Baroreflex Stimulation Devices
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This clinical policy covers the use and coverage determination for implanted baroreflex stimulation (baroreflex activation therapy) devices for all clinical applications for Blue Cross Blue Shield of North Carolina members and providers.
When Not Covered section updated to remove examples of hypertension and heart failure and now reads: 'Baroreflex stimulation devices are considered investigational for all applications.'
Billing/Coding section updated effective 1/1/26: codes 0266T-0273T deleted; codes 64654-64659 and 93145-93146 added.
Coverage Determination
Not Covered / Investigational
Covered when ALL of the following are met:
BCBSNC does not provide coverage for investigational services or procedures.
There are no covered indications for baroreflex stimulation devices under this policy. The policy explicitly lists the section "When Baroreflex Stimulation Devices are covered" as Not Applicable, indicating that BCBSNC does not recognize any condition or clinical scenario for which these devices are an approved benefit.
Baroreflex stimulation devices are not covered because they are considered investigational for all applications. As stated in the policy, BCBSNC does not provide coverage for investigational services or procedures, and requests for these devices will be denied on that basis.
Billing and Coding
| 64654 | Percutaneous implantation of peripheral neurostimulator electrode array; autonomic (e.g., carotid sinus) |
| 64655 | Percutaneous implantation of peripheral neurostimulator electrode array; autonomic (alternate code listed) |
| 64656 | Percutaneous implantation of peripheral neurostimulator, each additional lead |
| 64657 | Open surgical implantation of neurostimulator electrode array; autonomic (e.g., carotid sinus) |
| 64658 | Open surgical implantation of neurostimulator, each additional lead |
| 64659 | Revision or removal of neurostimulator electrode array |
| 93145 | Physician interpretation and report of arrhythmia monitoring |
| 93146 | Interpretation and report of external electrocardiographic recording |
| 0266T | Deleted effective 1/1/26 |
| 0267T | Deleted effective 1/1/26 |
| 0268T | Deleted effective 1/1/26 |
| 0269T | Deleted effective 1/1/26 |
| 0270T | Deleted effective 1/1/26 |
| 0271T | Deleted effective 1/1/26 |
| 0272T | Deleted effective 1/1/26 |
| 0273T | Deleted effective 1/1/26 |
Provider Requirements and Actions
Prior authorization / coding applicability
Inclusion of the listed procedure codes in the Billing/Coding section indicates these services may be subject to review; BCBSNC may require medical records to determine medical necessity for claims involving these codes.
Prior authorization
This policy's prior authorization section does not specify any separate prior authorization requirements for baroreflex stimulation devices.
Provide complete medical records when requested
When medical records are requested for these services, BCBSNC states that letters of support or explanation may be useful but are not sufficient unless they include all specific information needed to make a medical necessity determination.
- BCBSNC may request medical records for determination of medical necessity.
- Letters of support/explanation alone are not sufficient unless they contain all specific required information.
Step therapy
No step therapy requirements are specified in this policy for baroreflex stimulation devices.
Records may be requested
BCBSNC may request medical records to determine medical necessity; provide full clinical documentation when requested because partial documentation or letters alone may be insufficient.
- Include all specific clinical information requested to support a medical necessity determination.
Administrative resource links
The policy provides links to administrative resources — technical information, privacy policy, terms of use, and fraud & abuse — which may be relevant for billing, compliance, and other administrative tasks.
- Technical Information
- Privacy Policy
- Terms of Use
- Fraud & Abuse
Denial for investigational status
Requests for coverage of baroreflex stimulation devices will be denied because the devices are considered investigational for all applications.
- Policy statement: 'Baroreflex stimulation devices are considered investigational for all applications. BCBSNC does not provide coverage for investigational services or procedures.'
Provider action summary
The reviewed sections do not identify any specific denial triggers or prior authorization requirements beyond the investigational policy stance and standard documentation requests.
- No additional prior authorization requirements specified in the policy text.
- Denial risk is driven by investigational status rather than listed clinical triggers.
Clinical Background
Baroreceptors are pressure-sensitive sensors located in the walls of the carotid sinuses and aortic arch that detect changes in arterial stretch. Activation of these sensors modulates autonomic output via the baroreflex pathway: increased baroreceptor signaling produces parasympathetic activation and sympathetic inhibition, which together lower heart rate and blood pressure. Implanted baroreflex stimulation devices apply electrical stimulation to the carotid sinus baroreceptors (also described as baroreflex activation therapy) to engage this reflex and reduce sympathetic tone; the therapy has been studied as an alternative for treatment-resistant hypertension and as a potential therapy for certain patients with heart failure.
Definitions
Policy Revision History
Billing/Coding section updated: deleted CPT Category III codes 0266T–0273T and added codes 64654–64659 and 93145–93146, effective January 1, 2026.
When Not Covered section was revised to remove example indications and now states: 'Baroreflex stimulation devices are considered investigational for all applications.'
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