2025 CPT code 95991

Refilling and maintaining an implantable drug delivery pump (spinal or brain), including electronic analysis if performed.

Follow CPT guidelines for neurological services and implantable pump management. Ensure documentation supports the medical necessity and the level of service provided.

Modifiers 52 (reduced services), 53 (discontinued procedure), 59 (distinct procedural service), 76 (repeat procedure by the same physician), 77 (repeat procedure by another physician), 79 (unrelated procedure by the same physician during the postoperative period) could be applicable depending on the clinical scenario.

The medical necessity is established by the presence of a qualifying medical condition, such as intractable pain or a persistent infection, requiring continuous drug delivery via an implantable pump.Documentation must demonstrate the patient's condition warrants the procedure.

The physician or qualified healthcare professional identifies the pump location, cleanses the area, uses sterile technique, prepares the medication, accesses the pump with a Huber needle, removes existing fluid, injects the new medication, and performs an electronic pump analysis (if applicable).

IMPORTANT Do not report codes 95990, 95991 with 62367-62370. For systemic drug therapy (e.g., chemotherapy) pump refill and maintenance, use 96522.

In simple words: A doctor or qualified healthcare professional refills and maintains a pump implanted in the body to deliver medication directly to the spine or brain to treat conditions like pain or infection. They check the pump's functionality during the process.

This CPT code encompasses the refilling and maintenance of an implantable pump or reservoir designed for drug delivery to the spinal (intrathecal, epidural) or brain (intraventricular) areas.The procedure includes accessing the pump, removing existing fluid, injecting the prescribed medication, and performing an electronic analysis of the pump's functionality (reservoir status, alarms, drug prescription status), when performed.The service requires the skill of a physician or other qualified healthcare professional.

Example 1: A patient with chronic back pain receives intrathecal morphine via an implanted pump. The physician refills the pump and performs an electronic analysis to check its functionality., A patient with a brain infection is treated with intraventricular antibiotics delivered through an implanted pump. The healthcare professional refills and maintains the pump and checks the reservoir status., A patient with cancer pain uses an implanted pump for epidural analgesia.The healthcare professional refills the pump, noting the amount of medication infused and the pump's electronic data before, during, and after the procedure.

Complete medical record including diagnosis, indication for pump implantation, medication prescribed, date and amount of medication administered, electronic analysis results (if performed), and any complications or adverse events.Documentation should show the procedure was performed by a physician or other qualified healthcare professional.

** This code should only be used when the electronic analysis is performed at the same time as the refill and maintenance. If performed separately, code 62367-62370 should be used instead.

** Only Enterprise users with EHR integration can access case-specific answers. Click here to request access.