2025 CPT code 95990

Refilling and maintenance of an implantable drug delivery pump or reservoir (spinal or brain), including electronic pump analysis.

Follow established guidelines for sterile technique, medication administration, and electronic pump analysis.Consult the CPT manual and relevant payer guidelines for specific coding instructions and billing requirements.If physician involvement is required beyond simple refill, use code 95991.

Modifiers may be applicable depending on the specific circumstances, such as modifier 52 (reduced services) if some components of the procedure were not performed, or modifiers to indicate the place of service. Consult the CPT manual and payer-specific guidelines.

Medical necessity is established by the diagnosis requiring implantable pump drug delivery, such as chronic pain unresponsive to other treatments, intractable neurological disorders, or severe infections requiring targeted medication delivery.Appropriate documentation supporting the patient's medical condition and the necessity of pump therapy is crucial.

A qualified healthcare professional (nurse or technician) is responsible for the procedure, following established protocols for sterile technique, medication preparation, and pump maintenance.Physician oversight may be necessary depending on the complexity of the case and the patient's condition.

IMPORTANT Code 95991 should be used if physician or other qualified healthcare professional skills are required.Codes 62367, 62368, and 62370 may be applicable depending on the type of pump and the services performed (programmable pumps require specific coding considerations).

In simple words: A healthcare professional refills a pump implanted in the body to deliver medicine directly to the spine or brain.They check the pump's electronics and make sure it's working correctly. This is done to treat pain or infections.

This CPT code encompasses the refilling and maintenance of an implantable pump or reservoir designed for drug delivery to the spinal cord (intrathecal or epidural) or brain (intraventricular).The procedure includes the preparation and administration of the prescribed medication, electronic analysis of the pump's functionality (reservoir status, alarms, drug prescription status), and general maintenance to ensure proper operation.Sterile technique is mandatory throughout the process.

Example 1: A patient with chronic back pain receives medication via an intrathecal pump. A nurse refills the pump with the prescribed medication and performs routine maintenance and electronic analysis, documenting the process and pump's status., A patient with a brain infection requires intraventricular drug delivery. A qualified healthcare professional refills the implanted reservoir, maintaining sterility and verifying drug dosage. Electronic analysis is performed to assess the pump's functions., A patient with post-surgical pain has a programmable implantable pump. The healthcare professional refills the pump, performs necessary programming adjustments as per physician orders, and checks all pump functions using electronic analysis.

Detailed documentation should include the type of pump (programmable or non-programmable), location of the pump (spinal or brain), medication administered (name, dose, volume), date and time of the refill, verification of sterile technique, results of the electronic pump analysis, and any observed complications or unusual findings.

** Always consult the current CPT manual for the most up-to-date information on coding and billing guidelines.Clarify any uncertainty with the payer or coding specialist to ensure proper reimbursement.

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