Summary & Overview
CPT 64491: Paravertebral Nerve Block Injection, Second Level
CPT code 64491 represents the injection of an anesthetic agent for a nerve block at the second level of the cervical or thoracic paravertebral spinal nerves. This procedure is a critical component in pain management, particularly for patients suffering from conditions such as cervicalgia and thoracic spine pain. The code is used as an add-on to the primary nerve block procedure, allowing for expanded treatment across multiple spinal levels.
Major national payers, including Aetna, Blue Cross Blue Shield, Cigna Health, Medicare, and UnitedHealthcare, recognize and reimburse for this code, reflecting its widespread clinical and billing relevance. The publication provides a comprehensive overview of payer coverage, clinical indications, and typical sites of service for CPT 64491. Readers will gain insight into current benchmarks, policy updates, and the clinical context surrounding this interventional pain management procedure. The analysis also highlights associated diagnoses and related CPT codes, offering a clear understanding of how CPT 64491 fits into broader pain management strategies and billing practices.
This summary equips healthcare professionals, administrators, and policy stakeholders with essential information to navigate the complexities of coding, coverage, and clinical application for paravertebral nerve block procedures.
CPT Code Overview
CPT 64491 is used to report the introduction or injection of an anesthetic agent for a nerve block, specifically targeting the paravertebral spinal nerves and branches in the cervical or thoracic regions. This code is designated as an add-on procedure for the second level, meaning it is billed in addition to a primary procedure. The service is commonly performed as part of pain management or interventional pain procedures. Typical sites of service include outpatient hospital settings and physician offices, such as Office (POS 11) and Outpatient Hospital (POS 19/22).
Clinical & Coding Specifications
Clinical Context
A patient presents to the outpatient clinic or hospital with persistent neck or upper back pain, such as cervicalgia or thoracic spine pain, that has not responded to conservative treatments. The provider, specializing in pain management or physical medicine and rehabilitation, determines that a paravertebral nerve block is indicated for diagnostic or therapeutic purposes. The procedure involves injecting an anesthetic agent at the cervical or thoracic paravertebral spinal nerves. After performing the primary injection at the first level (coded with 64490), the provider proceeds to inject at a second level, which is reported with add-on code 64491. This workflow is typical for patients with multi-level spinal pain requiring targeted nerve blocks for pain relief or diagnostic evaluation.
Coding Specifications
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Modifier
+- Indicates that
64491is an add-on code and must be used in conjunction with the primary procedure code64490. It is not reported alone.
- Indicates that
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Associated Provider Taxonomies:
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