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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.

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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.

Service type: Intercostal nerve block (therapeutic and/or diagnostic injection)
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.

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CPT 64420: Intercostal Nerve Injection

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Billing Code Overview

Service type: Intercostal nerve block (therapeutic and/or diagnostic injection)
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).
`59`	Distinct procedural service	Use when the intercostal injection is separate from another procedure on the same date and not typically bundled.
`51`	Multiple procedures	Use when multiple unrelated procedures are reported during the same session and payer requires this modifier for multiple-procedure reductions.
`52`	Reduced services	Use when the procedure is partially reduced or not completed as described by the full code.
`53`	Discontinued procedure	Use when the procedure is started but halted due to extenuating circumstances.
`26`	Professional component	Use if billing only the physician’s professional component separate from a facility or technical component (rare for injections).
`TC`	Technical component	Use if billing only the technical component (facility/supply) when the provider bills separately.
`59`	Distinct procedural service	(Note: duplicate entry intentionally avoided; see above)
`RT`	Right side	Use to designate procedures performed on the right side when laterality reporting is required.
`LT`	Left side	Use to designate procedures performed on the left side when laterality reporting is required.
`50`	Bilateral procedure	Use when a bilateral intercostal injection is reported and payer accepts a bilateral modifier.
`76`	Repeat procedure by same physician	Use when a repeat procedure is performed later the same day by the same physician (not listed in input modifiers; omitted).

Taxonomy Code	Specialty	Notes
207RH0000X	Anesthesiology	Common providers performing intercostal nerve injections for acute or chronic thoracic pain.
2084P0800X	Pain Medicine	Interventional pain specialists performing image-guided nerve injections.
208D00000X	Physical Medicine & Rehabilitation	Physicians who may perform injections for post-surgical or musculoskeletal thoracic pain.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`S22.41XA`	Fracture of one rib, right side, initial encounter for closed fracture	Intercostal nerve injection may be used for analgesia in rib fracture pain localized to a single thoracic level.
`S22.42XA`	Fracture of one rib, left side, initial encounter for closed fracture	Same clinical relevance for left-sided rib fracture pain management.
`M54.6`	Pain in thoracic spine	Thoracic radicular or intercostal neuralgia symptoms may prompt intercostal nerve block.
`G89.29`	Other chronic pain	Used for chronic thoracic wall pain when intercostal injection is part of management.
`G58.9`	Mononeuropathy, unspecified	Intercostal neuropathy or neuritis may be coded under mononeuropathy when precise code unavailable.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`20552`	Injection(s); single or multiple trigger point(s), 3 or more muscle(s)	May be performed for coexisting myofascial chest wall pain in the same clinical visit.
`64450`	Injection, anesthetic agent; trigeminal nerve, any division	Example of other peripheral nerve block codes; not performed concurrently but shows similar coding structure.
`77002`	Fluoroscopic guidance for needle placement (radiological guidance)	Often performed contemporaneously to assist localization for `CPT 64420`.
`99213`	Established patient office visit, typically 15 minutes	Common same-day E/M service that may be billed with modifier `25` if separately identifiable from the procedure.
`99152`	Moderate sedation services by the same physician performing a diagnostic or therapeutic service (monitored anesthesia care)	Used when moderate sedation is provided during the injection procedure and reported per payer rules.

CPT 64400: Trigeminal Nerve Branch Injection

CPT-64405-GREATER-OCCIPITAL-NERVE-INJECTION

CPT 64405: Greater Occipital Nerve Injection for Pain Management

CPT-64408-VAGUS-NERVE-INJECTION

CPT 64408: Vagus Nerve Injection of Anesthetic and/or Steroid

CPT-64415-BRACHIAL-PLEXUS-NERVE-BLOCK-INJECTION

CPT 64415: Brachial Plexus Nerve Block Injection

CPT-64416-BRACHIAL-PLEXUS-CONTINUOUS-INFUSION-CATHETER

CPT 64416: Brachial Plexus Catheter Placement with Continuous Infusion

CPT-64417-AXILLARY-NERVE-INJECTION-NERVE-BLOCK

CPT 64417: Axillary Nerve Injection (Nerve Block)

CPT-64418-SUPRASCAPULAR-NERVE-INJECTION-SHOULDER

CPT 64418: Suprascapular Nerve Injection for Shoulder Pain

CPT-64421-INTERCOSTAL-NERVE-INJECTION-ADDITIONAL-LEVEL

CPT 64421: Intercostal Nerve Injection, Additional Level

CPT-64425-ILIOINGUINAL-ILIOHYPOGASTRIC-NERVE-INJECTION

CPT 64425: Ilioinguinal/Iliohypogastric Nerve Injection

CPT-64430-PUDENDAL-NERVE-INJECTION

CPT 64430: Pudendal Nerve Injection, Anesthetic or Steroid

Showing 1–10 of 37

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

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Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

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Clinical & Coding Specifications

Clinical Context

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).
`59`	Distinct procedural service	Use when the intercostal injection is separate from another procedure on the same date and not typically bundled.
`51`	Multiple procedures	Use when multiple unrelated procedures are reported during the same session and payer requires this modifier for multiple-procedure reductions.
`52`	Reduced services	Use when the procedure is partially reduced or not completed as described by the full code.
`53`	Discontinued procedure	Use when the procedure is started but halted due to extenuating circumstances.
`26`	Professional component	Use if billing only the physician’s professional component separate from a facility or technical component (rare for injections).
`TC`	Technical component	Use if billing only the technical component (facility/supply) when the provider bills separately.
`59`	Distinct procedural service	(Note: duplicate entry intentionally avoided; see above)
`RT`	Right side	Use to designate procedures performed on the right side when laterality reporting is required.
`LT`	Left side	Use to designate procedures performed on the left side when laterality reporting is required.
`50`	Bilateral procedure	Use when a bilateral intercostal injection is reported and payer accepts a bilateral modifier.
`76`	Repeat procedure by same physician	Use when a repeat procedure is performed later the same day by the same physician (not listed in input modifiers; omitted).

Taxonomy Code	Specialty	Notes
207RH0000X	Anesthesiology	Common providers performing intercostal nerve injections for acute or chronic thoracic pain.
2084P0800X	Pain Medicine	Interventional pain specialists performing image-guided nerve injections.
208D00000X	Physical Medicine & Rehabilitation	Physicians who may perform injections for post-surgical or musculoskeletal thoracic pain.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`S22.41XA`	Fracture of one rib, right side, initial encounter for closed fracture	Intercostal nerve injection may be used for analgesia in rib fracture pain localized to a single thoracic level.
`S22.42XA`	Fracture of one rib, left side, initial encounter for closed fracture	Same clinical relevance for left-sided rib fracture pain management.
`M54.6`	Pain in thoracic spine	Thoracic radicular or intercostal neuralgia symptoms may prompt intercostal nerve block.
`G89.29`	Other chronic pain	Used for chronic thoracic wall pain when intercostal injection is part of management.
`G58.9`	Mononeuropathy, unspecified	Intercostal neuropathy or neuritis may be coded under mononeuropathy when precise code unavailable.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`20552`	Injection(s); single or multiple trigger point(s), 3 or more muscle(s)	May be performed for coexisting myofascial chest wall pain in the same clinical visit.
`64450`	Injection, anesthetic agent; trigeminal nerve, any division	Example of other peripheral nerve block codes; not performed concurrently but shows similar coding structure.
`77002`	Fluoroscopic guidance for needle placement (radiological guidance)	Often performed contemporaneously to assist localization for `CPT 64420`.
`99213`	Established patient office visit, typically 15 minutes	Common same-day E/M service that may be billed with modifier `25` if separately identifiable from the procedure.
`99152`	Moderate sedation services by the same physician performing a diagnostic or therapeutic service (monitored anesthesia care)	Used when moderate sedation is provided during the injection procedure and reported per payer rules.

CPT 64400: Trigeminal Nerve Branch Injection

CPT-64405-GREATER-OCCIPITAL-NERVE-INJECTION

CPT 64405: Greater Occipital Nerve Injection for Pain Management

CPT-64408-VAGUS-NERVE-INJECTION

CPT 64408: Vagus Nerve Injection of Anesthetic and/or Steroid

CPT-64415-BRACHIAL-PLEXUS-NERVE-BLOCK-INJECTION

CPT 64415: Brachial Plexus Nerve Block Injection

CPT-64416-BRACHIAL-PLEXUS-CONTINUOUS-INFUSION-CATHETER

CPT 64416: Brachial Plexus Catheter Placement with Continuous Infusion

CPT-64417-AXILLARY-NERVE-INJECTION-NERVE-BLOCK

CPT 64417: Axillary Nerve Injection (Nerve Block)

CPT-64418-SUPRASCAPULAR-NERVE-INJECTION-SHOULDER

CPT 64418: Suprascapular Nerve Injection for Shoulder Pain

CPT-64421-INTERCOSTAL-NERVE-INJECTION-ADDITIONAL-LEVEL

CPT 64421: Intercostal Nerve Injection, Additional Level

CPT-64425-ILIOINGUINAL-ILIOHYPOGASTRIC-NERVE-INJECTION

CPT 64425: Ilioinguinal/Iliohypogastric Nerve Injection

CPT-64430-PUDENDAL-NERVE-INJECTION

CPT 64430: Pudendal Nerve Injection, Anesthetic or Steroid

Showing 1–10 of 37

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

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CPT 64420: Intercostal Nerve Injection

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Billing Code Overview

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CPT 64420: Intercostal Nerve Injection

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Billing Code Overview

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References