Urgent® PC
Claim Submission

Step 1: Contact your payer
Note: Depending on the carrier/payer the process may vary. Contact your carrier/payer to determine exact process.

• Determine preferred CPT® code - 64999 or 64555
  
  The American Urological Association (AUA) and the American Medical Association (AMA) recommend 64999 - unlisted procedure, nervous system as the most appropriate code for reporting PTNS. Some payers still recommend the use of 64555 – implantation of neurostimulator electrode.
• Determine payer's preferred process for submitting a claim using an unlisted code.
• If PTNS was previously submitted under CPT® code 64555, educate the payer that this is the same procedure now being submitted under CPT® code 64999 and you would expect the same payment.
• Determine if claim can be filed electronically or manually. Claims for an unlisted code may be filed electronically or manually depending on the payer's preference.

Step 2: File Urgent® PC initial claim

• Manual: For CPT® code 64999, complete CMS 1500 claim form with PTNS in comments box, line #19.
• Electronic: Depending on the claims submission software the provider is using, 64999 may be added in a specific field. Contact your carrier/payer to determine specific field.

Step 3: Claim Approval or Denial

• Payer's approval via electronic or written response
• If the claim is denied, you and your patient have the right to appeal.
• Tools are available to support you in the appeals process. To learn more, visit the Denials and Appeals page