In October 2020, the CPT Editorial Panel replaced three CPT Category III codes with three new CPT Category I codes to report the open implantation, revision or replacement, and removal of a hypoglossal nerve stimulator array. In addition, the CPT Editorial Panel made editorial revisions to CPT codes 64568, 64569, 64570, 64575, 64580, and 64581.
Effective January 1, 2026, payment of CPT 64568 will change when billed in an ambulatory surgery center (ASC). This payment change applies to ASC facility reimbursement only and does not affect professional fee billing or hospital inpatient claims. The calendar year 2026 Hospital Outpatient Prospective Payment System and Ambulatory Surgery Center (HOPPS/ASC) final rule assigned CPT 64568 to New Technology Ambulatory Payment Classification (APC) 1580. Your ASC may direct you to use either 64568 or 64582 based on payer requirements and contracts; you should check with your organization for specific coding guidance. The Academy does not provide specific coding guidance, and the Academy’s coding resources are not meant to serve as the definitive or sole authority on billing and coding issues. In practice, payer policy and contractual requirements may supersede CPT code specificity when determining whether 64568 or 64582 is required.
CMS outlines the options for coding implantation, revision, replacement, and removal of hypoglossal nerve stimulators—including the usage of modifier 52—in its current Local Coverage Determination (LCD) and related LCD reference article for hypoglossal nerve stimulation. When appending modifier -52, documentation should reflect reduced physician work and procedural complexity, not solely differences in implanted hardware. In addition, because LCDs are MAC-specific, providers should confirm that the cited coverage criteria apply to their geographic jurisdiction.
The AAO-HNS acknowledges the need for further updates to these codes as technology advances, and the Academy continues to actively participate in discussions with CMS and other relevant stakeholders.
Q: How do I code for the implantation of a hypoglossal nerve stimulation system that includes placement of a chest wall sensor(s) (i.e., a hypoglossal nerve stimulation system that includes two leads: one for stimulation and one for sensing respiratory effort)?
A: CPT 64582 (Open implantation of hypoglossal nerve neurostimulator array, pulse generator, and distal respiratory sensor electrode or electrode array)
This code is valued with a work RVU of 13.65, including 35 minutes of pre-service evaluation time, 20 minutes of pre-service positioning time, 14 minutes of pre-service scrub/dress/wait time, 140 minutes of intra-service time, and 20 minutes of immediate post-service time. The valuation of this code also includes discharge day management (CPT 99238) and two office visits (CPT 99213). Standard 90-day global period direct practice expense inputs apply to CPT 64582.
Additionally, drug-induced sleep endoscopy, or “DISE” (CPT 42975), must be performed to determine candidacy for the hypoglossal nerve stimulator procedure. However, if the physician performs both services, these elective procedures are commonly separated by months, given the realities of scheduling.
Q: How do I code for the revision or replacement of a hypoglossal nerve neurostimulator array and distal respiratory sensor electrode or electrode array, including connection to an existing pulse generator?
A: CPT 64583 (Revision or replacement of hypoglossal nerve neurostimulator array and distal respiratory sensor electrode or electrode array, including connection to an existing pulse generator)
This code is valued with a work RVU of 14.14, including 20 minutes of pre-service positioning time, 14 minutes of pre-service scrub/dress/wait time, 150 minutes of intra-service time, and 20 minutes of immediate post-service time. The valuation of this code also includes discharge day management (CPT 99238) and two office visits (CPT 99213). Standard 90-day global period direct practice expense inputs apply to CPT 64583.
Q: How do I code for the removal of a hypoglossal nerve neurostimulator array, pulse generator, and distal respiratory sensor electrode or electrode array?
A: CPT 64584 (Removal of hypoglossal nerve neurostimulator array, pulse generator, and distal respiratory sensor electrode or electrode array)
This code is valued with a work RVU of 11.70, including 40 minutes of pre-service evaluation time, 15 minutes of pre-service positioning time, 15 minutes of pre-service scrub/dress/wait time, 120 minutes of intra-service time, and 20 minutes of immediate post-service time. The valuation of this code also includes discharge day management (CPT 99238) and two office visits (CPT 99213). Standard 90-day global period direct practice expense inputs apply to CPT 64584.
Q: How do I code for the implantation of a hypoglossal nerve stimulator array and pulse generator (i.e., a one-lead hypoglossal nerve stimulation system that does not include a distal respiratory sensor electrode or electrode array, and instead uses an accelerometer housed within the pulse generator)?
A: CPT rules state that providers should use the code most specific to the service performed. We encourage you to check with your payer to determine coverage of the two codes below:
- CPT 64582 (Open implantation of hypoglossal nerve neurostimulator array, pulse generator, and distal respiratory sensor electrode or electrode array) explicitly references the hypoglossal nerve in the code descriptor, making it the more specific of the two options; however, when using this code, you should append the 52 modifier (Reduced Services) and reflect the decrease in work in your clinical note.
- CPT 64568 (Open implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator) broadly references “cranial nerve.” This code reflects the presence of only one respiratory sensor, which aligns it with certain new technologies. Therefore, CPT 64568 may be preferential for some payers and would also be appropriate.
References:
- Article – Billing and Coding: Hypoglossal Nerve Stimulation for the Treatment of Obstructive Sleep Apnea (A57948)
- LCD – Hypoglossal Nerve Stimulation for the Treatment of Obstructive Sleep Apnea (L38310)
Published October 2014
Revised December 2025
