Does 64451 require prior authorization?

No, 64451 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 64451?

Medicare facility rate: $72.48. Non-facility rate: $241.49. Work RVU: 1.48.

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

1.48

Facility

$72.48

Non-Facility

$241.49

Maintain a complete, legible medical record for each beneficiary including patient identification, dates of service, and the legible signature of the performing physician or non-physician practitioner.
Procedural report must document indications and medical necessity for the block and record pre- and immediate post-procedure percent (%) pain relief achieved.
Retain films that adequately document final needle position and contrast flow with a minimum of two views and make them available upon request.
The submitted medical record must support the selected ICD-10-CM diagnosis code(s) and the CPT/HCPCS code(s) billed must accurately describe the service performed.

Diagnostic sacroiliac joint injections (SIJI) and sacral nerve blocks (initial diagnostic injections) are covered and should be billed with the KX modifier for the initial diagnostic injection(s).
Therapeutic SIJI or sacral nerve block procedures (unilateral or bilateral) are covered when medically necessary and billed using CPT 27096 and/or 64451 as appropriate.
For ASC facility (specialty 49) and OPPS hospital outpatient department facility claims, use HCPCS G0260 for SIJI facility billing and document fluoroscopic or CT guidance in the medical record.
Critical Access Hospitals should report SIJI with CPT 27096 and sacral nerve blocks with CPT 64451; bilateral injections should be reported with modifier 50 for physician professional claims.
Diagnostic sacroiliac joint injection(s) (CPT 27096 and/or 64451) to confirm sacroiliac joint–mediated pain; may be performed unilateral or bilateral.
Therapeutic sacroiliac joint injection(s) (CPT 27096 and/or 64451) for treatment of sacroiliac joint pain; may be performed unilateral or bilateral.

A59257 — Billing and Coding: Sacroiliac Joint Injections and Procedures

J05

L39475 — Sacroiliac Joint Injections and Procedures

J05

A59233 — Billing and Coding: Sacroiliac Joint Injections and Procedures

J06

L39455 — Sacroiliac Joint Injections and Procedures

J06

A59192

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