Does 64435 require prior authorization?

No, 64435 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 64435?

Medicare facility rate: $38.75. Non-facility rate: $75.15. Work RVU: 0.73.

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

0.73

Facility

$38.75

Non-Facility

$75.15

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).
Nerve block evaluation and treatment is indicated for chronic pain defined as pain present continuously or intermittently for >= 3 months despite prior therapy.
Diagnostic nerve blocks (including injection of saline or local anesthetic) are indicated to identify the pain-generating nerve, determine nerve type, or distinguish peripheral versus central pain origin and to assess suitability for neurolytic or surgical interventions.
Therapeutic nerve blocks are indicated for painful conditions known to respond to nerve blockade, including sympathetic-mediated syndromes and celiac plexus block for pancreatic cancer pain.
Neurolytic agents or thermal (non-pulsed) radiofrequency may be used when longer-lasting or permanent blockade is clinically indicated.

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

A52725 — Billing and Coding: Nerve Blockade for Treatment of Chronic Pain and Neuropathy

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

L35456 — Nerve Blockade for Treatment of Chronic Pain and Neuropathy

L35457 — Nerve Blockade for Treatment of Chronic Pain and Neuropathy

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