Does 64605 require prior authorization?

No, 64605 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 64605?

Medicare facility rate: $423.86. Non-facility rate: $1100.89. Work RVU: 5.51.

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

5.51

Facility

$423.86

Non-Facility

$1100.89

All documentation must be maintained in the patient's medical record, be legible, include full patient identification, dates of service, and the legible signature of the responsible physician or non-physician practitioner.
The submitted medical record must support the selected ICD-10-CM code(s) and the CPT/HCPCS code must accurately describe the service performed.
Procedural reports must clearly document the indications and medical necessity for the injection or procedure; for diagnostic blocks, pre- and post-procedure pain intensity using a standardized scale must be recorded for the duration expected with the anesthetic.
Patient record should include the performing provider's assessment related to the complaint, relevant medical history, results of pertinent tests/procedures, and signed and dated office visit or operative reports to support medical necessity.

Peripheral nerve blocks (local anesthesia with or without corticosteroids) and denervation procedures are covered for chronic pain when they meet the reasonable and necessary requirements in LCD DL40261 and are not for cancer-related pain, spasticity, or perioperative/operative anesthesia.
Therapeutic radiofrequency neurolysis is covered for refractory trigeminal neuralgia.
Steroid injections with or without local anesthetic are allowable therapies for Morton's neuroma and carpal tunnel syndrome when medically necessary and documented.
Peripheral nerve blocks (PNBs) using local anesthesia with or without corticosteroids and denervation procedures for chronic pain are covered when they meet the reasonable and necessary criteria in LCD DL40263.
PNBs and radiofrequency neurolysis are covered for refractory trigeminal neuralgia.
PNBs and steroid injections are covered for carpal tunnel syndrome (CTS) when medically necessary.

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

A60301 — 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.