Allowable Covered Procedure Codes

50.4.2 – Allowable Covered Procedure Codes (Rev. 11021; Issued: 10-01-21; Effective: 10-29-21; Implementation: 10-29-21) The following procedure codes may be present: If ICD-10-PCS is applicable: ICD-10-PCS Code Code Description 00H00MZ Insertion of Neurostimulator Lead into Brain, Open Approach 00H03MZ Insertion of Neurostimulator Lead into Brain, Percutaneous Approach 00H04MZ Insertion of Neurostimulator Lead into Brain, Endoscopic Approach 00H60MZ Insertion of Neurostimulator Lead into Cerebral Ventricle, Open Approach 00H63MZ Insertion of Neurostimulator Lead into Cerebral Ventricle, Percutaneous Approach 00H64MZ Insertion of Neurostimulator Lead into Cerebral Ventricle, Percutaneous Endoscopic Approach 00P00MZ Removal of Neurostimulator Lead from Brain, Open Approach 00P03MZ Removal of Neurostimulator Lead from Brain, Percutaneous Approach 00P04MZ Removal of Neurostimulator Lead from Brain, Percutaneous Endoscopic Approach 00P60MZ Removal of Neurostimulator Lead from Cerebral Ventricle, Open Approach 00P63MZ Removal of Neurostimulator Lead from Cerebral Ventricle, Percutaneous Approach 00P64MZ Removal of Neurostimulator Lead from Brain, Open Approach 0H80XZZ Division of Scalp Skin, External Approach 0HSSXZZ Reposition Hair, External Approach Coverage policy may be found in the National Coverage Determinations Manual in Chapter 1, section 160.24: Deep Brain Stimulation, using the following link: (http://www.cms.hhs.gov/manuals/103_cov_determ/ncd103index.asp).