Summary & Overview
CPT 64742: Facial Nerve Transection for Relief of Facial Pain
CPT code 64742 designates a surgical neurolytic procedure that transects or forcibly tears the facial nerve or its branches to diminish sensation and relieve refractory facial pain. As an invasive, irreversible intervention, this code captures a high-acuity, specialized surgical service typically performed in hospital operating rooms or specialized surgical centers. Nationally, services billed under this code are important for coverage, utilization review, and clinical decision pathways for patients with severe, treatment-resistant facial pain.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of the clinical context for the procedure, common billing considerations, and how payers commonly categorize high-acuity neurolytic facial procedures. The publication also summarizes benchmarks for site-of-service expectations, documentation components that support medical necessity, and typical scenarios prompting use of this procedure code.
The content is geared to billing managers, surgical providers, clinical coders, and policy analysts seeking concise guidance on coding context, payer coverage landscape, and operational considerations for CPT code 64742. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 64742 describes a surgical procedure in which the provider transects or forcibly tears the facial nerve or any branch of the facial nerve to reduce facial pain by diminishing sensation. This procedure is a targeted neurolytic or destructive intervention intended to provide pain relief when other treatments are ineffective.
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Service type: Surgical neurolytic procedure on the facial nerve
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Typical site of service: Hospital operating room or specialized surgical center
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult with severe, refractory facial neuropathic pain (for example, postherpetic neuralgia or intractable trigeminal/facial neuralgia) who has failed conservative measures including multiple medication trials (anticonvulsants, antidepressants, opioids as appropriate), nerve blocks, and less invasive procedures. The patient presents to an outpatient surgical center or hospital operating room for a targeted peripheral facial nerve branch transaction (neurotomy) performed by a facial nerve specialist (otolaryngologist, plastic/reconstructive surgeon, or neurosurgeon) to diminish painful afferent signaling.
The clinical workflow includes preoperative evaluation with history, focused cranial nerve exam, review of prior imaging (CT/MRI) and nerve conduction or diagnostic nerve block results confirming the implicated branch. Informed consent documents discuss expected sensory changes and risk of motor dysfunction. On the day of service, the patient undergoes appropriate anesthesia (local with sedation or general), sterile preparation, surgical exposure or percutaneous approach to the offending facial nerve branch, controlled transection/avulsion for pain relief, hemostasis, and wound closure. Postoperative care includes pain control, wound care instructions, scheduled follow-up to assess pain reduction and facial function, and documentation of complications or additional procedures if needed.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
11 | Normal, unrelated postoperative follow-up |