CPT Code 64722: Decompression of Unspecified Peripheral Nerve

What is peripheral nerve decompression?

Peripheral nerve decompression is a surgical procedure designed to relieve pressure on peripheral nerves that are entrapped or compressed, often due to surrounding tissues such as muscles, ligaments, or scar tissue. It is commonly used to treat conditions like tarsal tunnel syndrome, diabetic neuropathy, and posterior tibial nerve decompression.

When a specific nerve cannot be identified, the 64722 CPT code may be used to report decompression of an unspecified nerve. The procedure typically involves external neurolysis, where the nerve is carefully exposed and freed to restore normal function and reduce pain.

Due to ongoing scrutiny from Medicare, Medicaid services, and commercial payers, the use of the 64722 CPT code must align with the Correct Coding Initiative (CCI) guidance, local coverage determinations (LCDs), and national coverage determinations (NCDs). In some cases, a procedure may be considered investigational if there is insufficient scientific evidence to support its efficacy for the diagnosed condition.

Ensure compliance with the National Correct Coding Initiative (NCCI) to avoid claim denials when reporting CPT 64722 alongside related procedures.

Documentation requirements

Thorough documentation is essential when reporting CPT code 64722 for decompression of an unspecified peripheral nerve. Include the following elements to support medical necessity, ensure accurate coding, and reduce the risk of denial:

• Preoperative diagnosis and clinical symptoms (e.g., nerve entrapment, diabetic neuropathy, or chronic pain)
• Specific nerve decompressed (e.g., posterior tibial nerve, plantar digital nerve) and surgical approach taken
• Detailed notice and description of structures released or exercised during the procedure
• Use of a microscope or surgical loupe, if applicable, as part of the decompression technique
• Intraoperative findings describing nerve condition, degree of compression, especially when using an unspecified nerve code, along with any relevant literature or scientific evidence, if the procedure is not widely covered
• Post-op care and treatment plan for the patient, including referrals for physical therapy or follow-up management

Documentation should align with CCI rules, LCDs, and NCDs where applicable, especially when coverage may be limited due to insufficient evidence.  

Billing guidelines

For proper billing of CPT code 64722, keep in mind the following guidelines:

• Do not report CPT 64722 in conjunction with named nerve decompression codes (e.g., 64721 for median nerve or 64718 for ulnar nerve) for the same surgical site, as this would constitute unbundling under NCCI edits.
• The procedure can be reported bilaterally using modifier -50 or -LT/-RT, depending on payer-specific requirements.
• If microsurgical techniques were used, CPT 69990 (operating microscope) may be billed separately, but only if supported by operative documentation and if not bundled per CCI guidelines.
• The procedure is subject to the global surgical package; E/M services during the global period are not separately billable unless they are unrelated and separately identifiable (modifiers like -24 may be required).
• Always check for NCCI edits when billing 64722 alongside procedures involving tendons, vessels, or other structures in the same anatomic region, as bundling rules may apply.

Other relevant CPT codes

• 64721: Neuroplasty and/or transposition of the median nerve at the carpal tunnel
• 64718: Ulnar nerve at elbow transposition
• 69990: Microsurgical technique (add-on)