Denials – Chemodenervation of the Facial Nerves for Migraine

Question:

We are getting denials for code 64615 chemodenervation of the facial nerves for migraine headache. Any suggestions?

Answer:

Code 64615 is reported for chemodenervation of muscle(s) innervated by facial, trigeminal, cervical spinal, and accessory nerves, bilateral (e.g., for chronic migraine). Per CPT, code 64615 is used to report a chemodenervation injection procedure specifically for the treatment of chronic migraine. To report this code, the following criteria must be met:

• 15 or more days of headache or a headache that lasts 4 hours or more per day, prior to treatment.

• Treatment must include, 31 injection sites over 7 muscle groups are typically identified on the face, head, neck and upper back (the frontalis, corrugatore, procerus, occipatlis, temporalis, trapezius, and cervical paraspinal muscle groups). The code is reported once, for injection of these sites. Ultrasound guidance may be reported with these codes using 76942.

If this procedure is performed and reported accurately (as described above), appeal the denial with appropriate documentation.

*This response is based on the best information available as of 06/22/17.