Pain management procedures are among the most challenging to bill. The services are quite similar to one another. However, despite their similarity, every procedure is billed with a different CPT code and requires specific documentation.
One such code that many billers get wrong is CPT code 64520. That’s why our billing experts at MediBillMD have created this detailed guide on code 64520. Take a look.
CPT Code 64520 – Description
CPT code 64520 is officially defined as:
“Injection, anesthetic agent; lumbar or thoracic (paravertebral sympathetic).”
64520 is related to pain management. To put it simply, it represents a nerve block injection. As evident from the definition, during the procedure, an anesthetic agent is injected into the paravertebral sympathetic nerves, located in the lumbar or thoracic region.
Since the procedure involves direct interaction with the nervous system, physicians must place the injection needle very carefully. For this, physicians might use fluoroscopy techniques to guide the needle placement. However, that’s not a mandatory requirement.
The whole purpose of this procedure is to disrupt sympathetic nerve transmission, which can provide significant pain relief.
Scenarios Where CPT Code 64520 is Applicable
CPT code 64520 can be used in various situations. Let’s explore a couple of scenarios in which it can be used:
Complex Regional Pain Syndrome (CRPS)
Suppose that a patient comes to the hospital with severe burning pain in her left foot and leg. Six months prior, the patient had an ankle fracture. The patient is also experiencing skin color changes, swelling, and extreme sensitivity to touch in the affected area. After assessing all the symptoms, the physician suspects CRPS.
Oral medications have a little chance of working here. So, to alleviate the pain, the physician decides to administer a lumbar sympathetic nerve block to interrupt the pain signals.
At the end, the medical billing department codes and submits the claim for reimbursement. In this case, CPT code 64520 can be used.
Phantom Limb Pain
A 55-year-old patient arrives at a clinic with persistent phantom limb pain in his right leg, which was amputated below the knee two years ago due to diabetes complications. He experiences shooting and burning sensations where his foot used to be, significantly impacting his quality of life. Conservative treatments failed to provide relief. To manage his phantom limb pain, the physician performs a lumbar sympathetic nerve block targeting the sympathetic chain.
Since the procedure is justified based on the medical conditions, the billing department can use CPT code 64520 to report the procedure.
Applicable Modifiers for CPT Code 64520
Many modifiers can be used with CPT code 64520. However, the following are the most commonly appended modifiers:
| Modifier | Description | Application |
|---|---|---|
| 50 | Bilateral Procedure | Apply to CPT 64520 when the injection is administered on both sides of the body. |
| LT | Left Side Procedure | Use when the injection is administered on the left side. |
| RT | Right Side Procedure | Use when the injection is administered on the right side. |
CPT Code 64520 – Billing & Reimbursement Guidelines
Denials can occur even after ensuring accurate coding, primarily because of small mistakes that go unnoticed by billers. Keep in mind the following details to get your claims right:
Meet the Documentation Requirements
Documentation is the backbone of medical billing. Without proper documents, your claims will never get reimbursed, even if you have done everything else correctly. Your appended medical records must justify why the procedure was medically necessary. We advise you to provide the following details with your claims:
- Patient symptoms and physician diagnosis that meet the criteria for using 64520.
- Proof of failed initial conservative treatment.
- Type of nerve block used and the dosage details.
- Pre-procedure patient symptoms, such as pain level, swelling, and range of motion limitations.
- Procedural details, including needle size, injection technique, and patient response.
- Post-procedure instructions and follow-up plans.
Confirm Separate Reimbursement of Imaging
Pain management injections under CPT code 64520 can be administered both with and without fluoroscopic guidance. But how do you bill the fluoroscopy with 64520? Well, that’s a question that confuses many billers. Let’s make it simple for you.
Every insurance payer has its own rules for reimbursing fluoroscopy with code 64520. Many private insurance payers consider fluoroscopy a separate service and allow you to bill it via CPT codes 77002 and 77003. However, Medicare bundles fluoroscopic guidance and 64520, which means that the imaging is not separately billable.
Verify the Medicare Reimbursement Rates
Medicare currently pays around $218.66 nationally for CPT code 64520 in non-facility settings and $82.48 in facility settings, according to the 2025 Physician Fee Schedule.
However, this amount is the national average, and the actual payment varies for each Medicare Administrative Contractor (MAC) locality. You can check the exact reimbursement rate for your MAC locality via the PFS Lookup Tool.
Wrapping Up
So, there you have it, the complete description of CPT code 64520. We know this is a lot of information to absorb. So, let’s do a quick recap of the important points.
Code 64520 represents an interventional pain management procedure. The procedure involves injecting an anesthetic drug into the lumbar or thoracic paravertebral sympathetic nerves. For fair reimbursement, you must provide detailed documentation with your claims and append the appropriate modifiers.
If you’re still having trouble with medical coding or want to outsource your non-clinical operations, you can always count on MediBillMD’s pain management billing services.
