Billing Category III Cpt code (for Morph device)

Thank you gentlemen for weighing in!

As for sending a letter to the state board, I would suggest that an individual provider contact their state CAC rep and go through the channels of their state component association. The issue of obtaining coverage for a DPM for a service not previoulsy covered is usually much better handled by the state association. This issue will not just simply impact you but every other DPM in your state. If you are not a member of APMA and your state society, it should not matter as this is an issue for the greater good, than just you.

Your state association will no doubt appreciate your input and advice.

Also beware, if you do this on your own and it blows up in your face, every DPM in your state will be pointing the finger at you.

You also don't have the resources that typically the state component has to obtain an advisory decision from your state board.

Once you have a positive advisory note from the state board, you can fight with Medicare.

Having been there before, those are my suggestions.

Luke:

1) Alex gave some great advice. First look at the Category 3 CPT definition "0720T is a CPT code that stands for percutaneous electrical nerve field stimulation, cranial nerves, without implantation. It specifically refers to a medical procedure where a device with electrodes is placed on the external ear area to deliver electrical stimulation to the cranial nerves."

2) I always say just because a vendor says bill something this way does NOT make it right or accurate.

3) If something is payable by Medicare CPT 64553, that is not the reason to provide the services.

4) LCD's limit provider utilization, can't just go by a LCD. In Medicare services are based ultimately on "medical necessity criteria".

5) Is this within the scope of your practice "electrodes is placed on the external ear area to deliver electrical stimulation to the cranial nerves"? If it is grey, send a letter to your state board of licensure and ask if they consider this within the scope of a podiatric physician's licensure. This is very important when jumping into a grey area.

After looking at the device and watching those videos, (and knowing of some colleague's experiences with something similar some years ago), here is my 0.02......a device attached to the ear through tiny needles the size of acupuncture needles would certainly not qualify as an implantable neurostimulator. CPT 64553 is defined as "Percutaneous IMPLANTATION of neurostimulator electrode array; cranial nerve". (my emphasis). In fact, when looking in the 2025 CPT Professional Edition coding book, under CPT 64553, it says, "For percutaneous electrical stimulation of a cranial nerve using needle[s] or needle electrode[s] [eg PENS, PNT], use CPT 64999 -- which is an unlisted code. When I researched CPT 0720T, it is a category III code, and is defined as "Percutaneous electrical nerve field stimulation, cranial nerves, WITHOUT implantation". This device has been around under various names for some time, and one particular company (not around any more) suggested billing only a HCPCS code, L8679, and not CPT 64553 (or CPT 64555). L8679 is defined as, "Implantable neurostimulator, pulse generator, any type". The reimbursement on L8679 was > $9,000. Needless to say, some docs got in big trouble with that. I would be extra cautious with this device.