64999
HCPCS/CPT
Prior Authorization
No Prior Auth Required
No active coverage policies found for this code (low confidence)
Medicare Pricing
Work RVU
0.00
Facility
N/A
Non-Facility
N/A
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.
- To bill for these (denied) procedures, providers must report CPT code 64999 for both trial and permanent electrode-array insertions and indicate whether the procedure is a trial or permanent in the claim narrative/comment field adjacent to CPT 64999.
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.
- Bill use of Dolor Technologies SphenoCath® or other similar delivery devices with CPT code 64999 (unlisted 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.
20 Active Policies
L40299 — Peripheral Nerve Blocks and Procedures for Chronic Pain
J05
A60321 — Billing and Coding: 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
J06
Related Codes
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