2025 CPT code 64420
(Active) Effective Date: N/A Revision Date: N/A Surgery - Surgical Procedures on the Nervous System Surgery Feed
Injection(s) of anesthetic and/or steroid into a single intercostal nerve.
Modifier 50 (Bilateral Procedure) can be appended when the procedure is performed on both sides of the body. Add-on code 64421 is reported for each additional level blocked.
Medical necessity is established when the patient exhibits significant pain in the chest wall that interferes with daily activities and other conservative treatment options have failed.The need for intercostal nerve block should be justified by the clinical presentation, and its diagnostic and/or therapeutic value.
A physician, typically an anesthesiologist or pain management specialist, administers the injections under appropriate sterile conditions.Pre-procedure assessment, informed consent,injection technique, post-procedure monitoring for complications (such as pneumothorax or infection), and patient education are all part of the clinical responsibility.
In simple words: The doctor injects numbing medicine and/or steroid medication near a nerve under one of your ribs to relieve chest or upper abdomen pain. This is done to treat pain or to find out what's causing the pain.
This CPT code encompasses the injection of one or more anesthetic agents and/or steroids into a single intercostal nerve at a single level.The procedure involves the introduction of medication near an intercostal nerve to relieve pain or for diagnostic purposes.Multiple injections at the same level are included in a single code report.Imaging guidance (fluoroscopy or CT) may be reported separately, unless included as part of the inclusive components of the code itself.The code is reported once per level, regardless of the number of injections performed at that level. For additional levels, add-on code 64421 should be reported in addition to 64420.
Example 1: A patient presents with severe post-herpetic neuralgia (shingles pain) affecting the right chest wall.An intercostal nerve block at the affected level (T5) is performed to provide diagnostic and therapeutic pain relief., A patient requires a thoracotomy (chest surgery). An intercostal nerve block (T6-T8) is performed preoperatively to reduce postoperative pain and anesthetic requirements., A patient experiences chronic chest pain of unknown origin.A series of intercostal nerve blocks at various levels are performed to localize the source of the pain and guide further diagnostic investigations.
** Thorough documentation is critical for proper coding and reimbursement.The level of intercostal nerve blocked must be precisely documented.When using imaging guidance, document the method utilized.
- Revenue Code: P6C (Medicare Fee Schedule: MINOR PROCEDURES - OTHER)
- RVU: Refer to the current Medicare Physician Fee Schedule for RVU values and payment rates.These values can vary based on geographic location and other factors.
- Global Days: This procedure does not typically involve a global surgical period.
- Payment Status: Active
- Modifier TC rule: No Technical Component modifier applies.
- Fee Schedule: Historical fee schedules vary greatly by payer and geographic location. Consult historical CMS fee schedules for relevant data.
- Specialties:Anesthesiology, Pain Medicine, Surgery
- Place of Service:Office, Hospital (Inpatient or Outpatient), Ambulatory Surgery Center, Other Place of Service (as appropriate)