Summary & Overview
CPT 64530: Celiac Plexus (Solar Plexus) Nerve Block for Abdominal Pain
CPT code 64530 denotes a celiac plexus (solar plexus) nerve block, an interventional pain management procedure used to reduce severe visceral abdominal pain, often associated with cancer or chronic pancreatitis. This procedure is clinically important nationwide because it can provide significant symptom relief, reduce opioid requirements, and improve quality of life for patients with refractory abdominal pain.
Key payers considered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical indications and typical sites of service, plus payer coverage context and common billing considerations. The publication highlights benchmarks for utilization, reimbursement patterns across major payers, and recent policy updates affecting authorization and coding practice.
The report provides practical context for clinicians, coders, and revenue professionals: clinical rationale for the procedure, how it is billed as an interventional pain service, and where it is typically performed (hospital outpatient departments, ambulatory surgical centers, and interventional pain clinics). It also summarizes payer coverage trends and administrative considerations that affect access and payment. Data gaps are noted where source information was not provided.
Billing Code Overview
CPT code 64530 describes a celiac plexus (solar plexus) nerve block, a targeted procedure that interrupts sympathetic nerve signals to the abdominal organs to treat severe abdominal pain. The procedure is used most commonly for pain related to malignancy or chronic pancreatitis, providing diagnostic and therapeutic relief of visceral abdominal pain.
Service type: Interventional pain management procedure (nerve block)
Typical site of service: Hospital outpatient department, ambulatory surgical center, or interventional pain clinic
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 62-year-old patient with metastatic pancreatic adenocarcinoma presents with severe, refractory upper abdominal and epigastric pain despite optimized opioid therapy. The pain is described as constant, deep, and radiating to the back, interfering with oral intake and quality of life. The palliative care team and interventional pain physician evaluate the patient and determine that a diagnostic and therapeutic celiac plexus block is appropriate to interrupt sympathetic nociceptive input from the pancreas and upper abdominal viscera. The patient undergoes pre-procedure assessment including informed consent, review of anticoagulation status, and imaging review. In a monitored procedural suite or interventional radiology room, the physician performs 64530 (celiac plexus block) using fluoroscopic or CT guidance, administers local anesthetic with or without steroid or neurolytic agent as indicated, and monitors hemodynamics and pain response. Post-procedure, the patient is observed for potential complications (hypotension, diarrhea, local bleeding, transient motor or sensory changes), pain score reassessment, and discharge instructions are provided. Typical sites of service are an outpatient ambulatory surgery center, hospital outpatient department, or interventional radiology suite within a hospital. Common clinical indications include intractable abdominal pain from chronic pancreatitis or malignancy-related visceral pain where celiac plexus blockade can provide diagnostic confirmation and therapeutic relief.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 |