Hospital, Ambulatory Surgical Center