Summary & Overview
CPT 64405: Greater Occipital Nerve Injection for Pain Management
CPT code 64405 denotes an injection of an anesthetic and/or steroid into the greater occipital nerve and is commonly used in the management of occipital neuralgia and posterior scalp pain. Nationally, this procedural code matters because it represents a frequently billed interventional pain service performed in outpatient settings and influences clinical pathways for headache and neuropathic pain management. Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.
Readers will learn what CPT code 64405 represents clinically and operationally, how it is typically delivered (nerve block in outpatient clinics, ambulatory surgery centers, or physician offices), and which major payers cover or adjudicate claims for this service. The publication provides benchmarks for utilization and reimbursement (where available), summaries of relevant policy considerations and documentation expectations, and clinical context around indications and typical procedural settings. Data not available in the input will be clearly noted. The focus is national in scope and intended for billing managers, clinicians involved in pain procedures, and policy analysts tracking interventional pain services.
Billing Code Overview
CPT code 64405 describes an injection of an anesthetic and/or steroid agent into the greater occipital nerve. The procedure targets the greater occipital nerve, a sensory nerve serving the posterior scalp, and is reported for one or more injections performed during a single procedure.
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Service type: Nerve block / peripheral nerve injection for pain management
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Typical site of service: Outpatient clinic, ambulatory surgery center, or physician office where interventional pain procedures are performed
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A typical patient is a 38-year-old with recurrent unilateral or bilateral occipital headaches refractory to oral medication, presenting to an outpatient pain clinic. The patient reports sharp, burning pain at the posterior scalp with tenderness over the greater occipital nerve distribution and occasional associated photophobia. After clinical evaluation and review of prior imaging and medication trials, the pain physician or interventionalist recommends a diagnostic and therapeutic greater occipital nerve block using an anesthetic with or without a corticosteroid.
The clinical workflow includes: pre-procedure consent and history, focused neurologic and vascular exam, review of anticoagulation status, time-out and positioning prone or seated, aseptic prep, landmark or ultrasound guidance to identify the greater occipital nerve, injection of local anesthetic with or without steroid, observation for immediate response and complications, documentation of laterality and number of injections (note: 64405 is reported for one or more injections during the single procedure), and post-procedure discharge instructions with follow-up for pain response assessment.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
25 | Significant, separately identifiable E/M service by the same physician on the day of procedure | When a distinct evaluation and management visit is provided on the same day as (e.g., new evaluation leading to block). |