Wiki sphenopalatine nerve blocks

[lch]

My doctor's are wanting to start doing sphenopalatine blocks in our office. I am being told by an outside coding source that you can bill 64505-RT, 64505-LT to Medicare, since 50 modifier isn't allowed by Medicare for this code. I don't see how that can be correct though... anyone have any experience w/ biling these? thanks!

 

[dwaldman]

In the past, Medicare did not paid at 150 percent with the 50 modifier for CPT 64505. But if you look at the payment policy indicator for bilateral procedures on the CMS site, they currently pay at 150 percent when reporting the 50 modifier.

http://www.cms.gov/apps/physician-fee-schedule/search/search-criteria.aspx

Need to confirm with the physician that this will be an injection procedure. The transnasal approach using cotton tip applicators is reported unlisted.

Below is a private response from the AMA CPT Network in response to reporting with cotton tip applicator with anesthetic.

".....CPT code 64999, Unlisted procedure, nervous system, should be reported. Although code 64505, Injection, anesthetic agent; sphenopalatine ganglion, is available in the CPT code set, this code describes the “injection” of the sphenopalatine ganglion."

 

[lch]

Very good information, I didn't realize that they would now allow mod. 50. We will be using injection technique and not cotton tip applicator, I do know that for sure. Thanks for your response!