Destruction of an intercostal nerve with a neurolytic agent such as alcohol or phenol, used for persistent chest wall or rib pain.
- Medicare
- $225.79
- Work RVU
- 2.82
- Global, days
- 10
- Region
- Spine
Documentation requirements
What must appear in the operative or office note to support the claim.
Source · Editorial brief grounded in 2 cited references ↓
- Each intercostal nerve treated, by level and side
- Neurolytic agent and volume
- Result of the prior diagnostic block
- Pain history and failed conservative care
- Imaging guidance used, if any
- Complications or post procedure findings
Applicable modifiers
Modifiers commonly billed with this code.
Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual
What this code covers
Source · Editorial summary grounded in 2 cited references ↓
64620 reports chemical neurolysis of an intercostal nerve. It is a destruction code, not a diagnostic block. The diagnostic intercostal block, done first to confirm the pain generator, is billed with the nerve block codes.
Ortho and spine practices run into it with patients who have chronic pain after rib fractures, thoracic surgery, or a thoracic spine procedure, and whose pain follows an intercostal distribution. The procedure has a 10-day global, so routine follow-up in that window is not separately billable.
When more than one intercostal nerve is treated, payers generally expect units that match the nerves in the note. Check the payer's unit limit and how it wants multiple nerves shown. Many payers require a documented positive diagnostic block before covering neurolysis, so keep the block result in the chart.
RVU & reimbursement
Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.
Source · CMS Physician Fee Schedule, RVU26A · January 2026
Work RVU vs. total RVU
The work RVU (2.82) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (6.76) adds practice overhead and malpractice, and is what drives the Medicare payment below.
| Work RVU | 2.82 |
| Practice expense RVU | 3.58 |
| Malpractice RVU | 0.36 |
| Total RVU | 6.76 |
| Medicare national rate | $225.79 |
| Global period | 10 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 | $225.79 |
HOPD (APC 5443) Hospital outpatient department | $903.63 |
ASC (PI A2) Ambulatory surgical center (freestanding) | $485.51 |
Common denial reasons
The recurring reasons claims for CPT 64620 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- No prior diagnostic block documented
- Units do not match nerves treated in the note
- E/M billed within the 10-day global without modifier 24 or 25
- Diagnosis does not support neuropathic chest wall pain
- Coded as a block instead of neurolysis or the reverse
- Payer considers repeat neurolysis too frequent
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 2 cited references ↓
01Is 64620 billed per nerve?
02What is the global period for 64620?
03Is a diagnostic intercostal block billed with 64620?
Sources & references
Editorial content was developed using the following public sources.
- 01CMS Physician Fee Schedule 2026
- 02cms.govhttps://www.cms.gov/medicare/coding-billing/national-correct-coding-initiative-ncci-edits
Mira Scribe
Mira Scribe notes capture the diagnostic block result and the levels treated, which gives neurolysis the medical necessity trail payers ask for.
See how Mira captures CPT 64620 documentation