2025 CPT code 64517

Superior hypogastric plexus nerve block; this procedure involves injecting a local anesthetic into the superior hypogastric plexus to treat chronic pelvic pain.

Fluoroscopic guidance is reported separately when performed.For bilateral blocks, code 64517 is reported once per side.

Modifiers 22 (increased procedural services), 50 (bilateral procedure), 59 (distinct procedural service) may be applicable depending on the circumstances of the procedure.

Medical necessity is established when a patient has chronic pelvic pain that is refractory to conservative medical management, including analgesics and other appropriate therapies. The procedure should be considered only after other treatment options have failed to provide adequate relief.

The physician is responsible for performing the nerve block, which involves prepping the patient, using fluoroscopic guidance to accurately place needles, administering contrast to verify needle placement, and injecting the local anesthetic. They must ensure that the needles are not placed within blood vessels, spinal nerves, or ureters.

IMPORTANT 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, 62321, 62322, 62323, 62324, 62325, 62326, 62327. Codes 64400-64455, 64461, 64462, 64463, 64479, 64480, 64483, 64484, 64490-64495 are unilateral procedures. For bilateral procedures, report codes with modifier 50. Add-on codes 64421, 64462, 64480, 64484, 64491, 64492, 64494, 64495 are reported twice bilaterally, without modifier 50.

In simple words: This procedure helps relieve chronic pelvic pain that doesn't get better with medicine.A doctor uses imaging to guide needles to a specific area of nerves in the lower back.A numbing medicine is injected to block pain signals.

This procedure, a superior hypogastric plexus nerve block, targets chronic pelvic pain unresponsive to medication.The superior hypogastric plexus, a nerve bundle innervating lower pelvic organs and genitalia (located where L5 meets S1), is accessed using fluoroscopic guidance. Two needles are inserted into the prevertebral space, anterior to the L5/S1 vertebral junction, after verification of placement (free of blood vessels, spinal nerves, or ureters) via contrast injection, a local anesthetic is injected bilaterally into the superior hypogastric plexus.Fluoroscopic guidance is reported separately if performed.

Example 1: A 45-year-old female presents with chronic pelvic pain unresponsive to medication.The pain is significantly impacting her quality of life. A superior hypogastric plexus nerve block is performed to provide pain relief., A 60-year-old male with a history of prostate cancer experiences severe pelvic pain following radiation therapy.A superior hypogastric plexus nerve block is performed to manage the pain., A 30-year-old female with endometriosis has intractable pelvic pain despite hormonal therapy. A superior hypogastric plexus nerve block is performed as a palliative treatment.

Detailed history and physical examination focusing on pelvic pain, including location, duration, character, and aggravating/relieving factors.Imaging studies (e.g., MRI, CT) to confirm the diagnosis and rule out other causes of pelvic pain.Documentation of the procedure, including needle placement verification using fluoroscopy and contrast, and volume of anesthetic injected.Post-procedure assessment of pain levels.

** This procedure may be performed under fluoroscopic guidance or ultrasound guidance.The choice of modality should be documented.The use of additional medications (e.g., steroids) should be noted.Post-procedural follow-up is essential to evaluate pain relief and identify any complications.

  • Revenue Code: P6C
  • RVU: Information not available in source.
  • Global Days : Information not available in source.
  • Payment Status: Active
  • Modifier TC rule: Information not available in source.
  • Fee Schedule : Information not available in source.
  • Specialties:Pain Management, Anesthesiology, Neurosurgery, Urology, Gynecology
  • Place of Service:Office, Outpatient Hospital, Ambulatory Surgical Center
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