Summary & Overview
CPT 64517: Superior Hypogastric Plexus Nerve Block
CPT code 64517 denotes a superior hypogastric plexus nerve block, an interventional pain-management procedure used to treat chronic pelvic pain refractory to medication. The code is clinically significant because chronic pelvic pain affects a substantial patient population and may require advanced procedures when conservative care fails; superior hypogastric plexus blockade can provide diagnostic and therapeutic benefit, especially in pain related to malignancy, gynecologic conditions, and other persistent pelvic pain syndromes. Nationwide relevance stems from utilization in hospital outpatient departments, ambulatory surgery centers, and specialized interventional pain clinics where image guidance and monitored anesthesia care are routinely available.
Key payers considered in typical coverage discussions include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for the procedure, common billing considerations, and expected sites of service. The publication outlines benchmarks and coverage patterns where available, highlights policy updates affecting interventional pain services, and clarifies clinical indications reflected by the code description. The summary equips coding, billing, and clinical teams with a focused reference for documentation needs, site-of-service expectations, and the clinical role of superior hypogastric plexus blockade in managing refractory chronic pelvic pain. Data not available in the input for specific modifiers, taxonomies, ICD-10 pairings, and payer-specific rates.
Billing Code Overview
CPT code 64517 describes a superior hypogastric plexus nerve block, a targeted autonomic nerve block of the thoracolumbar sympathetic chain aimed at relieving chronic pelvic pain that has not responded to medication. The procedure involves injection(s) of anesthetic and/or neurolytic agent(s) to interrupt pain transmission via the superior hypogastric plexus, commonly used when pain arises from malignancy, menstrual-related conditions, or other chronic pelvic pain disorders.
Service Type: Interventional pain management procedure — sympathetic plexus block.
Typical Site of Service: Hospital outpatient department, ambulatory surgery center, or interventional pain clinic where image guidance and monitored anesthesia care are available.
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 52-year-old female with a three-year history of refractory chronic pelvic pain related to endometriosis and prior pelvic radiation presents to the interventional pain clinic. She has failed multiple medication trials including NSAIDs, hormonal therapy, and opioid-sparing analgesics, and reports severe constant deep pelvic pain radiating to the sacral region that impairs ambulation and sleep. Imaging excludes acute surgical pathology. After multidisciplinary discussion, the pain management specialist schedules a fluoroscopy-guided superior hypogastric plexus block using local anesthetic with steroid for diagnostic and therapeutic purposes.
The clinical workflow: the patient arrives to an outpatient interventional radiology/procedural suite or ambulatory surgery center; informed consent and time-out are performed; IV access and monitoring are established; conscious sedation may be provided per protocol; the provider positions the patient prone, uses fluoroscopic or CT guidance to localize the L5–S1 region anterior to the vertebral bodies, advances a spinal needle to the superior hypogastric plexus region, injects contrast to confirm spread, and administers anesthetic ± steroid. The patient is observed for a recovery period for hemodynamic stability and immediate pain response before discharge with post-procedure instructions and follow-up plan.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when reporting only the physician/practitioner professional portion of a diagnostic service if a split-billing scenario exists (rare for procedure-focused codes). |