Implants to Auth Required “02.93”, “61850” “C1767”, “C1820”, Neurostimulators “04.92”, “61888”, “64553”, “0155T”, “0156T” Vagus Nerve to “86.96” “64555” “64595” Implants , None Listed Auth Required “57.96” “53899” Neurostimulators Unlisted code and no “57.97” Urologic HCPCS/NDC-require notes to pay Neurostimulator 43647”, Auth Required “ Services “43648”, “43881”, “43882”, “61531” to “61533”, to “63650” “63688”, “95980” to “95982”, “95999” Implants to Auth Required “01.20”, “61885” “L8685”, Neurostimulators “01.29”, “61888”, “64590”, “L8688” Deep Brain “02.93”, “64595” “86.94” to “86.97” Implant External to Auth Required “37.68” “33975” Cardiac Assist deleted code 2010 “33976”, “33979”, Device to on Lifespan table “33981” “33983” Implants Eye J7311 Auth Required “14.79”, “67027” “99.29” Implant Artificial Auth Required “11.73” “65770” “C1818”, “L8609” Cornea Implant Skin Auth Required Restricted “250.80” “86.67” “15365”, “15366” “Q4106” Dermagraft Diabetic to to CPT codes for foot; Ulcers Lifespan table includes “250.83”, additional codes. “249.80”, “249.81”, “707.14”, “707.15” Implants “92601”-“92604”, Services “92640” Notes:
Implants Neurostimulators Vagus Nerve “02.93”, “04.92”, “86.96” “61850” to “61888”, “64553”, “64555” to “64595” “C1767”, “C1820”, “0155T”, “0156T” Auth Required Implants Neurostimulators Urologic “57.96” , “57.97” “53899” None Listed Auth Required Unlisted code and no HCPCS/NDC-require notes to pay Neurostimulator Services “ 43647”, “43648”, “43881”, “43882”, “61531” to “61533”, “63650” to “63688”, “95980” to “95982”, “95999” Auth Required Implants Neurostimulators Deep Brain “01.20”, “01.29”, “02.93”, “86.94” to “86.97” “61885” to “61888”, “64590”, “64595” “L8685”, “L8688” Auth Required Implant External Cardiac Assist Device “37.68” “33975” to “33976”, “33979”, “33981” to “33983” Auth Required deleted code 2010 on Lifespan table Implants Eye “14.79”, “99.29” “67027” J7311 Auth Required Implant Artificial Cornea “11.73” “65770” “C1818”, “L8609” Auth Required Implant Skin Dermagraft Diabetic Ulcers “250.80” to “250.83”, “249.80”, “249.81”, “707.14”, “707.15” “86.67” “15365”, “15366” “Q4106” Auth Required Restricted to CPT codes for foot; Lifespan table includes additional codes. Implants Services “92601”-“92604”, “92640” Notes: