64640 billing guidelines. Jul 7, 2023 · As with any medical billing, there are specific coding guidelines and documentation requirements that need to be followed to ensure accurate reimbursement. ALL MEDICAL DECISIONS ARE SOLELY THE RESPONSIBILITY OF THE PATIENT AND PHYSICIAN. Mar 13, 2017 · Hey all! We've been told that 77002 in 2017 is an add-on code that does not work with 64640 (genicular RF). This article explains the importance of accurate coding for claim accuracy and revenue cycle management using AI. Upon Jun 3, 2019 · Hello all, I am new to the spine coding and have the below op report that the provider is saying to code as 64635, 64636, 64640, 64640 (of course with appropriate LT and 59 modifiers: The skin and subcutaneous tissues were anesthetized with 1% lidocaine. Guidelines from the AAOS stated: "We are unable to recommend for or against arthroscopic partial meniscectomy in patients with osteoarthritis of the knee with a torn meniscus". I have a provider challenging my coding. genicular) is coded as 64640. AMA clarified in October 2017 that cryoanalgesia of the peripheral nerve (ex. ” BILLING GUIDELINES AND CODING GENERAL See associated local coverage articles (LCAs) for related billing and coding guidance, as well as additional coverage and non-coverage scenarios and frequency utilization allowances and limitations: Most specifically, the provider must not bill CPT codes 64450 or 64640 for these injections, since those codes respectively address the additional work of an injection of an anesthetic agent (nerve block), neurolytic or sclerosing agent into relatively more difficult peripheral nerves, rather than that involved in an injection of relatively Mar 12, 2025 · Learn about suprascapular nerve radiofrequency ablation cpt code, billing guidelines, & insurance coverage to ensure accurate claim submission & reimbursement. 64640 DESTRUCTION BY NEUROLYTIC AGENT; OTHER PERIPHERAL NERVE OR BRANCH 64999 UNLISTED PROCEDURE, NERVOUS SYSTEM Coverage Indications, Limitations, and/or Medical Necessity Botulinum toxin injections are used to treat various focal muscle spastic disorders and excessive muscle contractions such as dystonias, spasms and twitches. 64600 Trigeminal, supraorbital, infraorbital, mental, or inferior alveolar branches only Use this page to view details for the Local Coverage Article for Billing and Coding: Peripheral Nerve Blocks. How are others billing the imaging component for genicular radiofrequency ablations since imaging is still not bundled in with 64640? Thanks! Rose NASS clinical guidelines (Kreiner et al. BENEFITS ARE DETERMINED BY THE GROUP CONTRACT, MEMBER BENEFIT BOOKLET, AND/OR INDIVIDUAL SUBSCRIBER Comprehensive coding and billing information for iovera procedures. It is crucial to document the specific nerve targeted and the rationale for the procedure. Would you code the following with 64640 x1 or 64640 x9?? Can you provide me written documentation for your answer for either scenario? POSTOPERATIVE DIAGNOSES: 1. Nov 26, 2023 · Learn how AI can automate complex medical billing tasks with CPT code 64640 and its modifiers. The following guidelines should be used when billing for injections of Botulinum toxin for covered conditions/diagnosis. Claims submitted for services that are not accompanied by covered code(s) under the applicable Coverage Policy will be denied as not covered. , 2020) provide evidence-based recommendations which are endorsed by the American Academy of Physical Medicine and Rehabilitation (AAPM&R) and American Association of Neurological Surgeons and Congress of Neurological Surgeons (AANS/CNS), for the diagnosis and treatment of adults with LBP. . Previous guidance to report unlisted code 64999, Unlisted procedure, nervous system, pending future CPT coding changes, rather than code 64640 for cryoneurolysis, is rescinded. When billing, providers must use the most appropriate codes as of the effective date of the submission. Chemical neuroablation involves the percutaneous administration of phenol or alcohol around a nerve to denervate it. Most specifically, the provider must not bill CPT codes 64450 or 64640 for these injections, since those codes respectively address the additional work of an injection of an anesthetic agent (nerve block), neurolytic or sclerosing agent into relatively more difficult peripheral nerves, rather than that involved in an injection of relatively Subject: Neurolysis/Ablation THIS MEDICAL COVERAGE GUIDELINE IS NOT AN AUTHORIZATION, CERTIFICATION, EXPLANATION OF BENEFITS, OR A GUARANTEE OF PAYMENT, NOR DOES IT SUBSTITUTE FOR OR CONSTITUTE MEDICAL ADVICE. Jan 31, 2022 · January 31, 2022 - Updated March 10, 2022 Billing and Coding Instructions: Cryoneurolysis Cryoneurolysis a medical treatment which has been proposed to be a mechanism for relieving pain by freezing the affected peripheral nerves. These procedures may be performed using one of several mechanisms. Under direct fluoroscopic guidance, a Dec 12, 2008 · ok all of my spine FRIENDS!! I need help. CPT codes, coverage details & reimbursement resources for HCPs. Jan 1, 2024 · Codes 64640 and 64624 require the destruction of target nerve (s). Nov 17, 2017 · One of our clinics is looking into using Iovera as well and I'm researching for coding guidance as well. One manufacture of this system, Iovera, instructs providers on their website to bill the treatment with Current Procedural Terminology (CPT) code 64640 (Destruction Overview This Coverage Policy addresses destruction of a peripheral nerve using cryoablation, or electrical, laser, chemical or radiofrequency ablation, alone or in combination, for treatment of trigeminal neuralgia, chronic sacroiliac joint, knee, and/or foot pain, headache and/or occipital neuralgia, and pain resulting from conditions such as complex regional pain syndrome, peripheral nerve There has been confusion recently regarding Current Procedural Terminology (CPT®) code 64640, Destruction by neurolytic agent; other peripheral nerve or branch, and its applicability for reporting cryoneurolysis. Also, Optum's Oct 12, 2025 · AMA CPT ® Assistant - 2019 Issue 4 (April) Coding Clarification: Reporting Code 64640 for Cryoneurolysis (April 2019) April 2019 page 9 Coding Clarification: Reporting Code 64640 for Cryoneurolysis There has been confusion recently regarding Current Procedural Terminology (CPT®) code 64640, Destruction by neurolytic agent; other peripheral nerve or branch, and its applicability for reporting Jan 1, 2024 · Use this page to view details for the Local Coverage Article for Billing and Coding: Cryoneurolysis Instructions. Medical Necessity Aetna considers the following nerve blocks medically necessary: Adductor canal block for manipulation of the knee under anesthesia and post-operative pain control after arthroscopic tibiotalar arthrodesis, anterior cruciate ligament reconstruction, total ankle arthroplasty, and total knee Most specifically, the provider must not bill CPT codes 64450 or 64640 for these injections, since those codes respectively address the additional work of an injection of an anesthetic agent (nerve block), neurolytic or sclerosing agent into relatively more difficult peripheral nerves, rather than that involved in an injection of relatively We would like to show you a description here but the site won’t allow us. Chronic low back pain Percutaneous Neuroablation: Percutaneous Neuroablation is a procedure utilized to destroy neural tissue to relieve pain. The Iovera system is temporary and not destructive. A comprehensive review of the guidance published in CPT® Assistant, as well as requests for advice through the CPT Knowledge Base on this code, highlighted response variations. However, in the beginning of 64640's section, CPT states not to report a code labeled as destruction when using therapies that are not destructive of the target nerve. Therefore, CPT codes 64640 and 64624 are not appropriate for Medicare billing. Oct 1, 2015 · Use this page to view details for the Local Coverage Article for Billing and Coding: Nerve Blockade for Treatment of Chronic Pain and Neuropathy. CPT code 64640 is used when a healthcare provider performs neurolysis on peripheral nerves or their branches to alleviate pain. 6 AMA=American Medical Association; CPT=Current Procedural Terminology. Comprehensive coding and billing information for iovera procedures. Jul 25, 2025 · The authors acknowledged that the Food and Drug Administration (FDA) has questioned hyaluronic acid’s mechanism of action in treatment of knee pain and that “clinical practice guidelines for orthopaedic surgeons do not currently recommend hyaluronic acid for the treatment of knee osteoarthritis pain. In this article, we will discuss the coding guidelines and documentation requirements for billing suprascapular nerve radiofrequency ablation. Failure to report the surgical procedure may result in denial of the claim. Coding Guidelines: Aug 26, 2022 · As per guidance issued by the American Medical Association, the relevant codes for documenting treatment with iovera° are 64640 and 64624, and refer to treating anterior and posterior knee pain Policy Scope of Policy This Clinical Policy Bulletin addresses nerve blocks. The AAOS identified only a single study of arthroscopic partial meniscectomy that met criteria for inclusion in their analysis. Percutaneous application of heat (radiofrequency neuroablation) or cold (cryoneurolysis) to 64632 Plantar Common Digital Nerve 64640 All Others *CPT codes 64635/64636 or 64999 may also be considered when billing for Medial Branch Nerves. qyqs snw8s qgmvd kth ajhdo q8ummx g4urkw tlj rkgcgi y9ks