Inspire SleepSync Programming System
Diagnosis Codes
Inspire Hypoglossal Nerve Stimulation (HGNS) therapy is used to treat a subset of patients with moderate to severe Obstructive Sleep Apnea (OSA) (apnea-hypopnea index [AHI] of greater than or equal to 15 and less than or equal to 100).
Diagnosis coding for HGNS implantation may involve the following code
| ICD-10-CM Diagnosis Code | Code Description |
| G47.33* | Obstructive sleep apnea (adult), (pediatric) |
This code includes obstructive sleep apnea-hypopnea.
For Medicare and Medicare Advantage Plans, there is a dual diagnosis requirement. Coverage for hypoglossal nerve stimulation procedures on patients who meet coverage criteria must include both a primary ICD-10-CM diagnosis code indicating the reason for the procedure and a secondary ICD-10-CM diagnosis code indicating the Body Mass Index (BMI) is less than 35 kg/m2 as set forth in the LCD Covered Indications. Commercial Insurance may cover BMI up to 40.
Report a primary diagnosis code of OSA and a secondary diagnosis code from the Group below
| ICD-10-CM Diagnosis Code | Code Description |
| Z68.1 | Body mass index [BMI] 19.9 or less, adult |
| Z68.20 | Body mass index [BMI] 20.0-20.9, adult |
| Z68.21 | Body mass index [BMI] 21.0-21.9, adult |
| Z68.22 | Body mass index [BMI] 22.0-22.9, adult |
| Z68.23 | Body mass index [BMI] 23.0-23.9, adult |
| Z68.24 | Body mass index [BMI] 24.0-24.9, adult |
| Z68.25 | Body mass index [BMI] 25.0-25.9, adult |
| Z68.26 | Body mass index [BMI] 26.0-26.9, adult |
| Z68.27 | Body mass index [BMI] 27.0-27.9, adult |
| Z68.28 | Body mass index [BMI] 28.0-28.9, adult |
| Z68.29 | Body mass index [BMI] 29.0-29.9, adult |
| Z68.30 | Body mass index [BMI] 30.0-30.9, adult |
| Z68.31 | Body mass index [BMI] 31.0-31.9, adult |
| Z68.32 | Body mass index [BMI] 32.0-32.9, adult |
| Z68.33 | Body mass index [BMI] 33.0-33.9, adult |
| Z68.34 | Body mass index [BMI] 34.0-34.9, adult |
Implant Procedure CPT® Procedure Codes
Procedures involving HGNS may involve the following code:
| CPT® Procedure Code | Code Description | Component |
|
64582 |
Open implantation of hypoglossal nerve neurostimulator array, pulse generator, and distal respiratory sensor electrode or electrode array |
Generator, stimulation lead, and breathing sensor lead |
HCPCS II Device Codes
Coding for the HGNS device may involve the HCPCS II codes listed below. Some payors will contract for the device on C-codes while other payors will contract for the device on L-codes. Prior authorization is a good time to check for private payor’s device-coding requirements. CPT® codes are assigned for the HGNS implant procedure. HCPCS II codes are assigned to identify the device itself.
| HCPCS II Code | Code Description |
| C1767 | Generator, neurostimulator (implantable), non-rechargeable |
| C1778 | Lead, neurostimulator (implantable) |
| C1787 | Patient programmer, neurostimulator |
| L8688 | Implantable neurostimulator pulse generator, dual array, non- rechargeable, includes extension |
| L8680 | Implantable neurostimulator electrode, each |
| L8681 | Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only |
CPT Copyright 2024 American Medical Association. All rights reserved. CPT® is a registered trademark of the American Medical Association. Applicable FARS/DFARS Restrictions Apply to Government Use. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.
Disclaimers
Inspire Medical Systems has authorized the completion of this Guide for the benefit of hospitals implanting Inspire HGNS therapy. Readers of this Guide are advised that the contents of this publication are to be used as guidelines and are not to be construed as policies of Inspire Medical Systems. Inspire Medical Systems specifically disclaims liability or responsibility for the results or consequences of any actions taken in reliance on the statements, opinions, or suggestions in this Guide. Inspire Medical Systems makes no representations or warranties concerning the contents of the Guide and disclaims any implied guarantee or warranty of fitness for any particular purpose. Inspire Medical Systems will not be liable to any individual or entity for any losses or damages that may be occasioned by the use of this Guide.
Specifications
- Product Name: Inspire Hypoglossal Nerve Stimulation (HGNS) therapy
- Intended Use: Treat a subset of patients with moderate to severe Obstructive Sleep Apnea (OSA)
- Diagnosis Criteria: AHI of greater than or equal to 15 and less than or equal to 100
Frequently Asked Questions (FAQ)
Q: What are the diagnosis criteria for HGNS implantation?
A: Patients with moderate to severe Obstructive Sleep Apnea (OSA) and an AHI of greater than or equal to 15 and less than or equal to 100 are eligible for HGNS therapy.
Q: Are there specific BMI requirements for insurance coverage?
A: For Medicare plans, BMI should be less than 35 kg/m2, while commercial insurance may cover BMI up to 40.
Documents / Resources
 |
Inspire SleepSync Programming System [pdf] User Guide SleepSync Programming System, SleepSync, Programming System, System |