Summary & Overview
CPT 64658: Removal of Lead from Baroreflex Activation Therapy System
CPT code 64658 identifies the surgical removal of a single lead from a baroreflex activation therapy (BAT) system. This narrowly scoped procedure is used when only the lead component requires explantation — for example, due to lead malfunction, infection localized to the lead, or device revision plans that preserve other system elements. Nationally, accurate use of this code matters for procedural classification, claims accuracy, and monitoring utilization of neuromodulation therapies for cardiovascular and autonomic indications.
Key payers considered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for the procedure, billing and coding considerations, and comparisons to related procedural codes where applicable. The publication offers benchmarks on typical settings of care, common reasons the lead-only removal is performed, and how payers commonly position coverage for BAT device management. Policy updates and payer guidance summaries are provided to clarify documentation and coding best practices for accurate billing.
This summary is intended for clinicians, coding professionals, and policy analysts seeking a focused reference on CPT code 64658, its clinical role, and the payer landscape affecting billing and coverage decisions at a national level.
Billing Code Overview
CPT code 64658 describes the removal of a single lead from a baroreflex activation therapy (BAT) system. This procedure involves explanting only the lead component of an implanted BAT device while leaving other system components in place.
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Service type: Lead removal procedure for an implanted neuromodulation device
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Typical site of service: Outpatient operating room or ambulatory surgery center
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Clinical & Coding Specifications
Clinical Context
A typical patient is an adult with an implanted baroreflex activation therapy (BAT) system who presents for targeted removal of the BAT lead due to lead malfunction, lead infection limited to the lead, lead displacement, or pain at the lead site. The patient has a history of resistant hypertension or heart failure for which BAT was previously implanted. Pre-procedure workflow includes clinical evaluation, review of device interrogation reports, imaging if lead position or integrity is in question, medication reconciliation, and informed consent focused on lead removal risks and possible need for full system explantation. On the day of service, the patient undergoes local or general anesthesia based on provider assessment, sterile exposure of the generator pocket and lead tract, isolation and extraction of the lead only while leaving any generator or additional leads intact. Intraoperative monitoring includes hemodynamic surveillance and device interrogation. Post-procedure workflow includes wound care, post-extraction device check if generator remains, observation for bleeding or infection, documentation of procedure details including reason for lead removal and whether complete or partial removal was achieved, and planning for re-implantation or alternative therapy if indicated. Typical sites of service are the hospital operating room, ambulatory surgery center, or interventional suite depending on patient comorbidity and institutional practice.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when work required is substantially greater than typical for the procedure. |