64450

Injection, anesthetic agent; other peripheral nerve or branch

CPT code 64450 describes the therapeutic or diagnostic injection of an anesthetic agent into a peripheral nerve or one of its branches, excluding specific nerves covered by more discrete CPT codes (e.g., trigeminal, facial, brachial plexus, sciatic, femoral, pudendal). The primary purpose of this procedure is to block nerve conduction temporarily, which can provide pain relief, reduce muscle spasm, or assist in diagnosing the source of neuropathic pain. The anesthetic agent, such as lidocaine or bupivacaine, may be injected alone or in combination with other substances like steroids to achieve sustained anti-inflammatory effects.

Clinical Indications

  • Neuropathic pain conditions localized to a specific peripheral nerve or its branches
  • Post-herpetic neuralgia
  • Entrapment neuropathies (e.g., meralgia paresthetica, intercostal neuralgia, suprascapular neuropathy, lateral femoral cutaneous neuropathy, occipital neuralgia) where a more specific code does not apply
  • Diagnostic evaluation of pain syndromes to identify the specific nerve involved
  • Acute or chronic pain unresponsive to conservative treatments
  • Myofascial pain syndromes with a distinct neural component
  • Complex regional pain syndrome (CRPS) affecting a peripheral nerve distribution

Procedure Steps

  1. Patient evaluation and consent, including review of medical history and allergies.
  2. Identification of the target nerve or branch through anatomical landmarks, palpation, nerve stimulator, and/or imaging guidance (ultrasound or fluoroscopy).
  3. Preparation of the injection site with antiseptic solution.
  4. Local anesthetic infiltration of the skin and subcutaneous tissue at the injection site (optional).
  5. Advance the needle toward the identified peripheral nerve or branch.
  6. Confirm needle placement, often using nerve stimulation or real-time imaging guidance.
  7. Aspirate to ensure intravascular placement is avoided.
  8. Slow injection of the anesthetic agent (with or without steroid) around the nerve.
  9. Withdraw the needle and apply pressure to the injection site.
  10. Post-procedure monitoring and instructions to the patient.

Coding Guidelines

  • Use of imaging guidance (e.g., ultrasound, fluoroscopy) for needle placement should be reported separately using appropriate add-on codes (e.g., 76942 for ultrasound guidance, 77002 or 77003 for fluoroscopic guidance) if performed and documented.
  • Multiple injections performed on different peripheral nerves or branches during the same encounter may be reported separately by appending modifier 59 (Distinct Procedural Service) or an anatomical modifier, if appropriate, to the additional codes.
  • This code should not be used for injections of specific peripheral nerves that have dedicated CPT codes (e.g., trigeminal, facial, brachial plexus, sciatic, femoral, pudendal nerve blocks).
  • Documentation must clearly specify the nerve injected, the agent(s) used, the volume, and any guidance employed.
  • Bilateral injections of the same nerve or branch should be reported with modifier 50 (Bilateral Procedure) or by listing the code twice with appropriate modifiers (e.g., RT/LT).
  • If the injection is performed for diagnostic purposes, the rationale for diagnosis should be clearly documented.
  • This code has a 0-day global period, meaning that evaluation and management services related to the procedure on the same day are typically included and not separately billable.

Associated ICD-10 Codes