Injection of anesthetic agent and/or steroid into the plantar common digital nerve(s), typically for Morton's neuroma treatment or diagnosis.

Verified May 8, 2026 · 5 sources ↓

Medicare: $50.10
Total RVUs: 1.5
Global, days: 0
Region: Foot & ankle

Drawn from CMSAAPCPayerprice

Documentation requirements

What must appear in the operative or office note to support the claim.

Source · Editorial brief grounded in 5 cited references ↓

Identify the specific interspace(s) injected (e.g., second, third web space) — 'plantar injection' alone is insufficient
Document laterality explicitly (left, right, or bilateral) in the procedure note
Record the agent(s) injected: anesthetic name and volume, steroid name and dose
State the clinical indication — Morton's neuroma diagnosis, ICD-10 code, and any prior conservative treatment that failed
If billing bilateral same-day, document each side as a discrete procedure with separate clinical rationale
Note whether imaging guidance was used; if ultrasound-guided, ensure 76942 documentation exists separately

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

25 Significant separate E/M 50 Bilateral procedure 52 Reduced services 59 Distinct service 76 Repeat, same physician 79 Unrelated during global LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 5 cited references ↓

64455 covers injection into the plantar common digital nerve(s) — the intermetatarsal nerves most commonly involved in Morton's neuroma. The injection may use anesthetic alone (diagnostic block to confirm the symptomatic interspace), steroid alone, or a combination. The 000-day global means no pre- or post-operative visits are bundled; each encounter stands alone.

Site of service dramatically affects payment. The HOPD facility rate dwarfs the ASC rate — see the Site of Service comparison on this page. Most payers expect the procedure performed in-office when no imaging guidance is required. If ultrasound guidance is added to confirm needle placement, separately report 76942 with modifier 26 for the professional component when appropriate.

Bilateral injection on the same date requires LT and RT on separate line items, or modifier 50 depending on payer preference. Use RT or LT — not T-modifiers, which are reserved for nail and hammertoe procedures. Frequency limits apply: some MACs restrict the number of injections per interspace per year, so check your jurisdiction's LCD before billing a repeat injection.

RVU & reimbursement

Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	0.73
Practice expense RVU	0.7
Malpractice RVU	0.07
Total RVU	1.5
Medicare national rate	$50.10
Global period	0 days

Payment by site of service

Medicare pays different rates by setting. HOPD typically pays substantially more than ASC for the same procedure.

Source · CMS OPPS Addendum B·ASC HCPCS payment rates·2026

Setting	Medicare rate (national)
Office (PFS non-facility) Procedure performed in physician's office	$50.10
HOPD (APC 5441) Hospital outpatient department	$313.60
ASC (PI P3) Ambulatory surgical center (freestanding)	$23.50

Common denial reasons

The recurring reasons claims for CPT 64455 get rejected.

Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓

Missing or vague laterality — note says 'plantar injection' without specifying left or right foot or interspace
Frequency limit exceeded — MAC LCDs cap injections per interspace; repeat injections without documentation of interval and response are denied
Wrong modifier for toe-level billing — T-modifiers applied instead of LT/RT triggers claim rejection
Bundling with E/M on same date without modifier 25 on the E/M service
Site of service mismatch — procedure billed under office POS but claim submitted under facility POS, or vice versa

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 5 cited references ↓

01Can I bill 64455 and an E/M on the same day?

Yes, but the E/M needs modifier 25 to survive NCCI editing. The E/M must reflect a separately identifiable service beyond the decision to inject — document the broader evaluation, not just the injection consent.

02Which modifier do I use for bilateral Morton's neuroma injections on the same date?

Bill two line items: one with LT, one with RT. Some commercial payers prefer modifier 50 on a single line — confirm with each payer. Do not use T-modifiers; those are for nail and hammertoe procedures, not nerve injections.

03Does adding ultrasound guidance change the code?

64455 itself doesn't change. Report 76942 separately for ultrasound guidance with real-time imaging documentation. Append modifier 26 for the professional component when billing in a facility setting.

04How many times can 64455 be billed per interspace per year?

There is no universal CMS limit, but MACs apply frequency restrictions through LCD policy. Noridian and NGS both address injection frequency for Morton's neuroma. Check your jurisdiction's active LCD and document response to prior injections before billing a repeat.

05Is 64455 the right code if the provider injected the plantar fascia rather than the nerve?

No. A plantar fascia injection is 20550 (tendon sheath/ligament) or 20551. 64455 is specifically for injection into the plantar common digital nerve(s). The operative note must state the target structure — needle proximity to a nerve sheath during a fascial injection does not support 64455.

06What ICD-10 codes typically support 64455?

G57.60/G57.61/G57.62 (Morton's neuroma, unspecified/right/left foot) are the primary payer-accepted diagnoses. M79.671-M79.679 (foot pain) may support a diagnostic block when neuroma is suspected but not yet confirmed. Payers vary on whether pain codes alone are sufficient without a prior workup.

Sources & references

Editorial content was developed using the following public sources. Last verified May 8, 2026.

Mira AI Scribe

Mira's AI scribe captures the specific interspace injected (e.g., third web space), laterality, agent name and dose, and the clinical indication from dictation. That prevents the most common denial trigger — a note that documents an injection without naming the nerve location or side. The scribe also flags when bilateral injection is dictated so the coder can split line items correctly with LT and RT instead of modifier 50, depending on payer rules.

See how Mira captures CPT 64455 documentation