Summary & Overview
CPT 64582: Hypoglossal Nerve Neurostimulator Implantation
CPT code 64582 covers open surgical implantation of a hypoglossal nerve neurostimulator electrode array with implantation of a programmable pulse generator and one or more distal respiratory sensor electrodes. This implantable neurostimulation system is used to manage obstructive sleep apnea by restoring or maintaining airway patency through targeted tongue muscle activation. The procedure is clinically significant as an alternative for patients who are intolerant of or unresponsive to positive airway pressure therapy, and it has implications for surgical, anesthesia, and device coverage policies across payers.
Key payers considered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise review of the clinical purpose and typical care setting for the procedure, plus national-level payer coverage considerations, common modifier usage, and benchmarking context where available. The publication outlines typical sites of service, service type, and the core clinical rationale, and it flags areas where data were not provided in the input. Intended audiences include billing and coding professionals, surgical and sleep medicine clinicians, and payer policy analysts seeking an authoritative, national-level summary of the code and its clinical use.
Billing Code Overview
CPT code 64582 describes an open surgical implantation of a hypoglossal nerve neurostimulator electrode array with placement of a programmable pulse generator and one or more distal respiratory sensor electrodes. The procedure targets the hypoglossal nerve, which innervates the tongue, as a treatment for sleep-disordered breathing such as obstructive sleep apnea.
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Service type: Implantation of neurostimulator system for hypoglossal nerve stimulation
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Typical site of service: Operating room or ambulatory surgery center (inpatient or outpatient surgical setting depending on clinical factors and payer rules)
Data not available in the input for associated taxonomies, ICD-10 diagnoses, and related procedure codes.
Clinical & Coding Specifications
Clinical Context
A 58-year-old male with moderate-to-severe obstructive sleep apnea (OSA) who is intolerant of positive airway pressure therapy presents for surgical implantation of a hypoglossal nerve neurostimulator system. The patient has failed conservative therapy including CPAP due to discomfort and poor adherence and continues to have daytime somnolence, witnessed apneas, and an Apnea–Hypopnea Index (AHI) consistent with device indications. Preoperative evaluation includes sleep medicine consultation, overnight polysomnography, head and neck examination to confirm absence of complete concentric collapse at the velopharynx (if required by device criteria), and anesthesia assessment.
The surgical workflow begins in an ambulatory surgery center or hospital operating room. Under general anesthesia with endotracheal intubation, the surgeon makes a submandibular or upper neck incision to expose the hypoglossal nerve and implant an electrode array via an open approach. A separate subcutaneous pocket is created—typically in the chest or subclavicular region—to implant a programmable pulse generator. Distal respiratory sensor electrodes are tunneled and placed to detect breathing effort. Intraoperative neurostimulation testing may be performed to confirm appropriate tongue stimulation and electrode placement. Hemostasis is achieved, incisions are closed, and the patient is recovered with monitoring for airway compromise and device function. Postoperative care includes device programming by a sleep medicine or device representative, wound care, pain control, and follow-up sleep testing or titration studies as indicated.
Coding Specifications
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