Summary & Overview
CPT 64681: Superior Hypogastric Plexus Neurolysis for Pelvic Pain
CPT code 64681 denotes neurolytic destruction of the superior hypogastric plexus to reduce pelvic pain, often used for malignant pain or refractory pelvic pain from conditions such as endometriosis. The procedure can employ chemical, thermal, or electrical means and is commonly performed with imaging guidance. Nationally, this code is relevant for specialty pain practices, interventional radiology, and oncology palliative care due to its role in managing severe pelvic pain when conservative measures fail.
Key payers in coverage discussions include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers can expect coverage and utilization benchmarks, common clinical indications, and coding context relevant to billing and prior authorization workflows. The publication provides guidance on typical service settings, expected documentation elements tied to indication and imaging guidance, and how payers commonly frame medical necessity for neurolytic procedures.
This summary is intended for a national audience of clinicians, practice managers, and reimbursement analysts seeking a concise overview of CPT code 64681, its clinical application, and the payer landscape. Data not available in the input is noted where applicable in detailed sections.
Billing Code Overview
CPT code 64681 describes a neurolytic procedure in which the superior hypogastric plexus is destroyed by injection of a neurodestructive agent (chemical, thermal, or electrical) to reduce pelvic pain. The description notes use for conditions such as malignancy or endometriosis. The procedure may be performed with imaging guidance.
Service type: Neurolytic pain control / nerve destruction procedure
Typical site of service: Hospital outpatient department, ambulatory surgical center, or interventional pain clinic
Clinical & Coding Specifications
Clinical Context
A 54-year-old female with advanced gynecologic malignancy presents with severe, intractable pelvic pain refractory to escalating opioid therapy and multiple prior pelvic nerve blocks. After multidisciplinary review, the pain management specialist schedules a superior hypogastric plexus neurolytic block. The procedure is performed in an outpatient procedure suite with appropriate monitoring. Under fluoroscopic or CT guidance, the provider advances needles to the anterior surface of the L5–S1 vertebral junction and injects a neurodestructive agent (chemical neurolytic such as alcohol or phenol, thermal ablation, or radiofrequency lesioning) to disrupt the superior hypogastric plexus. Vital signs and neurologic status are monitored during recovery; the patient is observed for potential complications including hypotension, neurogenic bladder dysfunction, bleeding, infection, or inadvertent spread of neurolytic agent. Post-procedure documentation includes informed consent, indication (e.g., malignant pelvic pain), imaging guidance used, laterality if applicable, agent and volume, immediate response to the block, and discharge instructions with follow-up planning.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
11 | Provider performs the service as usual (normal, baseline) | Use for standard reporting of the primary service when no other modifier applies. |