2025 CPT code 63685
(Revised) Effective Date: N/A Revision Date: N/A Surgery - Surgical Procedures on the Nervous System Surgery Feed
Insertion or replacement of a spinal neurostimulator pulse generator or receiver requiring pocket creation and connection to the electrode array.
Modifiers may be applicable depending on the circumstances of the procedure. Consult the CPT manual and payer guidelines for appropriate modifier use.
The medical necessity of spinal cord stimulation is supported by documentation of chronic, intractable pain refractory to conservative management.Specific criteria may vary depending on payer guidelines.
The surgeon is responsible for the entire procedure, from incision to closure.This includes creating the pocket, connecting the leads, testing the system, and ensuring proper placement of the device.
In simple words: The doctor inserts or replaces a device (spinal neurostimulator) that sends electrical signals to help manage pain.This involves creating a space under the skin and connecting the device to wires that lead to the spine.If the device is being replaced, the old one is removed first.
This CPT code encompasses the insertion or replacement of a spinal neurostimulator pulse generator or receiver.The procedure necessitates the surgical creation of a pocket for device placement and the establishment of a connection between the electrode array and the pulse generator or receiver.The procedure may involve dissecting an existing device from its pocket, disconnecting leads from the electrode array, attaching leads to a new generator (if replacing), and subcutaneously passing leads from the spinal electrode array to the implanted generator using a tunneling device. Test stimulations to verify system functionality may be performed. The generator is then secured in the pocket, the incision closed, and a sterile dressing applied. This code is specifically for systems with a detachable connection between the electrode array and pulse generator/receiver.For integrated systems, use codes 0784T-0787T.
Example 1: A patient with chronic back pain undergoes placement of a new spinal cord stimulator.Code 63685 would be used for the insertion of the pulse generator., A patient with an existing spinal cord stimulator experiences generator malfunction. The generator is removed and replaced with a new one. Code 63685 is appropriate for this replacement procedure., A patient with a spinal cord stimulator needs a lead revision, necessitating removal of the pulse generator to facilitate the connection of a new lead. After the lead revision, the pulse generator is re-implanted. In this instance, both 63685 (for the replacement of the pulse generator) and the appropriate lead revision code would be reported.
* Operative report detailing the procedure, including pocket creation, lead placement, and generator connection.* Preoperative and postoperative imaging (X-ray or fluoroscopy) to confirm lead and generator placement.* Patient history and physical examination findings justifying the need for neurostimulator implantation.* Anesthesia record.* Informed consent documentation.
** Always consult the most recent CPT manual, NCCI edits, and payer-specific guidelines for the most accurate coding practices.This information is for guidance only and does not constitute medical advice.
- Revenue Code: P1G (MAJOR PROCEDURE - OTHER)
- RVU: The RVUs will vary based on the geographic location and the specific payer. Consult the appropriate fee schedule for accurate values.
- Global Days: The global period will vary depending on payer and local policies.It is recommended to consult the specific payer's guidelines for details.
- Payment Status: Active
- Modifier TC rule: No TC modifier is applicable to this code because it represents the entire procedure.
- Fee Schedule: Historical fee schedules vary by payer and location.Consult historical fee schedules or claims data for specific information.
- Specialties:Neurosurgery, Pain Management
- Place of Service:Inpatient Hospital, Outpatient Hospital, Ambulatory Surgery Center