CPT 0165T Reimbursement & Benchmarks | OpenPayer

Summary & Overview

CPT 0165T: Revision and Replacement of Lumbar Artificial Disc (Add-On)

CPT code 0165T denotes an add-on surgical procedure for revision and replacement of a lumbar artificial disc in a different interspace performed during the same operative session as an initial lumbar artificial disc repair. This code captures care for patients who experience device movement or damage requiring replacement of an arthroplasty device and is relevant to spine surgeons, hospitals, ambulatory surgery centers, and payers overseeing coverage for lumbar total disc arthroplasty. Nationally, lumbar disc arthroplasty revisions are clinically significant due to device-specific indications, increased resource use, and surgical complexity.

Key payers included in the coverage landscape are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the clinical scenario and service type, typical sites of service, and which payers are commonly involved. The publication provides benchmarking context, policy and coding considerations, and the clinical background necessary to understand when CPT code 0165T applies. Data not available in the input is noted where applicable. The summary equips payers, coding professionals, and clinical leaders with a focused overview of this add-on lumbar arthroplasty revision code and what to expect in billing and utilization discussions.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare0165TCPTlumbar-arthroplastyspine-surgeryadd-on-proceduredisc-revisiontotal-disc-arthroplastyorthopedic-surgery

Billing Code Overview

CPT code 0165T is an add-on procedure describing revision and replacement of an existing lumbar artificial disc in a different lumbar interspace during the same operative session as an initial lumbar artificial disc repair. The procedure addresses movement or damage of an arthroplasty device and involves replacing a lumbar intervertebral disc with an artificial disc (total disc arthroplasty) to treat conditions such as degenerative disc disease or trauma-related disc damage.

Service type: Surgical revision and replacement of lumbar total disc arthroplasty (add-on procedure)
Typical site of service: Hospital inpatient or outpatient surgical setting, or ambulatory surgery center, depending on clinical complexity and payer site rules

Clinical & Coding Specifications

Clinical Context

A 55-year-old patient with a prior lumbar total disc arthroplasty presents with new onset mechanical low back pain and recurrent radicular symptoms several years after the index procedure. Imaging (plain radiographs and CT) demonstrates malposition and component wear of the previously implanted lumbar artificial disc at L4–5 and additional migration/damage to an adjacent implanted disc at L5–S1 during the same anesthesia session. The spine surgeon plans an operative revision: perform a primary revision and replacement of the symptomatic device at L4–5 followed by revision and replacement of the adjacent lumbar artificial disc at L5–S1 during the same operative session. The procedure coded with 0165T is the add-on service describing revision and replacement of the second lumbar artificial disc in another interspace during the same session.

Preoperative workflow includes focused history and physical, updated imaging review (flexion-extension radiographs, CT to assess component position and bone loss), anesthesia evaluation, and informed consent discussing risks of revision arthroplasty vs. fusion. Intraoperative workflow includes removal of the failed components, inspection of endplates and bone quality, implantation of revised artificial discs as indicated, fluoroscopic confirmation of placement, and layered closure. Postoperative workflow includes recovery monitoring, pain control, early mobilization, wound checks, and outpatient follow-up with activity restrictions and radiographic surveillance.

Coding Specifications

Modifier	Description	When to Use

CPT 0215T: Ultrasound-Guided Cervical/Thoracic Paravertebral Facet Joint Injection

CPT-0109T-HEAT-PAIN-SENSORY-THRESHOLD-TESTING-EXTREMITY

CPT 0109T: Heat Pain Sensory Threshold Testing, Extremity

CPT-0110T-SENSORY-THRESHOLD-TESTING-EXTREMITY

CPT 0110T: Sensation and Pain Threshold Testing of an Extremity

CPT-0513T-ADDITIONAL-SKIN-WOUND-SHOCK-WAVE-THERAPY

CPT 0513T: Shock Wave Therapy for Additional Skin Wound

CPT-0207T-THERMAL-PRESSURE-TREATMENT-MEIBOMIAN-GLAND-DYSFUNCTION-DRY-EYE

CPT 0207T: Thermal and Pressure Treatment for Meibomian Gland Dysfunction

CPT-0071T-MRGFUS-UTERINE-FIBROID-ABLATION

CPT 0071T: MRgFUS Ablation of Uterine Leiomyomata ≤200 cc

CPT-0175T-CHEST-RADIOGRAPH-COMPUTER-AIDED-DETECTION

CPT 0175T: Computer-Aided Detection for Chest Radiographs

CPT-0200T-SACRAL-AUGMENTATION-VERTEBRAL-AUGMENTATION

CPT 0200T: Sacral Augmentation for Fractured Sacrum

CPT-0164T-LUMBAR-DISC-ARTHROPLASTY-ADD-ON-ADDITIONAL-DISC-REMOVAL

CPT 0164T: Lumbar Total Disc Arthroplasty, Add-On Removal of Additional Disc

CPT-0671T-ANTERIOR-SEGMENT-DRAINAGE-DEVICE-INSERTION

CPT 0671T: Insertion of Anterior Segment Drainage Device(s)

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Taxonomy Code	Specialty	Notes
`208W00000X`	Orthopaedic Spine Surgery	Primary specialty for lumbar disc arthroplasty and revisions.
`2084P0800X`	Neurological Surgery	Performs complex spine salvage and revision arthroplasty in some centers.
`208000000X`	Orthopaedic Surgery	General orthopaedic surgeons with spine fellowship training who perform lumbar arthroplasty.
`207L00000X`	Pain Medicine	May be involved preoperatively for diagnostic injections and postoperative pain management.
`207K00000X`	Anesthesiology	Provides perioperative anesthesia care for complex spine revisions.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`M51.36`	Other intervertebral disc degeneration, lumbar region	Degenerative disc disease is a common indication for lumbar disc arthroplasty and for subsequent revision when device movement/damage occurs.
`M51.37`	Other intervertebral disc degeneration, lumbosacral region	Degeneration at the lumbosacral level can necessitate arthroplasty and later revision in adjacent interspaces.
`S39.012A`	Dislocation of lumbar intervertebral disc, initial encounter	Traumatic damage or migration of an artificial disc component may be documented under trauma-related codes when applicable.
`T84.09XA`	Other mechanical complication of internal orthopaedic device, implant and graft, initial encounter	Used to report device movement, wear, or mechanical failure of the artificial disc leading to revision.
`M50.20`	Other cervical disc displacement, unspecified cervical region	Data not clinically relevant to lumbar procedures; included only when cervical-lumbar multi-region pathology is present — otherwise not typically used.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`0165T`	Revision and replacement of another artificial disc in another lumbar interspace at the same operative session as an initial lumbar artificial disc repair (add-on)	This is the add-on code describing the additional lumbar disc revision performed in the same operative session; billed in conjunction with the primary revision code.
`22859`	Total disc arthroplasty (artificial disc), lumbar, with insertion of prosthesis, single interspace; including discectomy with endplate preparation	Often used for primary lumbar total disc arthroplasty at a single level; the primary device insertion component in a non-revision setting.
`22860`	Revision or removal and replacement of total disc prosthesis, lumbar, single interspace	Represents the primary revision/replacement procedure for an index level; used for the initial revision in the operative session with `0165T` appended for the additional level.
`22864`	Insertion of posterior/anterior instrumentation (when applicable)	May be performed if intraoperative assessment requires supplemental fixation or conversion to fusion during revision.
`72020`	Radiologic examination, spine, postoperative; limited	Used for immediate postoperative radiographs to document prosthesis position and hardware status.

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