Does 64450 require prior authorization?

No, 64450 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 64450?

Medicare facility rate: $38.41. Non-facility rate: $80.83. Work RVU: 0.73.

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

0.73

Facility

$38.41

Non-Facility

$80.83

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.
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.

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.
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.
CPT 64450 is appropriate when a qualified health care professional performs a direct injection (nerve block) of an anesthetic agent and/or steroid into a peripheral nerve for treatment of peripheral neuropathy.
Code 64450 addresses the additional work of performing a nerve block (direct peripheral nerve injection) rather than injections into surrounding subcutaneous tissue.
Peripheral nerve blocks (local anesthesia with or without corticosteroids) and denervation procedures are covered for chronic non-cancer pain when reasonable and necessary per LCD DL40265.

A57589 — Billing and Coding: Nerve Blocks for Peripheral Neuropathy

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L35222 — Nerve Blocks for Peripheral Neuropathy

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L40299 — Peripheral Nerve Blocks and Procedures for Chronic Pain

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

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