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Wiki Inquiry Regarding CPT Code 64640 & HCPCS Code C9809

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dsibley67

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I'm looking for information regarding CPT code 64640 & HCPCS code C9809. Has anyone billed for these procedures and successfully received payment? If so, I'd appreciate any details or insights you can share.
Thank you in advance for your help!
 
What is the actual question?

64640 is a standard code and has been there for decades. We've largely gone from using phenol and other destructive agents to the new trend of thermal ablation. Pacira's Iovera system gets a separate pass through reimbursement from the NOPAIN Act. It amounts to a little over $250. Not sure that covers the cost. And it is only for ASC/HOPD, not in-office.

No private payor is required to reimburse that and they may have completely separate policy or LCD.
 
There's confusion around 64640 for iovera because in 2019 the CPT Assistant stated it can be used to report cryoneurolysis. Some people thought that meant they could bill iovera treatments with the code. However, the AMA doesn't set payment policy. As stated above you'll need to check each payer to see if they cover iovera at all, the required conditions and which code(s) you can use.
 
milleap said:

We found this billing article from CMS regarding the Iovera and are currently reviewing our prior claims.
Click to expand...

Just pointing out, that's only an article for Noridian. https://www.cms.gov/medicare/coding-billing/medicare-administrative-contractors-macs/who-are-macs
"Billing and Coding articles provide guidance for the related Local Coverage Determination (LCD) and assist providers in submitting correct claims for payment. Billing and Coding articles typically include CPT/HCPCS procedure codes, ICD-10-CM diagnosis codes, as well as Bill Type, Revenue, and CPT/HCPCS Modifier codes. The code lists in the article help explain which services (procedures) the related LCD applies to, the diagnosis codes for which the service is covered, or for which the service is not considered reasonable and necessary and therefore not covered."

Other MACs have info on their website: https://cgsmedicare.com/parta/pubs/news/2022/01/cope24853.html
"One manufacture of this system, Iovera, instructs providers on their website to bill the treatment with Current Procedural Terminology (CPT) code 64640 (Destruction by neurolytic agent; other peripheral nerve or branch).Code 64640 requires the destruction of target nerve. The Iovera system is temporary and not destructive. Therefore, CPT code 64640 is not appropriate for Medicare billing."

As suggested above, it is payer dependent.
 
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