Does 64455 require prior authorization?

No, 64455 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 64455?

Medicare facility rate: $30.06. Non-facility rate: $50.10. Work RVU: 0.73.

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

0.73

Facility

$30.06

Non-Facility

$50.10

The clinical record must document the elements leading to the diagnosis and the treatment decision to use injection (history, exam findings, diagnostic rationale).
Records must be made available upon request to support coding and medical necessity determinations.
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.

Injection therapy for Morton's neuroma (focal injection of tissue surrounding a localized plantar digital inflammatory focus) should be billed using CPT 64455 or 64632.
Injection therapy for plantar fasciitis is addressed and billed with CPT 20550 and corresponds to ICD-10-CM M72.2.
Injection to tendons at their origin or insertion sites should be reported using CPT 20551.
A single CPT 20551 should be reported when injections include both the plantar fascia and the area around a calcaneal spur.
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.

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

J05

L40299 — Peripheral Nerve Blocks and Procedures for Chronic Pain

J05

L40266 — Peripheral Nerve Blocks and Procedures for Chronic Pain

J06

L36850 — Peripheral Nerve Blocks

J06

A57452

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