2025 CPT code 64630

Destruction of the pudendal nerve using a neurolytic agent.

Refer to the most current CPT guidelines for coding neurolytic blocks, particularly sections on injection of therapeutic agents, and the use of 64999 for non-destructive therapies.

Modifiers may apply depending on the circumstances. For example, modifier 59 (distinct procedural service) might be necessary if other procedures are performed on the same day.Consult the CPT manual for appropriate modifier usage.

Medical necessity is established by documenting the presence of chronic pudendal neuralgia unresponsive to conservative management (e.g., physical therapy, medications). The procedure must be deemed appropriate given the severity of the pain and potential for improvement in quality of life.

The physician identifies and accesses the pudendal nerve (either transvaginally or perineally), inserts a needle, injects local anesthetic, and then injects the neurolytic agent.

IMPORTANT For intracranial surgery on cranial nerves, see 61450, 61460, 61790.For chemodenervation of the bladder, use 52287. For chemodenervation for strabismus involving the extraocular muscles, use 67345. For chemodenervation guided by needle electromyography or muscle electrical stimulation, see 95873, 95874.Do not report diagnostic/therapeutic injections separately. Do not report a code labeled as destruction when using therapies that are not destructive of the target nerve (e.g., pulsed radiofrequency), use 64999. For codes labeled as chemodenervation, the supply of the chemodenervation agent is reported separately. For chemodenervation of internal anal sphincter, use 46505.

In simple words: This procedure involves destroying a nerve (the pudendal nerve) that causes pain. A doctor injects a special medicine that damages the nerve to stop the pain signals.The doctor may use imaging guidance during the procedure.

This CPT code describes the destruction of the pudendal nerve via the injection of a neurolytic agent.The pudendal nerve is approached either transvaginally or via the perineal approach. After locating the nerve, a needle is inserted (using the loss of resistance technique), local anesthesia is injected, followed by the neurolytic agent. Fluoroscopic guidance, if used, is reported separately.

Example 1: A patient presents with chronic pudendal neuralgia following childbirth. After conservative measures fail, a neurolytic block is performed to alleviate pain., A patient with persistent pudendal neuralgia after pelvic surgery undergoes a pudendal nerve block using a neurolytic agent under fluoroscopic guidance to target the affected nerve branches., A patient experiences chronic perineal pain due to pudendal nerve entrapment, and a neurolytic block is chosen as a last resort after other treatments proved ineffective.

* Detailed history and physical examination documenting the patient's chronic pain and failed conservative treatments.* Imaging studies (e.g., MRI, ultrasound) to confirm the location of the pudendal nerve.* Documentation of the technique used (transvaginal or perineal approach).* Specific details about the neurolytic agent used and the volume injected.* Anesthesia record.* Post-procedure assessment and documentation of any complications.

** The choice of neurolytic agent and the technique used should be documented. Potential complications include infection, hematoma, nerve damage, and anesthesia dolorosa (pain in the anesthetized area).

  • Revenue Code: P5E (AMBULATORY PROCEDURES - OTHER)
  • Payment Status: Active
  • Modifier TC rule: Not applicable.
  • Specialties:Pain Management, Anesthesiology, Neurosurgery, Urogynecology
  • Place of Service:Office, Ambulatory Surgical Center, Hospital
** Only Enterprise users with EHR integration can access case-specific answers. Click here to request access.