Summary & Overview
CPT 64418: Suprascapular Nerve Injection for Shoulder Pain
CPT code 64418 represents a suprascapular nerve injection in which a provider administers an anesthetic agent and/or steroid near the suprascapular nerve above the scapula. This targeted nerve injection is used in the management of shoulder pain and can be performed as a diagnostic or therapeutic intervention. Nationally, it matters because suprascapular nerve injections are commonly used across outpatient and ambulatory settings to reduce pain, guide further management, and potentially avoid surgery.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find benchmarks for utilization and reimbursement practices across major payers, clinical context on indications and typical sites of service, and summaries of relevant policy elements affecting coverage and prior authorization. The publication also outlines billing considerations specific to 64418, payer variability, and common documentation expectations. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 64418 describes an injection of an anesthetic agent and/or steroid close to the suprascapular nerve, which lies above the scapula (shoulder blade). The procedure covers one or more injections administered during a single session.
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Service type: Peripheral nerve block / targeted shoulder injection
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Typical site of service: Outpatient clinic, ambulatory surgery center, or hospital outpatient department focused on shoulder/upper extremity procedures
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult presenting to an outpatient orthopedic or pain-management clinic with chronic shoulder pain, often localized to the posterior or superior shoulder and worse with overhead activities. The patient may report a history of rotator cuff tendinopathy, adhesive capsulitis, or unresolved pain following shoulder surgery. After a focused history and physical exam that localizes pain to the suprascapular nerve distribution and consideration of conservative care (rest, physical therapy, NSAIDs), the clinician discusses a diagnostic and/or therapeutic suprascapular nerve block. The procedure is performed in a procedure room or ambulatory surgery center. Under sterile technique and with either ultrasound or landmark guidance, the provider injects an anesthetic and may add corticosteroid near the suprascapular nerve at the suprascapular notch or spinoglenoid notch. Post-procedure, the patient is monitored briefly for adverse reactions, given post-procedure instructions, and scheduled for follow-up to assess pain relief and potential further interventions such as repeat injections or referral for surgical management.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when billing only the physician professional service separate from facility technical component (rare for this injection). |