Billing and Coding: Peripheral Nerve Blocks

Peripheral nerve block codes (CPT 64400-64530) may be billed on the date of surgery only for postoperative pain management when operative anesthesia is general, subarachnoid, or epidural and the intraoperative anesthesia does not depend on the block; otherwise blocks performed as the primary or supplemental anesthetic are included in the global surgical package. Dry needling and most acupuncture (except Medicare-covered chronic low back pain per NCD 30.3.3), prolotherapy, and sclerotherapy are non-covered; specific coding guidance requires use of CPT 20550/20551 for plantar fasciitis and calcaneal spur injections and adherence to NCCI/OPPS edits. Documentation must clearly support medical necessity (including whether the block is diagnostic vs therapeutic), include pre/post evaluations and patient education, list referring physician name/NPI when required, and more than three injections per anatomic site in six months or more than two nerves per session may trigger denial or medical review.