Summary & Overview
CPT 64680: Celiac Plexus Neurolytic Injection
CPT code 64680 denotes a celiac plexus neurolytic injection — an interventional pain management procedure that destroys the celiac plexus with a neurodestructive agent to reduce severe chronic abdominal pain from causes such as abdominal malignancy or chronic pancreatitis. This procedure can be performed with image guidance and is typically delivered in ambulatory surgical centers, hospital outpatient departments, or specialized interventional pain clinics. Nationally, 64680 matters because it is a specialized, clinically-driven service often associated with high-acuity pain management and oncology support care.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context and service settings, common payer coverage considerations, and the types of benchmarks and policy topics typically relevant to this code (coverage criteria, site-of-service implications, and utilization patterns). The publication summarizes common modifiers and administrative details provided in the input and identifies gaps where data were not supplied. The aim is to equip billing, clinical, and payer audiences with a clear, nationally-focused reference for CPT code 64680 to support coding, claims review, and policy discussions.
Billing Code Overview
CPT code 64680 describes a celiac plexus neurolytic injection in which the provider destroys the celiac plexus by injecting a neurodestructive agent to reduce abdominal pain. The procedure targets a cluster of ganglia and radiating nerves in the abdomen and is used for severe chronic abdominal pain caused by conditions such as abdominal cancer or chronic pancreatitis.
Service Type: Neurolytic abdominal pain intervention / interventional pain management
Typical Site of Service: Ambulatory surgical center, hospital outpatient department, or interventional pain clinic
Clinical & Coding Specifications
Clinical Context
A 62-year-old patient with metastatic pancreatic adenocarcinoma presents with severe, refractory upper abdominal and back pain despite escalating opioid therapy and adjuvant neuropathic agents. The pain significantly limits oral intake and activities of daily living. After multidisciplinary review, the interventional pain specialist schedules a celiac plexus neurolysis to reduce visceral abdominal pain.
The typical clinical workflow: the patient undergoes pre-procedure evaluation including review of cancer staging, coagulation status, and current anticoagulant/antiplatelet therapy. Informed consent documents expected benefits and risks. On the day of service the patient is placed in the prone or semi-upright position in an ambulatory surgery center or hospital procedure suite. Conscious sedation or monitored anesthesia care is provided. Imaging guidance (fluoroscopy, CT, or ultrasound) is used to localize the celiac plexus. A needle is advanced to the appropriate anatomic target and contrast may be injected to confirm spread. A neurolytic agent (commonly alcohol or phenol) is injected to destroy the celiac plexus. Post-procedure monitoring occurs for hemodynamic stability and pain response; discharge instructions address transient hypotension, diarrhea, and infection signs. Documentation includes indication, informed consent, sedation/anesthesia record, imaging guidance, needle approach, agent and volume, laterality if applicable, complications, and post-procedure status.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 |