76881
HCPCS/CPT
Prior Authorization
Prior Auth Required
Conditional coverage; review criteria to confirm PA need (medium confidence)
Medicare Pricing
Work RVU
0.88
Facility
$3.46
Non-Facility
$3.46
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).
- Nonvascular extremity ultrasound is covered when medical necessity is documented in the patient's record, including relevant medical history, physical examination, and results of pertinent diagnostic tests or procedures.
- Diagnostic nonvascular extremity ultrasound is covered when the claim includes an ICD-10-CM diagnosis code that best describes the patient's condition and the test result or the symptoms prompting the test are documented.
- CPT 64450 is appropriate when a qualified health care professional performs a direct injection (nerve block) of an anesthetic agent and/or steroid into a peripheral nerve for treatment of peripheral neuropathy.
- Code 64450 addresses the additional work of performing a nerve block (direct peripheral nerve injection) rather than injections into surrounding subcutaneous tissue.
20 Active Policies
L35222 — Nerve Blocks for Peripheral Neuropathy
J05
A57589 — Billing and Coding: Nerve Blocks for Peripheral Neuropathy
J05
A56787 — Billing and Coding: Nonvascular Extremity Ultrasound
J06
L33619 — Nonvascular Extremity Ultrasound
J06
L33693
Related Codes
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