Summary & Overview
CPT 64425: Ilioinguinal/Iliohypogastric Nerve Injection
CPT code 64425 represents an ilioinguinal/iliohypogastric nerve injection in which a provider delivers an anesthetic agent and/or steroid near branches of the first lumbar nerve to relieve lower abdominal or groin pain. Nationally, this code is relevant for pain management, postoperative analgesia after inguinal surgery, and diagnostic nerve blockade. Payers commonly involved in coverage decisions and reimbursement for this service include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.
Readers will find a concise overview of the clinical context for targeted peripheral nerve injections, payer coverage patterns, and common billing elements tied to this service. The publication outlines national benchmarks for utilization and reimbursement, highlights policy considerations that affect prior authorization and coding practice, and summarizes clinical indications and typical sites of service where 64425 is reported. Data not available in the input will be noted where applicable.
Billing Code Overview
CPT code 64425 describes an injection of an anesthetic agent and/or steroid administered close to the nerves that branch from the first lumbar nerve — specifically the ilioinguinal nerve or the iliohypogastric nerve. This procedure is used for targeted nerve blockade to relieve pain originating in the lower abdominal wall and groin region.
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Service type: Peripheral nerve block / therapeutic injection
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Typical site of service: Outpatient procedure room, ambulatory surgery center, or hospital outpatient department where minor image-guided or landmark-based injections are performed.
Clinical & Coding Specifications
Clinical Context
A 42-year-old female presents to an outpatient ambulatory surgery center with chronic right lower abdominal and groin pain localized to the ilioinguinal/iliohypogastric nerve distribution following an open inguinal hernia repair six months prior. Conservative measures including NSAIDs, neuropathic agents, and physical therapy provided incomplete relief. After history, physical exam with Tinel sign over the ilioinguinal region, and diagnostic local anesthetic injection confirming pain relief, the provider schedules a therapeutic ilioinguinal/iliohypogastric nerve block with corticosteroid.
Procedure is performed under sterile technique in a procedure room or minor operating room. The patient is positioned supine, and the provider identifies anatomical landmarks (approximately 1 cm medial and superior to the anterior superior iliac spine). After skin antisepsis and local skin anesthetic, a needle is advanced toward the ilioinguinal/iliohypogastric nerve plane and an anesthetic agent with or without steroid is injected. Post-procedure monitoring for vital signs and immediate complications occurs in the recovery area. Documentation includes indication, laterality, agents and volumes used, response to diagnostic anesthetic (if performed), consent, and post-procedure instructions.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
25 | Data not available in the input. | Data not available in the input. |