Summary & Overview
CPT 64450: Peripheral Nerve Injection, Anesthetic and/or Steroid
CPT code 64450 covers injections of an anesthetic agent, a steroid, or both administered adjacent to a peripheral nerve or branch that is not represented by a more specific code. Clinically, these procedures are used for diagnostic nerve blocks or therapeutic pain management and can be performed in outpatient, office-based, or ambulatory surgical settings. Nationally, this code matters because it captures a broad set of peripheral nerve injection procedures that affect billing consistency, prior authorization workflows, and payment policy across commercial and public payers.
Key payers in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of where 64450 fits in the procedural code set, comparisons to related injection codes, expected sites of service, and the common clinical contexts that support use of the code. The publication also outlines common billing considerations, allowable reporting conventions for multiple injections during a single procedure, and typical clinical indications linked to peripheral nerve injections.
This summary provides the context needed to interpret benchmarks and policy guidance, surface potential coding pitfalls, and inform revenue cycle and compliance stakeholders about operational impacts when 64450 is used.
Billing Code Overview
CPT code 64450 describes an injection of an anesthetic agent, steroid, or both administered close to a peripheral nerve or branch not represented by another code. This code is intended to represent one or more injections given during a single procedure when the targeted peripheral nerve or branch does not have a more specific CPT code.
Service Type: Peripheral nerve injection; anesthetic and/or steroid
Typical Site of Service: Outpatient procedure setting or ambulatory surgical center; may also be performed in office-based procedural suites depending on clinical context and payer rules.
Clinical & Coding Specifications
Clinical Context
A 62-year-old patient presents to an outpatient pain clinic with persistent neuropathic facial pain following a herpes zoster infection affecting the trigeminal distribution. Conservative measures including oral analgesics and neuropathic agents provided incomplete relief. The pain specialist performs a peripheral nerve block targeting branches of the trigeminal nerve using a mixture of local anesthetic and corticosteroid to reduce inflammation and interrupt pain signaling. The procedure is performed in an ambulatory procedure room with continuous monitoring (vital signs, pulse oximetry). Informed consent is obtained, sterile technique is used, and the injection is delivered at one or more nearby peripheral nerve branches not specifically described by other CPT codes. Post‑procedure observation includes monitoring for immediate adverse effects, documentation of the number of injections, agents used, laterality, and any procedure‑related complications. Typical settings include outpatient pain clinics, ambulatory surgery centers, or hospital outpatient departments.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
25 | Significant, separately identifiable evaluation and management (E/M) service by the same physician on the same day | When a distinct E/M visit is performed and documented on the same date as the injection procedure |