Clarifying Nerve Injection Coding: CPT 64451 vs. 64450

Question:

Hi KZA, I am new to pain management coding. If I’m injecting the L5, S1, S2, and S3 nerves, do all four have to be injected in order to report code 64451 appropriately? Could code 64451 still be reported if only one or two nerves are injected?

Answer:

All four nerves must be injected in order to report code 64451, Injection(s), anesthetic agent(s) and/or steroid; nerves innervating the sacroiliac joint, with image guidance (i.e., fluoroscopy or computed tomography).

The injection targets the L5 dorsal ramus nerve at the junction of the sacral ala and S1 superior articular process. In turn, the S1, S2, and S3 nerves are injected at the posterior lateral foramen of the S1, S2, and S3 foramen. CPT 64451 has an MUE of 1.

If only one or two nerves or branches were injected, code 64450, Injection(s), anesthetic agent(s) and/or steroid; other peripheral nerve or branch, may be reported with one or two units, respectively. Follow your individual third-party payor’s guidelines for appropriate modifier usage when each subsequent unit of 64450. CPT 64450 has an MUE of 10.

*This response is based on the best information available as of 4/10/25.