Coding for Inspire
Question:
How do we go about coding the new Inspire V that has only a stimulation lead and no sensing lead? Also, how would we code a revision from Inspire IV to Inspire V?
Answer:
The new Inspire V system received FDA approval on August 2, 2024 and is coded using CPT 64568, which describes the open implantation of a cranial nerve neurostimulator and pulse generator. This is appropriate because Inspire V includes only a stimulation lead, unlike Inspire IV, which includes both a stimulation and a sensing lead and is coded as 64582.
For revisions from Inspire IV to Inspire V, the correct code is CPT 61885. This code is used for the replacement of a cranial neurostimulator pulse generator with connection to a single electrode array, which accurately reflects the Inspire V configuration. Other revision codes assume the same device architecture and are not appropriate when transitioning from a dual-lead to a single-lead system. Coders can identify the use of Inspire V in the operative note by the absence of a sensing lead, and by the fact that the procedure does not require dissection through the pectoralis muscle both of which you may see involved in an Inspire IV operative note.
From a reimbursement perspective:
Medicare has revised NCD 160.18 to allow ICD-10 code G47.33 (Obstructive Sleep Apnea) to be billed with CPT 64568. This change was implemented on July 1, 2025, but is retroactively effective to January 1, 2025. Additionally secondary diagnosis requirement of BMI are still required to support medical necessity.
While many commercial payers have adopted this coding alignment, some have not, so it is essential to verify coverage and coding acceptance with each payer individually.
The Centers for Medicare & Medicaid Services (CMS) issued Change Request (CR) 13939, documented in:
*This response is based on the best information available as of 8/14/25.
