Summary & Overview
CPT 64445: Sciatic Nerve Injection / Nerve Block
CPT code 64445 denotes injection(s) of anesthetic agent(s) and/or steroid into the sciatic nerve region and is used for therapeutic or diagnostic peripheral nerve blockade of the leg. This code matters nationally because sciatic nerve injections are a common interventional pain-management modality for radicular and peripheral neuropathic pain, and consistent coding supports accurate clinical documentation, claims processing, and quality measurement across care settings. Key payers considered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical purpose of the code, typical sites of service, and the scope of services reported with 64445. The publication summarizes commonly observed billing patterns, payer coverage considerations, and operational benchmarks where available. It also outlines coding context that affects claim adjudication — such as how the code represents one or more injections during a single procedure — and highlights areas where policy updates or payer-specific rules commonly influence coverage and reimbursement. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 64445 describes injection of one or more anesthetic agents and/or a steroid into the area of the sciatic nerve. The procedure targets the sciatic nerve, which supplies the skin and muscles of the leg, and is reported when one or more injections are performed during a single procedure.
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Service type: Image-guided or non–image-guided peripheral nerve injection/nerve block targeting the sciatic nerve (therapeutic or diagnostic nerve block)
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Typical site of service: Outpatient procedural settings such as ambulatory surgical centers, hospital outpatient departments, or office-based procedure suites where peripheral nerve injections are commonly performed
Clinical & Coding Specifications
Clinical Context
A 56-year-old patient presents to an outpatient ambulatory surgery center with chronic unilateral posterior thigh and lower-leg pain radiating along the sciatic nerve distribution. Conservative management including oral analgesics, physical therapy, and activity modification produced incomplete relief. Imaging (lumbar MRI) shows lateral recess stenosis with possible nerve root irritation, and the physical exam reproduces radicular pain with straight-leg raise. The interventional pain physician performs a targeted sciatic nerve injection under fluoroscopic or ultrasound guidance, injecting one or more anesthetic agents with or without steroid around the sciatic nerve to provide diagnostic information and therapeutic relief. The typical workflow includes pre-procedure consent and time-out, positioning, sterile preparation, image localization, infiltration of local anesthetic at the skin, needle advancement to peri-neural location, aspiration, incremental injection of anesthetic/steroid, post-procedure monitoring for immediate response, and documentation of laterality, agents, volumes, and the patient’s response. Typical site of service is an outpatient ambulatory surgery center or physician office procedure suite; the service is reported for one or more injections during a single procedure using 64445.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when reporting only the physician professional component separated from technical services provided by facility or imaging staff. |