Does 64425 require prior authorization?

No, 64425 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 64425?

Medicare facility rate: $49.77. Non-facility rate: $120.91. Work RVU: 0.98.

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

0.98

Facility

$49.77

Non-Facility

$120.91

All documentation must be maintained in the patient's medical record, be legible, include appropriate patient identification (e.g., full name, dates of service), and be available to the contractor upon request.
The medical record must identify the physician or non-physician practitioner responsible for and providing the care.
The submitted medical record must support the selected diagnosis code(s) and the submitted CPT/HCPCS code must accurately describe the service performed.
Medical records must be maintained and available upon request; every page must be legible and include patient identification (e.g., full name, dates of service) and identify the physician or non-physician practitioner responsible for care.

Regional or local nerve blocks performed as part of an operative procedure (e.g., adjunct to or sole means of regional/local anesthesia for the procedure) are not affected by this non-coverage policy and may be billed as anesthesia for the operative procedure.
Regional or local nerve blocks performed as an adjunct to, or as the sole means of, regional/local anesthesia for an operative procedure are not affected by this noncoverage policy (i.e., such intraoperative regional/local anesthesia is allowed).
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 are covered when they meet the reasonable and necessary requirements specified in LCD L33933.
Peripheral nerve block is reasonable when the patient's pain appears due to a classic mononeuritis but neuro-diagnostic studies fail to provide a structural explanation.

A57452 — Billing and Coding: Peripheral Nerve Blocks

J06

L36850 — Peripheral Nerve Blocks

J06

A56034 — Billing and Coding: Nerve Blockade for Treatment of Chronic Pain and Neuropathy

AMBETTER-CP.MP.170 — Nerve Blocks and Neurolysis for Pain Management

L33933 — Peripheral Nerve Blocks

Ask Verity about documentation requirements, denial risks, or coverage in your state.