Urgent® PC
Frequently Asked Questions

Q. Are private insurance companies covering the use of Percutaneous Tibial Nerve Stimulation (PTNS) for treating urinary urgency, urinary frequency and urge incontinence?
A. PTNS using the Urgent PC Neuromodulation System may be covered by insurance companies. As with many therapies, it is recommended that you get a prior-authorization or a pre-determination from the patient's insurance company before treatment. For information on coding and payment, see the Coding & Payment Fact Sheet.

Q. Does Medicare cover PTNS for urinary urgency, urinary frequency and urge incontinence?
A. PTNS may be covered by Medicare on a case by case basis as long as the procedure is "medically necessary." Contact your local Medicare carrier for coding, payment and coverage information.

Q. What is a CPT® code?
A. CPT code is a listing of descriptive terms and identifying numbers for reporting medical services and procedures performed by physicians. CPT is the acronym for Current Procedural Terminology.

Q. What CPT® code should be used to report PTNS?
A. In Spring 2008, the American Urological Association (AUA) and the American Medical Association (AMA) recommended 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. Check with your payer for individual policies.

Q. What's the process for submitting a claim with an unlisted code?
A. The submission process for unlisted codes may vary by payer. The first step is to request more information from your payer about their preferred process. This flow chart provides a brief overview of the process. Additional tools that may be helpful for the unlisted code claim submission process include: Sample CMS 1500 Form and the Procedure Cost Assessment Tool.