CPT code 64400: Introduction/injection of anesthetic agent (nerve block), diagnostic or therapeutic procedures on the somatic nerves

What is CPT code 64400?

CPT code 64400 describes the injection of anesthetic agents and/or steroids near branches of the trigeminal nerve (fifth cranial nerve). Providers, such as anesthesiologists, neurologists, and pain management specialists, use this code to report peripheral nerve blocks targeting the ophthalmic, maxillary, or mandibular branches of the trigeminal nerve. The procedure involves administering anesthetics to alleviate acute or chronic pain conditions like trigeminal neuralgia, trauma-related facial pain, or post-surgical pain management. This nerve block is essential for effective pain control and diagnostic evaluation.

CPT Code 64400 documentation requirements

Thorough documentation is crucial to establish medical necessity and secure reimbursement for nerve block procedures under CPT code 64400.

Targeted nerve branch

Specify clearly in the patient’s medical record which branch or branches of the trigeminal nerve (ophthalmic, maxillary, or mandibular) were injected. Accurate identification of the targeted nerve ensures proper billing and reflects medical necessity.

Indication for nerve block

Document the clinical indication that justifies the nerve block. Common indications include trigeminal neuralgia, facial trauma, chronic neuropathic pain, or post-operative pain management following facial or oral surgical procedures.

Drugs used and dosage

Record the specific anesthetic and/or steroid medications used, including their dosages and concentrations. This supports the clinical rationale for the nerve block and ensures clarity for patient safety and treatment evaluation.

Imaging guidance (if applicable)

If ultrasound or other imaging modalities are utilized for precise needle placement during the nerve block, clearly document the imaging technique used. Include images or narrative notes in the medical record to substantiate billing for imaging guidance.

Patient response

Document the patient's immediate response to the procedure, noting pain relief achieved, any side effects, or complications experienced. Such documentation supports medical necessity and informs future pain control strategies.

CPT code 64400 billing guidelines

Proper coding and billing practices ensure correct reimbursement for services provided under CPT code 64400.

Bill once per branch injected

CPT code 64400 should be billed once per distinct trigeminal nerve branch injected (ophthalmic, maxillary, or mandibular). Multiple injections into divisions of the same branch count as one billing unit and should not be reported separately.

Modifier 59 for additional branches

When injections target multiple distinct trigeminal nerve branches during the same session, append Modifier 59 (Distinct Procedural Service) to subsequent units of 64400. This clarifies that each injection represents a distinct procedural service.

Imaging guidance (CPT 76942)

If imaging guidance, such as ultrasound, is employed and properly documented, report CPT code 76942 separately. Ensure documentation clearly justifies the necessity of imaging for accurate nerve localization.

Not reported with CPT 64450 for the same nerve

Do not bill CPT code 64400 alongside CPT code 64450 (other peripheral nerve injection) when injections involve the same nerve. CPT 64450 applies to injections targeting other peripheral nerves outside the trigeminal nerve distribution.

Related CPT codes

• 64402 – Injection, anesthetic agent; facial nerve
• 64405 – Injection, anesthetic agent; greater occipital nerve
• 64415 – Injection, anesthetic agent; brachial plexus, single
• 64447 – Injection, anesthetic agent; femoral nerve
• 64450 – Injection, anesthetic agent; other peripheral nerve or branch