HealthCare News

Billing BCBSND for the SphenoCath® Device

Issue: #398 DEC2017

Topic: Coding/Billing


This article is to provide guidance to providers when billing Blue Cross Blue Shield of North Dakota (BCBSND) for a procedure using a SphenoCath® device.

Definition:

A SphenoCath® device is a patented soft, easy-to-use catheter designed to enable practitioners to quickly, easily, and consistently deliver medication to the pterygopalatine fossa and sphenopalatine fossa. The device is used to deliver 1.5-2.0cc of anesthetic and is used in the treatment of migraine headaches and other primary headache syndromes.

Guidelines:

  • Current CPT® Coding guidelines indicate that CPT® Code 64999 should be used.
  • When billing for this service, providers will be required to indicate in the “Remarks” section of either the CMS-1500 or the UB04 that the bill being submitted is for a SphenoCath® procedure.
  • As 64999 is an unlisted procedure and is profiled “By Report” in the system, the amount paid to the provider will be in line with our By Report payment policy. For purposes of determining payment on 64999 when billed for a SphenoCath® procedure, CPT®Code 64505 will be used.