Medicare - Novitas Solutions JH
Novitas solutions, the Medicare carrier for Jurisdiciton H: AR, CO, LA, MS, NM, OK, and TX, has issued a positive coverage policy for PTNS.
PTNS standard treatment regimen, 12 weekly sessions, is covered for patients who have failed or demonstrated intolerance to pharmacotherapy. Patients must report an improvement in symptoms within 12 weeks for continued coverage.
After the initial 12 sessions, treatments will be allowed at a frequency of 1 every 1 to 2 months for a maximum of three years.
To be eligible for coverage, the medical record must document at least one of the following:
a. Patient failed treatment with two anticholinergic drugs, each taken for at least 4 weeks duration, prior to the PTNS therapy initiation
b. Patient intolerance to anticholinergic drug therapy
CPT® code: 64566 Posterior tibial neurostimulation, percutaneous needle electrode, single treatment, includes programming
ICD-10 diagnosis codes that support medical necessity:
- N39.41 Urge incontinence
- N39.46 Mixed incontinence
- R32 Unspecified urinary incontinence
- R35.0 Frequency of micturition
- R39.15 Urgency of urination
Please see the Medicare Coverage Database for the most up to date information.