CPT 64746 Phrenic Nerve Section Reimbursement | OpenPayer

Summary & Overview

CPT 64746: Phrenic Nerve Section for Unilateral Diaphragmatic Paralysis

CPT code 64746 denotes surgical severing or removal of part of the phrenic nerve to produce unilateral diaphragmatic paralysis. Clinically, the procedure is employed to collapse a diseased lung during extended thoracic operations or to address a damaged or diseased phrenic nerve via resection or repair. The code captures a specialized operative thoracic/nerve surgery with implications for perioperative respiratory management and postoperative rehabilitation.

This national overview covers coverage and payment considerations across major payers: Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the clinical intent and typical care setting, plus what to expect in payer coverage patterns and billing practice for complex thoracic nerve procedures. The publication summarizes common billing modifiers and related administrative notes, outlines typical sites of service, and highlights clinical context relevant to coding and claims submission. It also identifies gaps where input data is not available.

Intended readers include coding professionals, surgical and thoracic practice administrators, and policy analysts seeking a clear, national-level briefing on the use and administrative handling of CPT code 64746 in operative care.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare64746CPTphrenic nervethoracic surgerydiaphragmatic paralysisoperativesurgical codinghospital inpatientoperating room

Billing Code Overview

CPT code 64746 describes a surgical procedure in which the provider severs or removes a portion of the phrenic nerve, producing unilateral diaphragmatic paralysis. The procedure may be performed to collapse a diseased lung during extended thoracic surgery or to replace or repair a damaged or diseased nerve.

Service type: Operative — thoracic/nerve surgery

Typical site of service: Inpatient or outpatient operating room in a hospital or specialized surgical center, most commonly associated with thoracic surgical procedures.

Clinical & Coding Specifications

Clinical Context

A typical patient is an adult undergoing thoracic surgery for a localized malignant or severely diseased lung (for example, non-small cell lung cancer or a destructive postinfectious lung) where temporary or permanent ipsilateral diaphragmatic paralysis is required to facilitate lung collapse and optimize exposure or to replace/repair a damaged phrenic nerve. Preoperative evaluation includes chest imaging (CT chest), pulmonary function testing, anesthesia assessment, and informed consent discussing risks including respiratory compromise. In the operating room under general anesthesia with single-lung ventilation, the thoracic or cardiothoracic surgeon identifies the phrenic nerve intraoperatively and either severs or removes a portion of the nerve (64746) to produce hemi-diaphragmatic paralysis, or performs nerve graft/repair if indicated. Postoperative care includes chest tube management if lobectomy or pneumonectomy accompanies the procedure, monitoring in PACU or ICU for respiratory insufficiency, incentive spirometry, chest radiographs to confirm diaphragmatic elevation, pain control, and pulmonary rehabilitation as indicated. Expected site of service is an inpatient hospital operating room or, less commonly, an ambulatory surgery center when clinically appropriate for isolated nerve procedures.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when work or complexity substantially exceeds usual for (document specific reasons).

CPT 64771: Severance or Removal of Other Cranial Nerves

CPT-64760-ABDOMINAL-VAGOTOMY-REDUCTION-GASTRIC-SECRETION

CPT 64760: Abdominal Vagotomy to Reduce Gastric Secretion

CPT-64766-OBTURATOR-NERVE-NEURECTOMY-GROIN-PAIN

CPT 64766: Obturator Nerve Neurectomy for Groin Pain

CPT-64744-GREATER-OCCIPITAL-NERVE-SEVERING-FOR-OCCIPITAL-NEURALGIA

CPT 64744: Greater Occipital Nerve Severing for Occipital Neuralgia

CPT-64740-LINGUAL-NERVE-TRANSECTION-FOR-FACIAL-PAIN

CPT 64740: Lingual Nerve Transection for Facial Pain

CPT-64755-VAGOTOMY-REDUCTION-GASTRIC-SECRETION

CPT 64755: Surgical Vagotomy to Reduce Gastric Secretion

CPT-64736-MENTAL-NERVE-TRANSECTION-FOR-FACIAL-PAIN

CPT 64736: Mental Nerve Transection for Facial Pain

CPT-64734-INFRAORBITAL-NERVE-TRANSECTION-FOR-FACIAL-PAIN

CPT 64734: Infraorbital Nerve Transection for Facial Pain

CPT-64763-OBTURATOR-NERVE-DECOMPRESSION-OR-NEURECTOMY

CPT 64763: Obturator Nerve Neurectomy or Decompression

CPT-64738-INFERIOR-ALVEOLAR-NERVE-TRANSECTION-MANDIBLE

CPT 64738: Inferior Alveolar Nerve Transection via Mandible

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64746

Taxonomy Code	Specialty	Notes
2084P0800X	Thoracic Surgery	Thoracic surgeons most commonly perform `64746` during lung resections or complex thoracic operations.
2086S0125X	Cardiothoracic Surgery	Cardiothoracic surgeons perform phrenic nerve procedures when combined with cardiac or great vessel surgery.
207L00000X	General Surgery	General surgeons with thoracic expertise may perform this procedure in select settings.
208VP0002X	Otolaryngology (Head & Neck)	Otolaryngologists may perform phrenic nerve procedures when managing neck tumors or nerve reconstruction that involve the phrenic nerve.
261QM0800X	Neurological Surgery	Neurosurgeons may be involved for complex nerve grafting or reconstruction procedures involving the phrenic nerve.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`C34.90`	Malignant neoplasm of unspecified part of unspecified bronchus or lung	Lung cancer requiring lobectomy or pneumonectomy; phrenic nerve section may be done to collapse the lung for exposure during extended thoracic resection.
`J98.4`	Other disorders of lung	Severe localized destructive lung disease or bronchiectasis where lung collapse is needed to facilitate resection or control infection.
`S14.8XXA`	Injury of other nerves at neck level, initial encounter	Traumatic injury to the phrenic nerve requiring repair or resection.
`G54.0`	Brachial plexus disorders (used here as proxy for neuropathic injury contexts)	Nerve injury contexts where surgical nerve work, including phrenic nerve procedures for reconstruction, may be indicated.
`J95.1`	Postprocedural respiratory failure	Potential postoperative complication to monitor; listed here for clinical relevance to perioperative planning.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`32480`	Pleurodesis, mechanical or chemical (eg, talc), with chest tube; each	May be performed when pleural disease or recurrent effusion accompanies thoracic surgery requiring lung collapse; often adjunctive to thoracic procedures.
`32440`	Thoracotomy, with exploration and biopsy; diagnostic	May precede `64746` if open exploration is required to access the phrenic nerve or lung pathology.
`32551`	Thoracotomy including partial lobectomy, wedge resection, or segmental resection	Commonly performed in the same operative session when lung resection is the primary indication and temporary diaphragmatic paralysis is needed to facilitate exposure.
`32820`	Repair of diaphragmatic hernia or laceration	May be performed when the phrenic nerve procedure is undertaken to repair/replace a damaged nerve and address diaphragmatic injury.
`69990`	Microsurgical techniques, requiring use of an operating microscope (list separately in addition to code for primary procedure)	Used when nerve repair or grafting of the phrenic nerve requires microsurgical techniques in conjunction with `64746`.

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