Summary & Overview

CPT 64430: Pudendal Nerve Injection, Anesthetic or Steroid

CPT code 64430 identifies injection of an anesthetic agent, steroid, or both into the pudendal nerve, a targeted peripheral nerve procedure used for diagnostic blockade and therapeutic relief of perineal pain. Nationally, this code is relevant for pain management, urology, gynecology, and interventional anesthesia practices treating pudendal neuralgia and chronic pelvic pain. Use of this code affects outpatient procedural volumes, payer coverage policies, and per-procedure billing practices across national payers.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context for pudendal nerve injections, common service settings, and the typical documentation elements that support reporting of the code. The publication outlines benchmark considerations for utilization and reimbursement patterns, summarizes policy and coverage themes that influence payment and prior authorization, and highlights coding relationships relevant to procedural billing workflows.

The content is aimed at clinicians, coding specialists, and policy analysts seeking a clear, national-level briefing on CPT code 64430, its clinical purpose, and the payer landscape that affects access and billing for pudendal nerve injection services.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare64430CPTpudendal-nerve-injectionpain-managementoutpatient-proceduresinterventional-painneural-blockade

Billing Code Overview

CPT code 64430 describes an injection of an anesthetic agent, steroid, or both into the pudendal nerve, the principal nerve serving the perineum. This procedure is typically performed to provide diagnostic nerve blockade or therapeutic pain relief for pudendal neuralgia and related perineal pain syndromes.

Service Type: Peripheral nerve injection / neural blockade
Typical Site of Service: Outpatient procedure setting such as an ambulatory surgery center or outpatient clinic; may also be performed in a hospital outpatient department

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Clinical & Coding Specifications

Clinical Context

A 42-year-old woman with chronic pudendal neuralgia presents to an outpatient pain clinic after conservative treatments (physical therapy, oral neuropathic agents) provided inadequate relief. She reports sharp, burning perineal pain aggravated by sitting and sexual activity. The pain specialist documents focused history, pain mapping, and a targeted exam consistent with pudendal nerve distribution. After informed consent, the provider performs a diagnostic and therapeutic pudendal nerve injection using local anesthetic with steroid under fluoroscopic or ultrasound guidance. The procedure is performed in an ambulatory surgery center with standard monitoring, sterile technique, and sedation as indicated. Post-procedure, the patient is observed for the immediate analgesic response and monitored for complications before discharge with aftercare instructions and follow-up scheduling.

Coding Specifications

Modifier	Description	When to Use
`59`	Distinct procedural service	Use when the pudendal injection is distinct/separate from other procedures on the same day (e.g., separate anatomic site or independent service).
`62`	Two surgeons	Use when two surgeons of different specialties perform portions of the procedure concurrently and documentation supports co-surgery.
`66`	Surgical team	Use when multiple providers perform components of the procedure as a team and documentation supports team approach.
`76`	Repeat procedure by same physician	Use if the exact pudendal injection is repeated later the same day by the same provider.
`77`	Repeat procedure by another physician	Use if another provider repeats the identical pudendal injection the same day.
`52`	Reduced services	Use when the procedure is partially reduced or not completed as documented.
`53`	Discontinued procedure	Use when the procedure is started but terminated due to extenuating circumstances or patient choice.
`76`	Repeat procedure by same physician	Use if the same physician repeats the injection on the same day (documentation required).
`26`	Professional component	Use when reporting only the physician’s professional component separate from technical services (rare for injections but applicable when separate technical imaging or facility charges exist).
`TC`	Technical component	Use when reporting only the technical component (e.g., facility/imagery) without the physician’s professional work.
`RT`	Right side	Use to denote injection performed on the right pudendal nerve when laterality reporting is required.
`LT`	Left side	Use to denote injection performed on the left pudendal nerve when laterality reporting is required.
`AS`	Ambulatory surgical center facility	Use to report the facility fee when service is performed in an ambulatory surgical center.
`22`	Increased procedural services	Use when work required to perform the pudendal injection is substantially greater than typically required, with supporting documentation.

Taxonomy Code	Specialty	Notes
2084P0800X	Pain Medicine	Pain medicine physicians commonly perform image-guided pudendal nerve injections.
207L00000X	Anesthesiology	Anesthesiologists specializing in pain management frequently perform these injections.
2084P0225X	Physical Medicine & Rehabilitation	PM&R physicians with interventional pain training perform diagnostic and therapeutic pudendal nerve injections.
207RH0000X	Obstetrics & Gynecology	Gynecologists specializing in pelvic pain may perform or coordinate pudendal nerve injections.
3336P0200X	Neurology (Pain)	Neurologists with interventional pain focus may perform or interpret outcomes of injections.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`G57.8`	Other mononeuropathies of lower limb	Includes pudendal neuropathy presentations when a more specific code is not applicable; used for pudendal nerve-related neuropathic pain.
`G89.29`	Other chronic pain	Used when chronic perineal/pudendal pain is the indication for diagnostic or therapeutic injection.
`N94.89`	Other specified conditions associated with female genital organs and menstrual cycle	May be used for specified pelvic pain syndromes related to pudendal neuralgia in gynecologic contexts.
`R10.2`	Pelvic and perineal pain	Symptom code indicating pelvic/perineal pain leading to diagnostic pudendal nerve injection.
`F45.41`	Pain disorder exclusively related to psychological factors	Used when pain has psychological contributors; injections may be part of a multimodal approach when documented.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`64430`	Injection, anesthetic agent and/or steroid, pudendal nerve	Primary code for one or more pudendal nerve injections; used for diagnostic and therapeutic injections to the pudendal nerve.
`64505`	Percutaneous implantation of neurostimulator electrode array; sacral nerve	May be performed for refractory pudendal neuralgia as a subsequent neuromodulation therapy after diagnostic/therapeutic injections.
`64450`	Injection, anesthetic agent; other peripheral nerve or branch	Alternative code for injections to other peripheral nerves when site differs from pudendal nerve in the same patient encounter.
`77002`	Fluoroscopic guidance for needle placement (imaging guidance)	Used when fluoroscopic imaging is documented to guide pudendal nerve injection placement; billed when separate technical service is provided.
`76937`	Ultrasound guidance for needle placement	Used when ultrasound is used to guide needle placement for the pudendal nerve injection and appropriately documented.