Reimbursement Details
Our breathing pacemaker system has full premarket approval from the US FDA for adult and pediatric patients. It is approved for reimbursement under Medicare and is therefore covered for reimbursement by most private and government insurance plans around the world. The equipment is sometimes indexed as a phrenic nerve pacemaker, diaphragm pacemaker, or electrophrenic respiration. A proforma invoice is available upon request.
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Systems are available in a variety of configurations depending on the patient's needs. Additionally, custom components and conversions from other systems are also available. Please contact ABD for an appropriate price quotation. |
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ABD has compiled this coding information for your convenience. It is always the provider's responsibility to determine coverage and submit appropriate codes, modifiers, and charges for the services to be rendered. Please contact the patient's local carrier/payer for interpretation of appropriate coverage and coding policies. |
Medicare Coverage
Phrenic nerve stimulation is covered for reimbursement under Medicare. Almost all state medical assistance programs and most private insurers use the Medicare guidelines to determine coverage. The relevant section of the Medicare National Coverage Determinations Manual reads as follows:
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This document is available for download as a PDF file by clicking here. Adobe Reader is required to view PDF files. |
ICD-9-CM Code
34.85 |
Implantation of a diaphragmatic pacemaker |
Common Diagnosis Codes
V46.11 |
Dependence on Respirator, Status (ICD-10, Z99.11) |
327.24 |
Idiopathic sleep related nonobstructive alveolar hypoventilation (ICD-10, G47.34)) |
327.25 |
Congenital central alveolar hypoventilation syndrome (ICD-10, G47.35) |
344.01 |
C1-C4, Complete quadriplegia (ICD-10, G82.51) |
344.02 |
C1-C4, Partial quadriplegia (ICD-10, G82.52) |
356.8 |
Other specified idiopathic peripheral neuropathy (ICD-10, G60.8) |
519.4 |
Diaphragm paralysis (ICD-10, J98.6) |
748.8 |
Other specified congenital abnormalities of respiratory system (ICD-10, Q34.8) |
MS-DRG Codes
163,164,165 |
Major chest procedures (with MCC, with CC, without CC or MCC) |
907,908,909 |
Other OR procedures for injuries (with MCC, with CC, without CC or MCC) |
957,958,959 |
Extensive OR procedure unrelated to principal diagnosis (with MCC, with CC, without CC or MCC) |
981,982,983 |
Extensive OR procedure unrelated to principal diagnosis (with MCC, with CC, without CC or MCC) |
CPT Codes
64575 |
Incision for implantation of neurostimulator electrode array, peripheral nerve (CMS recommended replacement for Code 64577 which is deleted as of 1/1/2012). Use with HCPCS C1778. |
64590 |
Incision and subcutaneous placement of peripheral neurostimulator pulse generator or receiver, direct or inductive coupling. Use with HCPCS C1767. |
64595 |
Revision or removal of peripheral neurostimulator electrodes. If a revision procedure, use with HCPCS C1778. |
64595 |
Revision or removal of peripheral neurostimulator pulse generator or receiver. Use with HCPCS C1767. |
HCPCS Codes
C1778 |
Lead, neurostimulator (implantable). Use with CPT 64575 or 64585. |
C1816 |
Receiver and/or transmitter, neurostimulator). Use with CPT 64590 or 64595 |
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A summary of commonly billed codes is available for download as a PDF file by clicking here. Adobe Reader is required to view PDF files. |






