Billing and coding built only for pain management practices
Procedure billing guide
Nerve blocks are coded by the specific nerve or plexus injected, and the rules for imaging differ by code. Common pain management blocks include stellate ganglion (64510), lumbar sympathetic (64520), celiac plexus (64530), greater occipital (64405), genicular nerve (64454) and thoracic paravertebral blocks (64461 to 64463). DOCS4DOCS codes each block by nerve, level and side, and bills imaging only where the code allows it.
Updated
CPT codes
| Code | Description |
|---|---|
| 64405 | Greater occipital nerve block |
| 64418 | Suprascapular nerve block |
| 64454 | Genicular nerve branches block, including imaging |
| 64461, +64462 | Thoracic paravertebral block, single level and additional levels |
| 64510 | Stellate ganglion (cervical sympathetic) block |
| 64517 | Superior hypogastric plexus block |
| 64520 | Lumbar or thoracic paravertebral sympathetic block |
| 64530 | Celiac plexus block |
Codes shown for reference. Always confirm against the current year’s CPT code set and your payer’s policy.
Billing rules
It depends on the code. Some nerve block codes, such as 64454 and the paravertebral codes 64461 to 64463, include imaging guidance. Others allow fluoroscopic or ultrasound guidance to be reported separately when it is performed and documented. Getting this wrong either leaves money unbilled or triggers a denial for unbundling.
Code each block by the nerve or plexus injected, not by the condition being treated. Add RT and LT or modifier 50 when a unilateral code is done on both sides, and record the relief after diagnostic blocks, because it decides what can be billed next, such as genicular RFA (64624) after genicular blocks (64454).
Common denials
These are the denial reasons we see most often. We check for each one before a claim goes out, instead of finding out from a denial.
FAQ
A stellate ganglion (cervical sympathetic) block is CPT 64510.
For some nerve block codes, yes, when the images are recorded and the guidance is documented. Codes that include imaging, such as 64454 and 64461 to 64463, do not allow it to be billed separately.
Coverage rules change; always check the current version of each policy and your payer’s own rules.
Keep reading
Facet, genicular and SI joint RFA coding, diagnostic block rules and repeat limits.
Read more about Radiofrequency Ablation (Rhizotomy)Interlaminar and transforaminal ESI coding, LCD rules and prior authorization.
Read more about Epidural Steroid InjectionsCPT, ICD-10, HCPCS and modifier coding for every interventional pain procedure.
Read more about Pain Management CodingHow it works
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