Sphenopalatine Ganglion Nerve Block - CPT 64999


Sparks, NV
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We have a Noridian Medicare patient who gets a sphenopalatine ganglion nerve block via a cotton tipped intranasal topical anesthetic for her migraines. In the past, Medicare did not pay for this procedure. Our biller called Medicare last week as was told that Medicare would now cover this if billed with 64999 and records are submitted. In looking at Local Coverage Article A55584, it states "Noridian is issuing coding guidance for billing the use of Dolor Technologies SphenoCath (R) device or OTHER SIMILAR DELIVERY DEVICES. To bill for these devices use CPT (R) 64999 as described in CPT Assistant (July 2014, Volume 24, Issue 7, pages 8-9).

Is it fair to assume that a "cotton tipped applicator" would be considered an "other similar delivery device". Any input would be greatly appreciated.


True Blue
Clovis, CA
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That is an interesting question. We used to do this via Sphenocath, but we found the patients weren't getting the results that were shown in clinical trials (wasn't helping). The sphenocath is basically a long, skinny needle-less syringe, if you will. In my opinion, a cotton swab is not a "similar" delivery device. We numbed the nasal area with a cotton swab before using the sphenocath. The biggest cost is the sphenocath device itself.

So I would say no, it's not the same/similar, and I would think delivering lidocaine with a swab would be included in an office visit.