2025 CPT code 95972
(Active) Effective Date: N/A Revision Date: N/A Neurology - Neurostimulators Analysis-Programming Procedures Medicine Services and Procedures > Neurology and Neuromuscular Procedures Feed
Electronic analysis of an implanted spinal cord or peripheral nerve neurostimulator with complex programming.
Modifiers may be necessary to indicate reduced services (52), discontinued procedures (53), distinct procedural services (59), or repeat procedures (76, 77).Consult NCCI edits and payer guidelines for appropriate modifier application.
Medical necessity for code 95972 is established when the patient experiences inadequately managed symptoms or adverse effects related to their neurostimulator, necessitating adjustments to multiple device parameters to optimize therapeutic benefits and improve the patient's clinical outcome.Appropriate documentation must show the medical need for reprogramming.
A physician or other qualified healthcare professional performs the electronic analysis and complex programming of the implanted neurostimulator. This includes assessing the device's parameters, making necessary adjustments to optimize therapy, and documenting all changes.
- Medicine Services and Procedures > Neurology and Neuromuscular Procedures
- Neurostimulators Analysis-Programming Procedures
In simple words: The doctor checks and makes multiple adjustments to a device already placed in the body to stimulate nerves (like in the spine or other areas) to help manage pain or other conditions. This includes several detailed tests of the device and significant changes to its settings.
This CPT code describes the electronic analysis of an implanted spinal cord or peripheral nerve (e.g., sacral nerve) neurostimulator pulse generator/transmitter, including complex programming adjustments.Complex programming involves modifying more than three system parameters.Parameters may include contact group(s), interleaving, amplitude, pulse width, frequency, on/off cycling, burst, magnet mode, dose lockout, patient-selectable parameters, responsive neurostimulation, detection algorithms, closed-loop parameters, and passive parameters.The analysis assesses the device's functionality and ensures optimal therapeutic delivery.Each parameter adjusted, regardless of the number of times adjusted during the session, counts as one parameter.
Example 1: A patient with chronic back pain receives a spinal cord stimulator implant.During a follow-up appointment, the physician performs code 95972 to adjust more than three parameters (e.g., amplitude, pulse width, frequency, and on/off cycling) to optimize pain relief and minimize side effects., A patient with peripheral nerve injury receives a peripheral nerve stimulator implant. Three months later, the patient experiences increased pain in their leg. The physician performs 95972 to reprogram the device, modifying multiple parameters to address the changed clinical symptoms., Following the implantation of a sacral nerve stimulator for bowel and bladder dysfunction, the patient reports incomplete bladder emptying. The physician adjusts the parameters of the device during a follow up visit, using code 95972, because more than three settings need to be changed to correct the issue.
* Detailed documentation of the pre-programming settings and electrode impedances.* Thorough description of the patient's clinical presentation and symptoms that necessitated programming changes.* Clear record of all parameters adjusted, including the original and final values.* Documentation of the physician's assessment and rationale for making the programming changes.* Confirmation that the device was appropriately implanted.
** This code is reported only when programming is performed by a physician or other qualified healthcare professional.Test stimulations during implantation are not separately reportable.
- Payment Status: Active
- Modifier TC rule: A Technical Component (TC) modifier is generally not applicable to this code as it represents the physician's professional component of the service.
- Specialties:Neurology, Neurosurgery, Pain Management
- Place of Service:Office, Inpatient Hospital, Outpatient Hospital, Ambulatory Surgical Center