64520
HCPCS/CPT
Prior Authorization
No Prior Auth Required
No active coverage policies found for this code (low confidence)
Medicare Pricing
Work RVU
1.32
Facility
$76.82
Non-Facility
$242.16
Documentation Required
- 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.
Key Coverage Criteria
- 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.
14 Active Policies
AMBETTER-CP.MP.170 — Nerve Blocks and Neurolysis for Pain Management
AETNA-CPB-0729 — Diabetic Neuropathy: Selected Treatments
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
Related Codes
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