Summary & Overview
CPT 64804: Cervicothoracic Sympathetic Nerve Resection/Ablation
CPT code 64804 represents surgical removal or destruction of a portion of the cervicothoracic sympathetic nerve chain to relieve pain or improve blood flow in patients with vasospasm or narrowed vessels. Nationally, this procedure is relevant for specialists managing refractory neuropathic pain and vascular insufficiency where sympathetic denervation is indicated. Coverage and payment policies for this procedure affect access to a niche set of interventions often performed in inpatient or ambulatory surgical settings.
Key payers considered include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context and expected service settings, a summary of common modifiers and administrative considerations, and what typical payer coverage discussions focus on for this type of surgically invasive sympathetic denervation.
This publication provides benchmarks and policy-oriented context useful for coding, billing, and payer negotiation teams, as well as clinicians seeking clarity on how CPT code 64804 is categorized and where it is typically performed. Data not available in the input highlights where detailed payer-specific rates, associated taxonomies, and linked ICD-10 diagnoses are not provided and should be obtained from payer contracts or clinical documentation guidelines.
Billing Code Overview
CPT code 64804 describes a surgical procedure in which the provider removes or destroys a portion of the cervicothoracic sympathetic nerve chain. The intervention is performed to relieve neuropathic pain or to increase blood flow in patients with vasospastic or narrowed blood vessels.
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Service type: Surgical nerve ablation/resection of the cervicothoracic sympathetic chain
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Typical site of service: Ambulatory surgical center or hospital operating room
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 58-year-old patient with severe, refractory ischemic pain of the upper extremity and documented vasospasm secondary to peripheral vascular disease is referred for sympathetic chain interruption. The patient reports rest pain, trophic changes, and poor wound healing despite optimized medical therapy including antiplatelet agents, vasodilators, and smoking cessation counseling. Diagnostic evaluation includes vascular imaging and a sympathetic block that produced temporary relief. The interventional pain or vascular surgeon schedules a cervicothoracic (stellate) ganglionectomy/ablation (64804) to interrupt the cervicothoracic sympathetic chain to reduce vasospasm and improve blood flow.
The clinical workflow includes pre-procedure informed consent and review of imaging, perioperative assessment and anesthesia evaluation (local with monitored anesthesia care or general anesthesia), intraoperative localization of the cervicothoracic ganglion under fluoroscopic or ultrasound guidance, resection or chemical/radiofrequency ablation of the target portion of the sympathetic chain, hemostasis and closure, and post-anesthesia recovery with focused neurovascular and pulmonary monitoring. Follow-up visits assess pain reduction, improvement in perfusion, and surveillance for complications such as Horner syndrome, pneumothorax, infection, or neuropathic pain.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
11 |