2025 CPT code 63655
(Active) Effective Date: N/A Revision Date: N/A Surgery - Surgical Procedures on the Nervous System Feed
Laminectomy for implantation of neurostimulator electrodes, plate/paddle, epidural.
Modifiers such as 58 (staged procedure), 59 (distinct procedure), 22 (increased procedural services), and others may be applicable depending on the specific circumstances of the procedure and payer guidelines.
Spinal cord stimulation is considered medically necessary for patients with chronic neuropathic pain that has not responded to other treatment modalities.The patient must meet specific criteria, including a thorough evaluation, failed conservative treatments, and appropriate patient selection determined by a multidisciplinary team.
The physician is responsible for the entire surgical procedure, including patient preparation, anesthesia, lead placement and anchoring, pulse generator implantation and connection, system programming, and post-operative care.
In simple words: The doctor removes a small part of your backbone to place a flat electrode near your spinal cord. This electrode sends signals to help control chronic pain and muscle spasms.This is a more permanent way to help manage your pain when other treatments haven't worked.
This procedure involves the surgical implantation of a neurostimulator electrode plate/paddle into the epidural space via a laminectomy.It's performed for spinal cord stimulation to manage chronic pain and spasms when broader coverage or reduced electrode movement risk is necessary.The procedure includes anchoring the electrodes, positioning the pulse generator, tunneling and connecting the leads, and programming the stimulation pattern.
Example 1: A patient with chronic back pain unresponsive to conservative treatment undergoes a successful trial with percutaneous leads. The physician performs a laminectomy and implants a paddle lead for long-term pain management., A patient with multiple sclerosis experiences painful spasms.A trial with percutaneous electrodes provides significant relief, and the physician performs a laminectomy to implant a plate electrode for more stable and broader stimulation., A patient with a failed back surgery syndrome has persistent nerve pain.Following a successful trial, the physician replaces the percutaneous leads with a paddle lead via laminectomy for wider coverage of the affected area.
Documentation should include the diagnosis, medical necessity for the procedure (including failed conservative treatments), details of the pre-operative evaluation, operative report (including lead type and location), confirmation of lead placement and testing results, programming parameters, and post-operative care plan.
** For Medicare patients, implanted neurostimulator devices are not separately reimbursed in an ASC, as reimbursement is bundled into the surgical procedure. Prior authorization is often required. Ensure documentation supports the medical necessity for the procedure, including failed conservative treatment options, patient selection criteria, and expected outcomes.
- Revenue Code: P1G - MAJOR PROCEDURE - OTHER
- RVU: 10.92 (as of 2024-08-08)
- Global Days: 90 days
- Payment Status: Active
- Modifier TC rule: No specific TC modifier rules are inherently associated with 63655, as it describes the surgical implantation of the lead. However, TC modifiers might be applicable to other related procedures performed at the same time, like the insertion of a pulse generator.
- Fee Schedule: Fee schedule amounts and information may vary depending on location, payer, and other factors. Consult the relevant fee schedules for specific historical data.
- Specialties:Neurosurgery, Pain Management, Anesthesiology, Physical Medicine & Rehabilitation
- Place of Service:Ambulatory Surgical Center, Inpatient Hospital