Does 64640 require prior authorization?

No, 64640 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 64640?

Medicare facility rate: $111.56. Non-facility rate: $267.54. Work RVU: 1.93.

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

1.93

Facility

$111.56

Non-Facility

$267.54

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.

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).
Botulinum toxin injections are covered when medical necessity is documented according to the Local Coverage Determination (LCD) 'Botulinum Toxin Types A and B' Indications and Limitations of Coverage.
Approved formulations include Botox (onabotulinumtoxinA), Dysport (abotulinumtoxinA), Xeomin (incobotulinumtoxinA), and Myobloc (rimabotulinumtoxinB); when a formulation is used for an indication not listed in the AHFS, a physician statement explaining the reason(s) for the unapproved form must be in the medical record.
Focal dystonia, hemifacial spasm, orofacial dyskinesia, blepharospasm, severe writer's cramp, laryngeal spasm, and dysphonia are recognized indications for which prior failure of traditional therapies is not required to document medical necessity.
Botulinum toxin injections are covered when the medical record documents medical necessity consistent with the associated LCD Botulinum Toxin Types A and B (L35172).

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

J05

L40299 — Peripheral Nerve Blocks and Procedures for Chronic Pain

J05

A60301 — Billing and Coding: Peripheral Nerve Blocks and Procedures for Chronic Pain

J06

L40266 — Peripheral Nerve Blocks and Procedures for Chronic Pain

J06

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