You mentioned you checked an LCD, with the below LCD that we have with WPS Medicare J5 I don't believe that service would be covered. But 4 separate other peripheral nerves, separately injected, with a clear cut procedure note individually describing the performance of each injection with identification of the nerve injected, I believe you could report for the 4 nerves you mentioned. But 64450 x 4 without LCD or medical policy, would still draw my eye if I was reviewing claims for a carrier ---to want to see the procedure note and indications for service.
Local Coverage Determination (LCD):
Nerve Blocks for Peripheral Neuropathy (L32565)
http://www.cms.gov/medicare-coverage-database/details/lcd-details.aspx?LCDId=32565&ContrId=148
Coverage Indications Limitations and/or Medical Necessity
Nerve blocks cause the temporary interruption of conduction of impulses in peripheral nerves or nerve trunks by the injection of local anesthetic solutions.
The use of nerve blocks or injections for the treatment of multiple neuropathies or peripheral neuropathies caused by underlying systemic diseases is not considered medically necessary. Medical management using systemic medications is clinically indicated for the treatment of these conditions.
At present, the literature and scientific evidence supporting the use of peripheral nerve blocks or injections in multiple neuropathies or underlying systemic diseases that are producing peripheral neuropathies, especially for the Medicare population, is insufficient to warrant coverage. These procedures are considered investigational, and are not eligible for coverage for the treatment of multiple neuropathies or peripheral neuropathies caused by underlying systemic diseases.
!