Does 64405 require prior authorization?

No, 64405 does not require prior authorization (low confidence). No active coverage policies found for this code.

What is the Medicare reimbursement rate for 64405?

Medicare facility rate: $46.09. Non-facility rate: $78.83. Work RVU: 0.92.

HCPCS/CPT

No Prior Auth Required

No active coverage policies found for this code (low confidence)

Work RVU

0.92

Facility

$46.09

Non-Facility

$78.83

The performing provider must maintain medical record documentation that clearly supports the medical necessity of the billed service and include that documentation in the patient's record for review upon request.
Documentation should state whether the block was diagnostic or therapeutic, include pre- and post-procedure evaluations, and document patient education and the assessment of procedural outcome.
Documentation must support coverage criteria in the LCD 'Indications and Limitations of Coverage and/or Medical Necessity' section and the provider should document why services cannot be rendered by the surgeon when applicable.
For services requiring a referring/ordering physician, the referring/ordering physician's name and NPI must be reported on the claim.

CPT codes 64400-64530 for peripheral nerve blocks may be reported on the date of surgery when performed for postoperative pain management only if the operative anesthesia is general anesthesia, subarachnoid injection, or epidural injection and the adequacy of intraoperative anesthesia is not dependent on the peripheral nerve block.
Peripheral nerve block services that are separate, medically necessary services which cannot be rendered by the surgeon may be reported if the surgeon documents the reason for referral and the additional services are justified in the medical record.
Peripheral nerve blocks (PNBs) using local anesthesia with or without corticosteroids and denervation procedures for chronic pain are covered when they meet the reasonable and necessary criteria in LCD DL40263.
PNBs and radiofrequency neurolysis are covered for refractory trigeminal neuralgia.
PNBs and steroid injections are covered for carpal tunnel syndrome (CTS) when medically necessary.
PNBs and steroid injections are covered for Morton's neuroma when medically necessary.

A60321 — Billing and Coding: Peripheral Nerve Blocks and Procedures for Chronic Pain

J05

L40299 — Peripheral Nerve Blocks and Procedures for Chronic Pain

J05

A57452 — Billing and Coding: Peripheral Nerve Blocks

J06

L36850 — Peripheral Nerve Blocks

J06

L40266

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