C1823 Neurostimulator (HCPCS) Reimbursement | OpenPayer

Summary & Overview

HCPCS C1823: Implantable Non-Rechargeable Neurostimulator with Transvenous Leads

HCPCS Level II code C1823 identifies an implantable, non-rechargeable neurostimulator generator paired with transvenous sensing and stimulation leads. This code covers devices used to provide targeted neural stimulation via transvenous access for therapeutic neuromodulation. Nationally, such devices are significant for management of select neurologic and cardiac-related conditions where transvenous lead placement is indicated.

Key payers covered in typical coverage analyses include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical context for C1823, typical sites of service, and the kinds of benchmarks and policy considerations that influence coverage and billing for implantable neurostimulator systems. The publication summarizes reimbursement benchmarks, common billing modifiers and claim-line practices, and policy updates that affect coding and payment for transvenous neurostimulation systems. It also outlines clinical considerations relevant to billing, such as device type (non-rechargeable generator) and lead configuration (transvenous sensing and stimulation leads).

Data not available in the input: associated taxonomies, ICD-10 diagnoses, related CPT/HCPCS crosswalks, and specific payer policy details. The content supports national audiences seeking a clear coding and clinical snapshot for HCPCS Level II code C1823.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareC1823HCPCS Level IIneurostimulatorimplantable devicetransvenous leadsdevice implantationneuromodulationoutpatient surgeryreimbursement

Billing Code Overview

HCPCS Level II code C1823 describes an implantable, non-rechargeable neurostimulator generator with transvenous sensing and stimulation leads. This device is used to deliver electrical stimulation via leads placed through the venous system to targeted neural structures.

Service type: Implantation and management of an implanted neurostimulation system with transvenous leads
Typical site of service: Hospital operating room or ambulatory surgical center for implantation; subsequent programming and follow-up may occur in outpatient specialty clinics or device clinics

Clinical & Coding Specifications

Clinical Context

A 62-year-old patient with drug-refractory, symptomatic bradyarrhythmia and documented episodes of syncope is evaluated by a cardiac electrophysiologist. After noninvasive testing and invasive electrophysiology study, the team determines that an implantable, non-rechargeable neurostimulator with transvenous sensing and stimulation leads (C1823) is indicated to provide chronic pacing and sensing therapy via transvenous leads. The typical workflow includes pre-procedure evaluation (history, medication review, informed consent, device and lead selection), perioperative antibiotic prophylaxis, implantation in an electrophysiology lab or hybrid operating room under conscious sedation or monitored anesthesia care, transvenous lead placement via subclavian or cephalic approach, creation of a subcutaneous generator pocket (usually left or right subclavian), intraoperative device interrogation and programming, wound closure, and immediate post-operative device and wound checks. Typical site of service is an ambulatory surgical center or hospital outpatient department; inpatient admission occurs if medical comorbidities require observation or if complications arise. Typical patient scenario modifiers that may apply include AS for anesthesia services, UE for an item furnished by the hospital to its outpatient, and NU for a new device. Postoperative care includes device interrogation at discharge and scheduled follow-up in device clinic for programming and remote monitoring enrollment.

Coding Specifications

Modifier	Description	When to Use

HCPCS Level II C1782: Morcellator, Surgical Instrument

HCPCS-C1883-ADAPTER-EXTENSION-PACING-NEUROSTIMULATOR-LEAD-IMPLANTABLE

HCPCS Level II C1883: Adapter/Extension for Pacing or Neurostimulator Lead

HCPCS-C9250-HUMAN-PLASMA-FIBRIN-SEALANT-ARTISS-2ML

HCPCS C9250: Human Plasma Fibrin Sealant (Artiss), 2 ml

HCPCS-C9049-TAGRAXOFUSP-ERZS-10-MCG-INJECTION

HCPCS C9049: Injection, tagraxofusp-erzs, 10 mcg

HCPCS-C9484-ETEPLIRSEN-INJECTION-10MG

HCPCS C9484: Injection, eteplirsen, 10 mg

HCPCS-C2642-CESIUM-131-BRACHYTHERAPY-SOURCE-STRANDED

HCPCS C2642: Brachytherapy Source, Cesium-131, Stranded

HCPCS-C9792-LEFT-ATRIAL-TO-CORONARY-SINUS-SHUNT-TRANSCATHETER-IMPLANTATION

HCPCS Level II C9792: Transcatheter Left Atrial to Coronary Sinus Shunt Implantation

HCPCS-C9133-FACTOR-IX-RIXUBIS-RECOMBINANT-PER-IU

HCPCS C9133: Factor IX (rixubis), recombinant, per I.U.

HCPCS-C7538-LEFT-VENTRICULAR-PACING-LEAD-PLACEMENT-WITH-GENERATOR-INSERTION

HCPCS C7538: LV Pacing Lead Placement During Pacemaker/ICD Generator Insertion

HCPCS-C7504-PERCUTANEOUS-VERTEBROPLASTY-CERVICOTHORACIC-LUMBOSACRAL

HCPCS C7504: Percutaneous Vertebroplasty, Cervicothoracic/Lumbosacral

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Taxonomy Code	Specialty	Notes
207RP0000X	Cardiac Electrophysiology	Electrophysiologists perform device implantation and programming.
207RC0000X	Cardiovascular Disease	Interventional cardiologists and cardiologists commonly participate in device implantation.
208D00000X	General Surgery	Surgeons may perform device placement in complex anatomical or infectious scenarios.
363L00000X	Anesthesiology	Provides monitored anesthesia care or general anesthesia during implantation when indicated.
174400000X	Physician Assistant	PAs assist in perioperative and intraoperative management and may assist at surgery where permitted.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`I49.5`	Sick sinus syndrome	Common indication for implantation of an implantable generator with transvenous sensing and stimulation leads to treat symptomatic bradyarrhythmia.
`I44.0`	Atrioventricular block, first degree	May coexist with symptomatic conduction disease prompting device therapy planning and monitoring.
`I44.1`	Atrioventricular block, second degree	High-grade second-degree AV block can be an indication for permanent pacing with transvenous leads.
`I44.2`	Atrioventricular block, complete	Complete heart block is a primary indication for implantation of a permanent pacing generator with transvenous leads.
`R55`	Syncope and collapse	Recurrent syncope due to bradyarrhythmias is a common clinical presentation leading to implantation of such devices.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`33207`	Insertion or replacement of permanent pacemaker with transvenous electrodes; single lead	May be used when a single-lead transvenous pacing system is implanted prior to or instead of a multilead neurostimulator; relevant for lead count and technique comparison.
`33208`	Insertion or replacement of permanent pacemaker with transvenous electrodes; two leads	Relevant when the implanted system uses dual transvenous leads for sensing and stimulation.
`33213`	Insertion of leadless pacemaker (transcatheter)	Provided for context as an alternative pacing approach; not directly used with `C1823` but part of the differential device options.
`33233`	Insertion or replacement of permanent pacemaker generator only	Used when only the generator is replaced without lead revision; applies to future generator replacement events for devices like `C1823`.
`93288`	Programming device evaluation (in-office) with iterative adjustments	Used for device interrogation and reprogramming in clinic after implantation of an implantable generator with transvenous leads.

`NU`	New equipment	Use when the implanted generator is a new, initial device (first-time implant of this model).
`UE`	Item furnished by the hospital as outpatient	Use when hospital-owned device is supplied to an outpatient during a facility encounter.
`AS`	Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery	Use when an assistant at surgery from non-physician provider taxonomies participates under appropriate state law.
`62`	Two surgeons	Use when two surgeons of different specialties share the operative procedure as defined by payer policy.
`22`	Increased procedural services	Use when work required is substantially greater than typical (document justification).
`52`	Reduced services	Use when the service performed was partially reduced or eliminated at physician direction.
`53`	Discontinued procedure	Use when procedure is started but discontinued due to extenuating circumstances.
`56`	Pre-admission testing	Use when separate pre-admission testing service is performed and billed separately as allowed.
`CQ`	Service furnished under an outpatient kidney dialysis center renal dialysis service	Use only when applicable CMS policy permits; rarely applicable to this implantable device.
`QX`	CRNA service with physician absence	Use when a certified registered nurse anesthetist provides anesthesia without medical direction and billing CRNA separately is permitted.

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