New CPT Codes for Genicular Block / RFA, Sacroiliac RFA

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Does anybody know what these CPT codes are? Did they come into effect Jan 2020, or is it later?
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Do you use them per nerve like 64625 x 4 or per joint?
 
www.beckersasc.com

Deciphering the 2020 CPT code changes - Becker’s ASC

The American Medical Association (AMA) publishes the Current Procedural Terminology code set changes every year, usually in September, for the upcoming new year. The changes impacting CPT 2020 were released on September 4, 2019. There was a total of 394 code changes, of which, 58 affect the...
www.beckersasc.com www.beckersasc.com

NEW CODES
Specific codes have been created for both genicular nerve and sacroiliac joint nerve procedures with comprehensive directives by the AMA listed within the parentheticals of these codes.

• CPT 64454 - Injection(s), anesthetic agent(s) and/or steroid; genicular nerve branches, including imaging guidance, when performed
(Do not report 64624 in conjunction with 64454). (Do not report 64454 in conjunction with 64624). (64454 requires injecting all of the following genicular nerve branches: superolateral, superomedial, and inferomedial. If all 3 of these genicular nerve branches are not injected, report 64454 with modifier 52).

• CPT 64624 - Destruction by neurolytic agent, genicular nerve branches including imaging guidance, when performed
(Do not report 64624 in conjunction with 64454.) (64624 requires the destruction of each of the following genicular nerve branches: superolateral, superomedial, and inferomedial. If a neurolytic agent for the purposes of destruction is not applied to all of these nerve branches, report 64624 with modifier 52.)

• CPT 64451 - Injection(s), anesthetic agent(s) and/or steroid; nerves innervating the sacroiliac joint, with image guidance (ie, fluoroscopy or computed tomography)
(For injection, anesthetic agent, nerves innervating the sacroiliac joint, use 64451.) (Do not report 64451 in conjunction with 64493, 64494, 64495, 77002, 77012, 95873, 95874.) (For injection, anesthetic agent, nerves innervating the sacroiliac joint, with ultrasound, use 76999.)

• CPT 64625 - Radiofrequency ablation, nerves innervating the sacroiliac joint, with image guidance (ie, fluoroscopy or computed tomography)
(Do not report 64625 in conjunction with, 64636, 77002, 77003, 77012, 95873, 95874.) (For radiofrequency ablation, nerves innervating the sacroiliac joint, with ultrasound, use 76999.)

• CPT 62328 - Spinal puncture, lumbar, diagnostic
• CPT 62329 - Spinal puncture, lumbar, therapeutic
 
Ferrismonk said:
www.beckersasc.com

Deciphering the 2020 CPT code changes - Becker’s ASC

The American Medical Association (AMA) publishes the Current Procedural Terminology code set changes every year, usually in September, for the upcoming new year. The changes impacting CPT 2020 were released on September 4, 2019. There was a total of 394 code changes, of which, 58 affect the...
www.beckersasc.com www.beckersasc.com

NEW CODES
Specific codes have been created for both genicular nerve and sacroiliac joint nerve procedures with comprehensive directives by the AMA listed within the parentheticals of these codes.

• CPT 64454 - Injection(s), anesthetic agent(s) and/or steroid; genicular nerve branches, including imaging guidance, when performed
(Do not report 64624 in conjunction with 64454). (Do not report 64454 in conjunction with 64624). (64454 requires injecting all of the following genicular nerve branches: superolateral, superomedial, and inferomedial. If all 3 of these genicular nerve branches are not injected, report 64454 with modifier 52).

• CPT 64624 - Destruction by neurolytic agent, genicular nerve branches including imaging guidance, when performed
(Do not report 64624 in conjunction with 64454.) (64624 requires the destruction of each of the following genicular nerve branches: superolateral, superomedial, and inferomedial. If a neurolytic agent for the purposes of destruction is not applied to all of these nerve branches, report 64624 with modifier 52.)

• CPT 64451 - Injection(s), anesthetic agent(s) and/or steroid; nerves innervating the sacroiliac joint, with image guidance (ie, fluoroscopy or computed tomography)
(For injection, anesthetic agent, nerves innervating the sacroiliac joint, use 64451.) (Do not report 64451 in conjunction with 64493, 64494, 64495, 77002, 77012, 95873, 95874.) (For injection, anesthetic agent, nerves innervating the sacroiliac joint, with ultrasound, use 76999.)

• CPT 64625 - Radiofrequency ablation, nerves innervating the sacroiliac joint, with image guidance (ie, fluoroscopy or computed tomography)
(Do not report 64625 in conjunction with, 64636, 77002, 77003, 77012, 95873, 95874.) (For radiofrequency ablation, nerves innervating the sacroiliac joint, with ultrasound, use 76999.)

• CPT 62328 - Spinal puncture, lumbar, diagnostic
• CPT 62329 - Spinal puncture, lumbar, therapeutic
Click to expand...

What are these spinal puncture codes? For like LPs?
 
does anyone only do S1-3 LBB/RFA for SIJ? I was always taught to do L5-S3. Are we just expected to block/burn the same 4 nerves but now at a reduced rate?
 
People getting paid for this?! I’ve done a few (si rf) Medicare, some private ins pending. Haven’t looked at the lcd’s.
Thanks.
 
Multimodal said:
does anyone only do S1-3 LBB/RFA for SIJ? I was always taught to do L5-S3. Are we just expected to block/burn the same 4 nerves but now at a reduced rate?
Click to expand...
Thats what I do - I only have to do one set of LBBs if I eliminate the L5 and based on cadaver models the L5 DR contributes less than 10% to the SIJ.
 
Members don't see this ad :)
hard for me to tell, I'll try to look back and report
 
I have started to get a lot of denials due to the new code. People with prior SI/Genicular RFA with good relief being denied the repeat because the new code "isn't a covered benefit".
 
Some of these insurances take time changingTo new Medicare cot codes. I have a few insurances that are covering the new genicular codes and a few still not accepting.
 
Ferrismonk said:
I have started to get a lot of denials due to the new code. People with prior SI/Genicular RFA with good relief being denied the repeat because the new code "isn't a covered benefit".
Click to expand...
Just got a denial for this today from Blue Cross. No longer a covered benefit. Did a 'peer to peer' with the doc. I was told it is not a 'covered benefit' because "there is no evidence to support that it benefits patients". To which I responded, "so you're telling me that it is your insurance company's policy to refuse to look at the available, well-published data that patients get significant relief with genicular RF?". She got loud with me and said "NO THAT'S NOT WHAT I SAID, BUT YOU CAN MAKE AN APPEAL!"

These insurance companies are just getting worse and worse every week. Sheesh.
 
Also, to my knowledge, Medicare still does not have a fee schedule associated to the new codes. I checked last week; haven't checked this week. So far, Medicare has not paid me for their new codes that I've been using for the last 6 weeks or so.
 
iwumd07 said:
Just got a denial for this today from Blue Cross. No longer a covered benefit. Did a 'peer to peer' with the doc. I was told it is not a 'covered benefit' because "there is no evidence to support that it benefits patients". To which I responded, "so you're telling me that it is your insurance company's policy to refuse to look at the available, well-published data that patients get significant relief with genicular RF?". She got loud with me and said "NO THAT'S NOT WHAT I SAID, BUT YOU CAN MAKE AN APPEAL!"

These insurance companies are just getting worse and worse every week. Sheesh.
Click to expand...
Similar to the patient telling you "I talked to my insurance company about the denial, they said that you just need to talk to them to get (fill in the blank) covered"
 
Can you guys please update me on this? I haven't had any of the right patients the first 6 months of the year, but now I have ideal patients for both procedures. 2 SIJ RF and 2 genicular RF. If I'm not going to be paid for this, I'll ask the patients to pay in cash instead?
 
Anyone getting paid for SIJ RF and or genicular RFA in 2020 with the new codes?

1- by medicare?
2- by commercial insurance?

3- anyone getting paid for the blocks but not the ablations?
 
Last edited:
Anyone seeing that they get paid for the blocks but not the ablations?

Anyone just using the old codes for the blocks and getting paid?

Bueller? Bueller?
 
bedrock said:
Anyone seeing that they get paid for the blocks but not the ablations?

Anyone just using the old codes for the blocks and getting paid?

Bueller? Bueller?
Click to expand...


I have been reimbursed for si block/rf and genicular block/rf from medicare

My experience with commercial plans is that they will pay for the blocks but will not reimburse the rf. Aetna, bcbs and united have denied the rf for a few of my patients but reimbursed the blocks
 
smarterchild said:
I have been reimbursed for si block/rf and genicular block/rf from medicare

My experience with commercial plans is that they will pay for the blocks but will not reimburse the rf. Aetna, bcbs and united have denied the rf for a few of my patients but reimbursed the blocks
Click to expand...

Thank you. Thank you.

I was beginning to wonder if no one on this board does genicular RFA anymore!!!! Given the lack of other responses.

Can anyone else confirm that experience? Medicare paying for both blocks and both ablations with the knee/SIJ? Commercial paying for blocks only?
 
smarterchild said:
I have been reimbursed for si block/rf and genicular block/rf from medicare

My experience with commercial plans is that they will pay for the blocks but will not reimburse the rf. Aetna, bcbs and united have denied the rf for a few of my patients but reimbursed the blocks
Click to expand...

Can anyone point me to a resources demonstrating the reimbursement figures ($$$) for these block and RF codes? At least the Medicare reimbursement ?

Also, has anyone tried doing an L5 block/ablation on the same day as a SIJ RF and gotten paid separately for the L5?
 
Last edited:
bedrock said:
Thank you. Thank you.

I was beginning to wonder if no one on this board does genicular RFA anymore!!!! Given the lack of other responses.

Can anyone else confirm that experience? Medicare paying for both blocks and both ablations with the knee/SIJ? Commercial paying for blocks only?
Click to expand...
Can confirm the same thing. Medicare replacement plans are also not paying just like commercial insurance.
 
i am getting reimbursed for genicular RFA by Medicare/Medicaid plans.

have asked for SI RFA. not so much benefit, but they since they do pay for lumbar RFA.
 
Thank you.

Seems that regular medicare patients are set and you can do both blocks and RFA without fear of nonpayment and for everyone else, so Commercial insurance or medicare HMO/Advantage, you can do the genicular/SIJ blocks and if positive, you can offer the patients the ablation as a cash procedure, but at least spare them the cost of the blocks.
 
bedrock said:
Can anyone point me to a resources demonstrating the reimbursement figures ($$$) for these block and RF codes? At least the Medicare reimbursement ?

Also, has anyone tried doing an L5 block/ablation on the same day as a SIJ RF and gotten paid separately for the L5?
Click to expand...

ASIPP has published this every year for awhile now: https://www.asipp.org/Fee Schedules/2020HOPDFinalRates.pdf

Your intention is the innervation of the joint so you won’t get paid for L5 separately in the same encounter; but you should probably do it. You can always work them up two levels at a time starting at T12-L1 and burn your way down. You’re bound to catch something going into the SI joint... maybe do TON to be sure.
 
chibadriver said:
ASIPP has published this every year for awhile now: https://www.asipp.org/Fee Schedules/2020HOPDFinalRates.pdf

Your intention is the innervation of the joint so you won’t get paid for L5 separately in the same encounter; but you should probably do it. You can always work them up two levels at a time starting at T12-L1 and burn your way down. You’re bound to catch something going into the SI joint... maybe do TON to be sure.
Click to expand...

Not exactly sure why you felt the need to be a smart ass. Studies have demonstrated that L5 is often involved in SIJ innervation or maybe you were too busy being the class clown in fellowship to learn that???

And just because I'd like to get paid for the work to do L5, where do you come off suggesting that I"m a needle jockey?

I've posted on this board for 15 years, and all the regular posters know me, but you don't as you're just a newb.
However it's still poor form anytime to assume things about people you don't know. Unfortunate your mother didn't teach you that, or maybe you're just an ass. I don't know, but I won't assume either way........
 
bedrock said:
Not exactly sure why you felt the need to be a smart ass. Studies have demonstrated that L5 is often involved in SIJ innervation or maybe you were too busy being the class clown in fellowship to learn that???

And just because I'd like to get paid for the work to do L5, where do you come off suggesting that I"m a needle jockey?

I've posted on this board for 15 years, and all the regular posters know me, but you don't as you're just a newb.
However it's still poor form anytime to assume things about people you don't know. Unfortunate your mother didn't teach you that, or maybe you're just an ass. I don't know, but I won't assume either way........
Click to expand...
My understanding is L5 dorsal ramus is bundled in the SIJ. If you don’t do it with the SI RF, you have to bill with the reduced services modifier.
 
bedrock said:
Not exactly sure why you felt the need to be a smart ass. Studies have demonstrated that L5 is often involved in SIJ innervation or maybe you were too busy being the class clown in fellowship to learn that???

And just because I'd like to get paid for the work to do L5, where do you come off suggesting that I"m a needle jockey?

I've posted on this board for 15 years, and all the regular posters know me, but you don't as you're just a newb.
However it's still poor form anytime to assume things about people you don't know. Unfortunate your mother didn't teach you that, or maybe you're just an ass. I don't know, but I won't assume either way........
Click to expand...

Just a lighthearted joke, not meant as a trigger for you personally.
 
Ferrismonk said:
www.beckersasc.com

Deciphering the 2020 CPT code changes - Becker’s ASC

The American Medical Association (AMA) publishes the Current Procedural Terminology code set changes every year, usually in September, for the upcoming new year. The changes impacting CPT 2020 were released on September 4, 2019. There was a total of 394 code changes, of which, 58 affect the...
www.beckersasc.com www.beckersasc.com

NEW CODES
Specific codes have been created for both genicular nerve and sacroiliac joint nerve procedures with comprehensive directives by the AMA listed within the parentheticals of these codes.

• CPT 64454 - Injection(s), anesthetic agent(s) and/or steroid; genicular nerve branches, including imaging guidance, when performed
(Do not report 64624 in conjunction with 64454). (Do not report 64454 in conjunction with 64624). (64454 requires injecting all of the following genicular nerve branches: superolateral, superomedial, and inferomedial. If all 3 of these genicular nerve branches are not injected, report 64454 with modifier 52).

• CPT 64624 - Destruction by neurolytic agent, genicular nerve branches including imaging guidance, when performed
(Do not report 64624 in conjunction with 64454.) (64624 requires the destruction of each of the following genicular nerve branches: superolateral, superomedial, and inferomedial. If a neurolytic agent for the purposes of destruction is not applied to all of these nerve branches, report 64624 with modifier 52.)

• CPT 64451 - Injection(s), anesthetic agent(s) and/or steroid; nerves innervating the sacroiliac joint, with image guidance (ie, fluoroscopy or computed tomography)
(For injection, anesthetic agent, nerves innervating the sacroiliac joint, use 64451.) (Do not report 64451 in conjunction with 64493, 64494, 64495, 77002, 77012, 95873, 95874.) (For injection, anesthetic agent, nerves innervating the sacroiliac joint, with ultrasound, use 76999.)

• CPT 64625 - Radiofrequency ablation, nerves innervating the sacroiliac joint, with image guidance (ie, fluoroscopy or computed tomography)
(Do not report 64625 in conjunction with, 64636, 77002, 77003, 77012, 95873, 95874.) (For radiofrequency ablation, nerves innervating the sacroiliac joint, with ultrasound, use 76999.)

• CPT 62328 - Spinal puncture, lumbar, diagnostic
• CPT 62329 - Spinal puncture, lumbar, therapeutic
Click to expand...

Are you billing, 64493 x 1 unit and 64451 x 3 units for L5 DPR and S1 to S3 LBB??

What about SI joint RFA? do you bill 64635 and 64625 x 3??
 
PAINISGOOD said:
Are you billing, 64493 x 1 unit and 64451 x 3 units for L5 DPR and S1 to S3 LBB??

What about SI joint RFA? do you bill 64635 and 64625 x 3??
Click to expand...
For rfa the code is inclusive of all the nerves. (Both for codes) So you just bill the code once. Unless you’re doing bilateral the you do 50 modifier.
 
reviving old thread...

local LCD is denying all the new codes as experimental (64624, 64625).

it is also denying the old code 64640 for peripheral nerve RFA. and 64999.

anyone have any suggestions on other codes to try?
 
Ducttape said:
reviving old thread...

local LCD is denying all the new codes as experimental (64624, 64625).

it is also denying the old code 64640 for peripheral nerve RFA. and 64999.

anyone have any suggestions on other codes to try?
Click to expand...

Have been fighting this battle for a year now. There is no winning. Even for those patients that have had rfa with good results for a year or more. Sad. Best thing is to try to set up a cash price for those procedures (which is harder than I thought for being hospital employed.)
 
buddababa said:
Have been fighting this battle for a year now. There is no winning. Even for those patients that have had rfa with good results for a year or more. Sad. Best thing is to try to set up a cash price for those procedures (which is harder than I thought for being hospital employed.)
Click to expand...
yup
 
Ducttape said:
reviving old thread...

local LCD is denying all the new codes as experimental (64624, 64625).

it is also denying the old code 64640 for peripheral nerve RFA. and 64999.

anyone have any suggestions on other codes to try?
Click to expand...

my experience the past 8 months mirrors this. Basically I tell anyone who doesn’t have regular Medicare up front that I am able to get their blocks paid for but the ablation would be for cash.

About 1/4 patients will then do the blocks and 1/5 pay for the ablation in cash.

Stinks but it’s the way it is.

You hospital based docs may want to refer the cash ablation to PP docs with more flexibility than a hospital bureaucracy.
 
Does anyone know the wRVUs for these SIJ codes?

• CPT 64451 - Injection(s), anesthetic agent(s) and/or steroid; nerves innervating the sacroiliac joint, with image guidance (ie, fluoroscopy or computed tomography)
(For injection, anesthetic agent, nerves innervating the sacroiliac joint, use 64451.) (Do not report 64451 in conjunction with 64493, 64494, 64495, 77002, 77012, 95873, 95874.) (For injection, anesthetic agent, nerves innervating the sacroiliac joint, with ultrasound, use 76999.)

• CPT 64625 - Radiofrequency ablation, nerves innervating the sacroiliac joint, with image guidance (ie, fluoroscopy or computed tomography)
(Do not report 64625 in conjunction with, 64636, 77002, 77003, 77012, 95873, 95874.) (For radiofrequency ablation, nerves innervating the sacroiliac joint, with ultrasound, use 76999.)
 
bedrock said:
Really sad how undervalued are the genicular/SIJ blocks ablations.

Many patients continue to suffer with both conditions because many pain docs don’t want to bother with these procedures for such low pay
Click to expand...
For the SI, hard to rationalize when perc fusion/27279 is ~12 wRVU
 
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