Summary & Overview
CPT 64420: Intercostal Nerve Injection
CPT code 64420 covers intercostal nerve injections in which an anesthetic agent and/or steroid is injected into the ventral branches of thoracic spinal nerves beneath the ribs. Intercostal nerve blocks are used for diagnostic and therapeutic pain control for thoracic wall and rib-related pain, post-thoracotomy pain, and certain acute pain presentations. Nationally, this procedure is commonly billed across physician specialties including anesthesiology, pain medicine, and thoracic surgery.
Key payers covered in this overview include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of clinical context and typical sites of service, followed by benchmarks and billing considerations where available. The publication summarizes common utilization patterns, payer coverage themes, coding guidance for single-level injections, and typical claim considerations. It also outlines areas where policy updates or payer-specific rules can affect claim adjudication. Data not provided in the input are noted as unavailable where relevant.
Billing Code Overview
CPT code 64420 describes an injection of an anesthetic agent and/or steroid into an intercostal nerve, which is one of the ventral branches of the thoracic spinal nerves located under each rib. This code is reported for one or more injections at a single thoracic level during a single procedure.
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Service type: Intercostal nerve block (therapeutic and/or diagnostic injection)
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Typical site of service: Procedure is typically performed in an ambulatory surgical center, hospital outpatient department, emergency department, or clinic procedure room depending on clinical context and monitoring needs.
Clinical & Coding Specifications
Clinical Context
A typical patient is a 55-year-old male with acute right-sided thoracic rib pain following a recent rib fracture and persistent intercostal neuritis after chest wall surgery. The patient presents to an ambulatory surgical center or hospital outpatient department for targeted pain control. After evaluation, the interventional pain specialist discusses risks and benefits and obtains informed consent. In the procedure room, the patient is positioned prone or lateral decubitus. Under sterile conditions and often with fluoroscopic or ultrasound guidance, the provider identifies the symptomatic thoracic level and injects a local anesthetic with or without corticosteroid around the intercostal nerve beneath the corresponding rib using CPT 64420 (one or more injections at a single level during a single procedure). Post-procedure monitoring occurs for a short observation period for vitals and potential adverse effects (e.g., pneumothorax, local anesthetic systemic toxicity). The patient is discharged to home with activity and follow-up instructions and analgesic plan documented in the outpatient medical record.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
25 | Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure | Use when a same-day E/M visit is distinct from the intercostal injection (e.g., new exam or decision-making). |