CPT 64786 Sciatic Nerve Tumor Excision Reimbursement | OpenPayer

Summary & Overview

CPT 64786: Sciatic Nerve Tumor Excision

CPT code 64786 denotes excision of a tumor or mass from the sciatic nerve, typically performed to remove a neuroma caused by injury or trauma and to restore nerve function while relieving pain. This procedural code is clinically significant because sciatic nerve tumors and traumatic neuromas can produce severe, persistent pain and functional impairment; accurate coding ensures appropriate procedural classification and facilitates coverage and quality tracking for nerve-sparing surgical interventions.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise national overview of clinical context for 64786, common sites of service, and the service type. The publication summarizes payer coverage patterns and benchmarks where available, highlights coding and policy updates relevant to peripheral nerve tumor excision, and situates the procedure within surgical and postoperative care pathways.

The report aims to help clinicians, billing teams, and policy stakeholders quickly understand what 64786 represents, how it is typically delivered, and which payers are relevant for coverage considerations. Data not available in the input will be noted as such in detailed sections.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare64786CPTperipheral-nerve-surgerysciatic-nerveneuroma-excisionsurgical-procedureorthopedicsneurosurgery

Billing Code Overview

CPT code 64786 describes the surgical removal of a tumor or mass from the sciatic nerve. The procedure targets a neuroma or other nerve lesion that is causing pain and loss of nerve function due to injury or trauma. The primary clinical objective is to relieve pain and restore neurologic function in the affected lower extremity.

Service type: Surgical procedure — peripheral nerve tumor excision
Typical site of service: Hospital operating room or ambulatory surgical center, with potential inpatient or outpatient postoperative care depending on clinical complexity and patient factors

Clinical & Coding Specifications

Clinical Context

A 48-year-old patient presents with progressive posterolateral thigh pain, numbness in the posterior leg and foot, and weakness in ankle dorsiflexion after a remote penetrating injury to the buttock. Conservative management including physical therapy, activity modification, and epidural steroid injections over six months produced minimal relief. MRI of the pelvis demonstrates a 2.5 cm mass along the proximal sciatic nerve consistent with a neuroma or peripheral nerve sheath tumor compressing the nerve. The surgical team (orthopedic peripheral nerve surgeon or neurosurgeon) schedules operative excision of the mass with microsurgical dissection of the sciatic nerve under general anesthesia.

Preoperative workflow includes neuromuscular exam, informed consent documenting expected benefits and risks (including persistent neuropathic pain, sensory loss, motor deficit), baseline nerve conduction studies if indicated, and pre-op imaging review. Intraoperative steps include patient positioning (prone), surgical exposure of the sciatic nerve, careful microsurgical dissection to remove the mass (CPT 64786), nerve repair or grafting if necessary, hemostasis, and layered wound closure. Postoperative care includes pain control, wound checks, outpatient physical therapy for gait and strengthening, and follow-up nerve conduction testing as indicated to assess recovery of nerve function.

Coding Specifications

Modifier	Description	When to Use
`22`

CPT 64795: Nerve Biopsy, Excision of Nerve Sample

CPT-64783-PERIPHERAL-NERVE-NEUROMA-EXCISION-HAND-FOOT-ADDITIONAL

CPT 64783: Additional Peripheral Nerve Neuroma Excision of Hand or Foot

CPT-64776-DIGITAL-NERVE-TUMOR-EXCISION-FINGER-TOE

CPT 64776: Excision of Tumor or Mass on Digital Nerve (Finger/Toe)

CPT-64782-PERIPHERAL-NERVE-TUMOR-EXCISION-HAND-FOOT

CPT 64782: Excision of Peripheral Nerve Tumor, Hand or Foot

CPT-64778-PERIPHERAL-NERVE-TUMOR-EXCISION-ADDITIONAL-DIGIT

CPT 64778: Excision of Additional Peripheral Nerve Tumor in Finger or Toe

CPT-64787-NERVE-END-IMPLANTATION-AFTER-NEUROMA-EXCISION

CPT 64787: Nerve End Implantation After Neuroma Excision

CPT-64784-PERIPHERAL-NERVE-TUMOR-EXCISION

CPT 64784: Peripheral Nerve Tumor Excision, Non-Sciatic

CPT-64792-NERVE-SHEATH-TUMOR-EXCISION-EXTENSIVE

CPT 64792: Excision of Extensive Nerve Sheath Tumor

CPT-64774-NERVE-TUMOR-EXCISION-PERIPHERAL-NERVE

CPT 64774: Excision of Tumor from Mixed Peripheral Nerve

CPT-64788-EXCISION-SUBCUTANEOUS-TUMOR-CUTANEOUS-NERVE

CPT 64788: Excision of Subcutaneous Tumor Along Cutaneous Nerve

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Taxonomy Code	Specialty	Notes
2084P0800X	Orthopedic Surgery	Peripheral nerve and musculoskeletal surgeons commonly perform sciatic nerve tumor excision.
2084N0400X	Neurological Surgery	Neurosurgeons with peripheral nerve expertise perform microsurgical tumor resections.
2084S0111X	Physical Medicine & Rehabilitation	PM&R physicians manage pre- and post-op rehabilitation and nerve function assessment.
207L00000X	Pain Management	Interventional pain specialists assist in pre-op pain control and post-op neuropathic pain management.
207K00000X	Anesthesiology	Anesthesiologists provide general or regional anesthesia for this procedure.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`G56.4`	Lesion of sciatic nerve	Directly describes focal neuropathy or mass affecting the sciatic nerve and is a primary indication for `CPT 64786`.
`G57.50`	Lesion of unspecified sciatic nerve, unspecified lower limb	Used when laterality is not specified or when documentation does not identify side.
`G57.51`	Lesion of right sciatic nerve	Use when the right sciatic nerve is affected and correlates with procedure laterality.
`G57.52`	Lesion of left sciatic nerve	Use when the left sciatic nerve is affected and correlates with procedure laterality.
`M79.2`	Neuralgia and neuritis, unspecified	May be used for neuropathic pain presentations related to neuroma when specific nerve code is not documented.
`D36.1`	Benign neoplasm of peripheral nerves and autonomic nervous system	Applies when imaging/ pathology suggests a benign nerve sheath tumor (e.g., schwannoma) excised by this procedure.
`S74.92XA`	Unspecified injury of nerve, unspecified thigh, initial encounter	Relevant when the neuroma is due to traumatic injury and the visit represents initial encounter for treatment.
`R20.2`	Paresthesia of skin	Symptom code used to document sensory complaints prompting evaluation and surgical treatment.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`64450`	Injection, anesthetic agent; other peripheral nerve or branch	May be used preoperatively for diagnostic or therapeutic peripheral nerve block of the sciatic nerve.
`95970`	Electronic analysis of implanted neurostimulator pulse generator system (e.g., trial)	Used when neuromodulation is considered for refractory neuropathic pain either before or after excision.
`64831`	Excision of lesion of peripheral nerve, arm or leg; single branch	Alternative peripheral nerve excision codes for smaller distal lesions that may be performed in conjunction with or instead of proximal sciatic excision.
`64718`	Neuroplasty and/or transposition; major peripheral nerve (e.g., sciatic)	Used when neurolysis or decompression without tumor excision is performed as part of the operative plan.
`20610`	Arthrocentesis, aspiration and/or injection; major joint or bursa (e.g., hip)	Occasionally performed if joint injection is needed for differential diagnosis of buttock/hip pain concurrent with nerve pathology.

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