Summary & Overview

CPT 64584: Hypoglossal Nerve Neurostimulator Removal

CPT code 64584 covers surgical removal of a hypoglossal nerve neurostimulator system, including the electrode array, pulse generator, and distal respiratory sensor electrode or array. This procedure is clinically significant because hypoglossal nerve stimulation is an established surgical therapy for obstructive sleep apnea; removal procedures are necessary for device complications, battery depletion, device upgrades, or infection management. Nationally, accurate coding for explantation affects surgical quality reporting, device management workflows, and payment integrity.

Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context, expected sites of service, and common billing considerations tied to this service type. The publication provides benchmarks where available, notes on payer coverage patterns, and explanations of clinical scenarios that typically generate use of this code. It highlights operational implications for ambulatory surgical centers and hospital operating rooms handling device removal, and summarizes documentation elements that commonly support medical necessity for explantation.

Data not available in the input for associated taxonomies, specific ICD-10 diagnoses, related codes, and payer-specific policy language.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare64584CPThypoglossal-nerveneurostimulatordevice-explantationsleep-apneasurgical-procedureambulatory-surgery

Billing Code Overview

CPT code 64584 describes the removal of a hypoglossal nerve neurostimulator system, including the electrode array, pulse generator, and a distal respiratory sensor electrode or electrode array. The hypoglossal nerve innervates the tongue, and the device may have been implanted to treat obstructive sleep apnea by stimulating tongue musculature to maintain an open airway.

Service type: Removal of an implanted neurostimulator system for the hypoglossal nerve
Typical site of service: Operating room or ambulatory surgical center where implantable pulse generator and electrode explantation procedures are performed

Clinical & Coding Specifications

Clinical Context

A 58-year-old patient with a previously implanted hypoglossal nerve stimulation system for obstructive sleep apnea presents for elective removal of the device due to infection of the pulse generator pocket and recurrent device-related pain. The procedure includes explantation of the pulse generator, removal of the hypoglossal nerve electrode array and any distal respiratory sensor electrode or array. Preoperative workflow includes device interrogation, imaging as needed to localize leads, informed consent discussing risks of neural injury, and perioperative antibiotics. Intraoperative workflow involves general anesthesia or monitored anesthesia care, surgical exposure of the generator pocket, careful dissection and mobilization of lead sleeves, removal of the electrode array from the hypoglossal nerve with neurosurgical technique to minimize nerve trauma, and removal of the distal respiratory sensor if present. Postoperative care includes wound monitoring, pain control, instructions for infection management, and device return or disposal documentation. Typical site of service is an inpatient or outpatient operating room at a hospital or ambulatory surgical center depending on clinical status and payer requirements.

Coding Specifications

Modifier	Description	When to Use
`11`	Provider's default billing indicator (standard service)	Use when procedure is performed as planned without unusual circumstances.
`22`	Increased procedural services	Use when extensive additional work beyond typical removal is required (eg, extensive scar tissue, prolonged operative time).
`23`	Unusual anesthesia	Use if general anesthesia is required for a procedure typically done with local/regional anesthesia.
`52`	Reduced services	Use when the procedure is partially performed or limited in extent.
`53`	Discontinued procedure	Use when procedure is stopped due to extenuating circumstances or patient safety.
`62`	Two surgeons	Use when two surgeons from different specialties are required for concurrent equal work (eg, otolaryngology and neurosurgery).
`63`	Procedure performed on infants less than 4 kg	Rarely applicable; use if patient meets weight criteria.
`78`	Unplanned return to the operating room for a related procedure during the global period	Use if an immediate reoperation is required for a complication related to the explant.
`79`	(Not in provided list)	Data not available in the input.
`80`	Assistant surgeon present	Use when an assistant surgeon is documented and required.
`81`	Minimum assistant surgeon	Use when assistant involvement is limited but documented.
`82`	Assistant surgeon when qualified resident not available	Use when no resident is available and an assistant is needed.
`AS`	Physician assistant, nurse practitioner, or clinical nurse specialist-supply	Use when an advanced practice clinician bills under their own NPI where applicable.
`QX`	Service performed by a certified nurse-midwife; CNM	Use if a certified midlevel clinician with this modifier provides billable services applicable to the payer (rare for this procedure).

Taxonomy Code	Specialty	Notes
207RH0000X	Otolaryngology (ENT)	Primary specialty that commonly performs hypoglossal nerve device implantation and explantation.
2084P0800X	Oral and Maxillofacial Surgery	May be involved when device leads traverse submandibular areas or for complex surgical exposure.
208D00000X	Neurological Surgery	Involved when nerve dissection or nerve-related complications require neurosurgical expertise.
207K00000X	Sleep Medicine	May be involved in preoperative device management and postoperative sleep disorder follow-up.
363A00000X	Physician Assistant	May assist in perioperative management and intraoperative assistance under supervision.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`G47.33`	Obstructive sleep apnea (adult) (pediatric)	Primary indication for hypoglossal nerve stimulation and for which explantation may be performed if device fails or is complicated.
`T85.698A`	Other mechanical complication of other internal prosthetic device, initial encounter	Used when the device malfunctions or mechanical issues prompt removal.
`T86.890`	Other complications of transplanted organ and tissue, not elsewhere classified	Rarely used; may apply when device-related tissue complications occur.
`L02.91`	Cutaneous abscess, unspecified site	Represents localized infection that can necessitate explantation of the generator pocket.
`T81.4XXA`	Infection following a procedure, initial encounter	Used when postoperative or device-related infection is the reason for removal.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`64585`	Revision or removal of peripheral neurostimulator electrode array, other than sacral, peripheral N.S.	May be used if an alternate or additional peripheral neurostimulator electrode array is removed in the same operative session.
`64590`	Revision or removal of peripheral neurostimulator pulse generator or receiver, direct or inductive coupling	Use when an alternative peripheral pulse generator is explanted; relates to removal of the pulse generator component.
`61880`	Excision or revision of spinal neurostimulator electrode array or pulse generator pocket	Relevant when techniques for device pocket revision or complex explantation overlap with neurostimulator hardware removal practices.
`15734`	Muscle, myocutaneous, or fasciocutaneous flap with microvascular anastomosis for reconstruction	May be applicable if wound coverage or complex reconstruction is required after explantation due to infection or soft-tissue loss.
`99284`	Emergency department visit, moderate complexity	Common preoperative encounter code if patient presents urgently for device infection or complications prior to scheduled explantation.