64999
HCPCS/CPT
Prior Authorization
No Prior Auth Required
No active coverage policies found for this code (low confidence)
Medicare Pricing
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.
- Submitted medical records must support the selected diagnosis code(s) and the submitted CPT/HCPCS code must accurately describe the service performed.
- This article provides billing/coding guidelines that complement the Local Coverage Determination (LCD) L33458 for chemodenervation; follow LCD L33458 for specific coverage criteria and coding guidance.
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).
- 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).
20 Active Policies
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
A55240 — Billing and Coding: Auricular Peripheral Nerve Stimulation (Electro-Acupuncture Device)
J12
CGS-L40260 — Peripheral Nerve Blocks and Procedures for Chronic Pain
J18 MAC Part B
WPS-L40299 — Peripheral Nerve Blocks and Procedures for Chronic Pain
J8 MAC Part B
NORIDIAN-L34328 — Peripheral Nerve Stimulation
JF Part B
NORIDIAN-L35456 — Nerve Blockade for Treatment of Chronic Pain and Neuropathy
JF Part B
NGS-L40266 — Peripheral Nerve Blocks and Procedures for Chronic Pain
JK MAC Part B
A52725 — Billing and Coding: Nerve Blockade for Treatment of Chronic Pain and Neuropathy
A57186 — Billing and Coding: Botulinum Toxin Types A and B
A60295 — Billing and Coding: Peripheral Nerve Blocks and Procedures for Chronic Pain
A60297 — Billing and Coding: Peripheral Nerve Blocks and Procedures for Chronic Pain
A57185 — Billing and Coding: Botulinum Toxin Types A and B
ANTHEM-DME.00011 — DME.00011 Electrical Stimulation as a Treatment for Pain and Other Conditions: Surface and Percutaneous Devices
A56646 — Billing and Coding: Chemodenervation
A56034 — Billing and Coding: Nerve Blockade for Treatment of Chronic Pain and Neuropathy
UHC-POL-nerve-graft-restore-erectile-function-during-radical-prostatectomy — Nerve Graft to Restore Erectile Function During Radical Prostatectomy
L34328 — Peripheral Nerve Stimulation
Related Codes
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