2025 CPT code 64408

Injection(s) of anesthetic and/or steroid into the vagus nerve.

Codes 64400-64450, 64454 describe the injection of anesthetic agent(s) and/or steroid into a nerve plexus, nerve, or branch. These codes are reported once per nerve plexus, nerve, or branch, regardless of the number of injections.Imaging guidance and localization may be reported separately for some codes, but are inclusive for others (refer to CPT guidelines for details). Codes 64400-64455, 64461, 64462, 64463, 64479, 64480, 64483, 64484, 64490-64495 are unilateral procedures.Modifier 50 should be used for bilateral procedures on specific codes, and add-on codes should be reported twice in bilateral procedures without modifier 50.

Modifiers 50 (bilateral procedure) may be applicable depending on the specific circumstances.Other modifiers may be used as clinically indicated.

Medical necessity for a vagus nerve block is established when the patient presents with severe or intractable pain related to the vagus nerve, or when there is a clinical indication for diagnosis of vagus nerve pathology.

The physician is responsible for pre-procedural assessment, preparation of the injection site, administering the injection(s) under aseptic technique, monitoring the patient's response, and providing post-procedural care and instructions.

IMPORTANT For injection or destruction of genicular nerve branches, see codes 64454 and 64624 respectively.For intracranial surgery on cranial nerves, see 61450, 61460, 61790. For destruction by neurolytic agent or chemodenervation, see 62280-62282, 64600-64681. For epidural or subarachnoid injection, see 62320-62327.

In simple words: The doctor injects medicine to numb or reduce swelling near a nerve in the neck and chest called the vagus nerve. This might be done to relieve pain or help diagnose a problem.

This CPT code 64408 represents the procedure of injecting an anesthetic agent and/or a steroid into the vagus nerve (tenth cranial nerve).The injection(s) may be performed for diagnostic or therapeutic purposes. The code is reported once per nerve, regardless of the number of injections. Imaging guidance, if used, is reported separately.

Example 1: A patient presents with severe, intractable pain due to a vagus nerve neuralgia.The physician performs a vagus nerve block with a local anesthetic and steroid to provide pain relief., A patient has undergone a prior surgical procedure on the neck that has resulted in vagus nerve dysfunction. The physician injects a steroid to reduce inflammation and improve nerve function., A patient experiences recurrent episodes of dysphagia (difficulty swallowing).Diagnostic injection of a contrast agent and local anesthetic into the vagus nerve is performed to pinpoint areas of nerve involvement.

* Detailed history and physical examination documenting the indication for the procedure.* Documentation of the specific nerve targeted (vagus nerve) and the technique employed.* Accurate record of the medications administered, including the type, dosage, and volume.* Documentation of the patient's response to the procedure.* Post-procedural care instructions and any complications encountered.* Imaging reports if imaging guidance was used.

** Always refer to the most current CPT codebook and coding guidelines for the most up-to-date information on coding and billing practices.

  • Revenue Code: P5E (AMBULATORY PROCEDURES - OTHER)
  • Payment Status: Active
  • Modifier TC rule: Not applicable.
  • Specialties:Anesthesiology, Pain Management, Neurosurgery, Otolaryngology
  • Place of Service:Office, Ambulatory Surgery Center, Hospital (Inpatient or Outpatient)
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