Neurology & Pain Management Coding Alert

Question: One of our payers refuses to reimburse 64614 bilaterally. The payer says that based on the CPT wording "extremity(s) and/or trunk muscle(s)" they are only required to pay for one injection. How should I handle this?

Nevada Subscriber

Answer: Physicians often perform chemodenervation to multiple sites during the same visit, but that doesn't mean you-ll always get reimbursed. This holds true for your procedure in question, 64614 (Chemodenervation of muscle[s]; extremity[s] and/or trunk muscle[s] [e.g., for dystonia, cerebral palsy, multiple sclerosis]).

Because of CPT's wording, your payer is correct: the descriptor includes both single or multiple muscles and extremities, which means the code covers both situations. You cannot report 64614 more than once per session and should not append modifier 50 (Bilateral procedure).

Payer policy note: Individual payers, however, might take a different stance on the issue. Blue Cross in Massachusetts, for example, allows bilateral injections. Other payers might let you report the injections on separate lines with modifier 51 (Multiple procedures). Because of these variations, check your payer's policy for special coding instructions.