Summary & Overview
CPT 62280: Neurolytic Subarachnoid Injection for Severe Pain
CPT code 62280 covers the injection or infusion of a neurolytic agent into the subarachnoid space to ablate specific spinal nerves and reduce severe pain, commonly used in advanced cancer pain involving the torso. This procedure is clinically significant because it provides a targeted option for refractory pain when other medical management has failed, and it can alter care trajectories for patients with limited prognoses.
Key payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context, typical service settings, and payer coverage considerations for CPT code 62280. The publication outlines benchmark considerations and common billing practices associated with the code, highlights policy-relevant elements that affect utilization and authorization, and summarizes clinical indications where neurolytic subarachnoid injections are most applicable.
What readers will learn: clinical purpose and typical sites of service for CPT code 62280, how major national payers approach coverage and prior authorization in general terms, and the procedural and policy factors that influence coding and billing for advanced pain interventions. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 62280 describes the injection or infusion of a neurolytic agent into the subarachnoid space at any spinal level. The procedure involves administering a substance intended to destroy targeted nerve tissue to relieve severe, often intractable pain; a therapeutic drug may be given concomitantly with the neurolytic.
Service type: Neurolytic spinal injection/infusion for pain management.
Typical site of service: Hospital outpatient department, ambulatory surgery center, or inpatient setting depending on clinical severity and monitoring needs.
Clinical & Coding Specifications
Clinical Context
A 62-year-old patient with advanced metastatic thoracic malignancy experiences severe, focal, intractable chest wall and intercostal neuropathic pain refractory to systemic opioids, adjuvant analgesics, and prior peripheral nerve blocks. The pain significantly limits oral intake and mobility. The pain management team evaluates goals of care and documents informed consent for a neurolytic procedure. The procedure is scheduled in an operating room or procedure suite with neuraxial capabilities. Under sterile technique and with fluoroscopic or ultrasound guidance, the interventional pain physician induces neuraxial access and injects a neurolytic agent into the subarachnoid space at an appropriate spinal level to ablate targeted sensory nerves. Monitoring includes continuous hemodynamic and respiratory assessment, available anesthesia support for sedation or airway management, and post-procedure observation for neurologic and autonomic effects. Post-procedure documentation includes pre-procedure pain scores, indication (e.g., cancer-related chest wall pain), details of agents used (neurolytic and any adjunctive therapeutic drug), level of injection, image guidance, complications or lack thereof, and patient response. Typical sites of service are the hospital operating room, ambulatory surgery center, or a hospital-based procedure suite capable of neuraxial and fluoroscopic procedures.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when reporting only the physician component separate from a facility or technical component for documentation or billing splits. |