CPT 64415 applies when a physician performs a single-injection brachial plexus nerve block using an interscalene, supraclavicular, or infraclavicular approach. The code captures the complete service: needle placement, injection confirmation, anesthetic and/or steroid delivery, and any imaging guidance used.
Clinical scenarios that support 64415:
Scope boundaries: Continuous catheter infusion techniques belong under 64416. If the procedure note documents catheter placement for extended postoperative analgesia, 64415 is incorrect regardless of which approach was used. Terminal branch blocks targeting individual nerves at the axilla may require individual nerve codes; however, an axillary-approach block that targets the plexus cords or trunks as a unit is still a brachial plexus block and is reported with 64415.
Provider and setting context: 64415 is a unilateral physician service code (PC/TC indicator = 0). It is reportable by anesthesiologists, pain management physicians, or surgeons who personally perform the block. The procedure is covered in the ASC setting (on the covered surgical procedures list since CY 2007, paid at OPPS relative weight). The ASC facility bills separately from the physician's professional service.
| Code | Description | When to Use Instead |
|---|---|---|
| 64415 | Brachial plexus, single injection, imaging guidance included | Interscalene, supraclavicular, or infraclavicular approach; single bolus technique |
| 64416 | Brachial plexus, continuous catheter infusion, imaging guidance included | Catheter placed for continuous or prolonged postoperative infusion at any brachial plexus approach |
| 64417 | Axillary nerve, single injection, imaging guidance included | Injection targets the axillary nerve itself (axillary nerve neuritis, shoulder abductor denervation); not for axillary-approach brachial plexus blocks |
The axillary nerve versus brachial plexus distinction is the most audited code selection point in this family. The axillary-approach brachial plexus block, where a needle enters at the axilla to anesthetize the cords or terminal branches as a network, remains a plexus block reported with 64415. CPT 64417 covers injection of a single named nerve (the axillary nerve), not the plexus as a whole.
flowchart TD
A[Nerve block performed] --> B{Target structure}
B -->|Axillary nerve itself| C[64417]
B -->|Brachial plexus network| D{Technique}
D -->|Single injection or bolus| E[64415]
D -->|Catheter for continuous infusion| F[64416]
Units and MUE: The MUE for 64415 is 1 per side per date of service. The plural "Injection(s)" in the descriptor is intentional; it confirms that multiple passes or injection volumes at the same plexus level are captured by one unit. Billing two units because two injections were made at the same brachial plexus results in automatic MUE denial.
Laterality modifiers:
Modifier 59/XS for same-date multi-nerve blocks: When 64415 is reported on the same date as another nerve block at a distinct anatomical site, append modifier 59 or the more specific XS (separate structure) to the second service. For example, a brachial plexus block and a separate intercostal nerve block on the same date represent distinct nerve targets and are reportable together with appropriate modifier.
Modifier 25 for same-day E/M: The global period for 64415 is 000 (minor procedure), meaning routine pre- and post-service evaluation is included. A separately identifiable E/M service is only reportable when the evaluation is significant and independent from the procedure. If reportable, modifier 25 attaches to the E/M code, not to 64415.
Imaging guidance is not separately reportable: The AMA CPT codebook states: "Imaging guidance and any injection of contrast are inclusive components of 64415, 64416, 64417." Do not report 76942 (ultrasound guidance) or 77002 (fluoroscopic guidance) with 64415 on any claim, in any setting. CMS NCCI edit pairs confirm bundling for both codes, and the hospital outpatient APC status for both imaging codes is "packaged." There is no modifier that overrides this bundling.
Required elements for 64415:
Audit red flags:
Medicare:
There is no national NCD for peripheral nerve blocks. Coverage is MAC-determined through Local Coverage Determinations for nerve blocks and pain management procedures. Medical necessity documentation must support the covered diagnosis; common supported diagnoses include brachial plexus disorders (G54.0), cervical radiculopathy (M54.12), and traumatic plexus injury (S14.3XXA).
Frequency limits for pain management indications are set at the MAC level. While no universal CMS frequency cap applies nationally, most MAC LCDs restrict brachial plexus blocks for chronic pain to 3 to 4 injections per year per site without additional documented justification. Surgical anesthesia use is not typically subject to frequency limitations.
In the hospital outpatient setting, the APC status indicator for 64415 is "Procedure or Service, Multiple Reduction Applies," so multiple procedure payment reduction rules apply when reported alongside other APC procedures.
Commercial payers:
Prior authorization may be required for pain management indications. Preoperative regional anesthesia use is generally not subject to prior authorization because the block is integral to the surgical procedure. Confirm each payer's preference for bilateral procedure reporting; some commercial payers do not accept modifier 50 and require two line items with RT and LT. Some plans apply automated downcoding rules that treat 64415 as non-covered for certain pain management diagnoses without prior authorization.
Denial: Bundled imaging guidance (post-2023)
The most frequent denial post-January 2023 is automatic NCCI edit denial when 76942 or 77002 appears on the same claim as 64415. This occurs when charge capture templates were not updated after the 2023 descriptor change. Prevention requires a charge capture audit to remove imaging guidance codes from all brachial plexus block templates. These denials cannot be successfully appealed on the merits; imaging guidance is bundled by both AMA CPT guideline and CMS NCCI.
Denial: MUE exceeded
Claims with more than one unit of 64415 for the same side on the same date are denied at adjudication. Root cause is typically a charge entry error or misinterpretation of the plural "Injection(s)" wording. Prevention: configure charge entry systems to limit 64415 to one unit per side per date of service.
Denial: Wrong code for catheter technique
When the procedure note documents catheter placement for continuous infusion but 64415 is submitted, payers flag the discrepancy on post-payment audit, resulting in repayment demand. Prevention: route charge entry to 64416 whenever the note explicitly documents catheter placement for extended infusion. Train providers to use unambiguous language: "single bolus injection" versus "catheter placed for continuous infusion."
Denial: Missing laterality modifier
Claims without laterality modifiers for a unilateral procedure are suspended or processed as a single unspecified service by payers that require RT/LT. For bilateral claims without modifier 50 or laterality modifiers, only one side may be processed. Prevention: build laterality as a required field in charge capture.
Scenario: An anesthesiologist performs an ultrasound-guided right interscalene brachial plexus block before total shoulder arthroplasty. The note documents the interscalene approach, 20 mL of 0.5% bupivacaine injected, and real-time ultrasound confirmation with a stored image.
Correct coding: 64415-RT with the surgical indication diagnosis
Why: Single-injection interscalene approach is 64415. Ultrasound guidance is included in the 2023 descriptor; separately reporting 76942 creates an NCCI violation.
Scenario: A pain management physician performs bilateral supraclavicular brachial plexus blocks under ultrasound guidance for a patient with bilateral thoracic outlet syndrome (G54.0) failing conservative management.
Correct coding: 64415-50 (or 64415-LT and 64415-RT on separate lines per payer preference) with diagnosis G54.0
Why: Bilateral blocks trigger the 150% bilateral payment rule (bilateral surgery indicator = 1). Confirm payer preference: some commercial plans reject modifier 50 and require laterality line items.
Scenario: An anesthesiologist places an infraclavicular continuous catheter under ultrasound guidance for a patient undergoing complex humeral fracture ORIF, with a plan for 48 hours of postoperative bupivacaine infusion.
Correct coding (procedure day): 64416 with the fracture diagnosis. For subsequent inpatient days: 01996.
Why: Catheter placement for continuous infusion = 64416, not 64415. The technique documented determines code selection; the approaches are otherwise identical, making this a common audit finding when 64415 is submitted instead.
Scenario: A pain physician evaluates a new patient with chronic right arm pain from cervical radiculopathy (M54.12). After a comprehensive evaluation, the physician performs an ultrasound-guided right supraclavicular brachial plexus block in the same visit.
Correct coding: 64415-RT with a separately reported E/M code appended with modifier 25
Why: The global period of 000 includes routine pre- and post-procedure work, but a comprehensive new patient evaluation is separately identifiable. Modifier 25 attaches to the E/M code; the E/M documentation must stand alone from the procedure note.
© Copyright 2026 American Medical Association. All rights reserved.
The CPT® Code 64415 refers to the procedure of injecting anesthetic agents and/or steroids into the brachial plexus, which is a network of nerves that supplies the arm and hand. This procedure is commonly known as a nerve block and can serve both diagnostic and therapeutic purposes. The injection may help alleviate pain or provide anesthesia in the arm and shoulder region. The process involves the careful placement of a needle into the brachial plexus sheath, which is located in the infraclavicular or supraclavicular area, depending on the specific approach taken. Imaging guidance, such as ultrasound, may be utilized to ensure accurate needle placement, enhancing the safety and effectiveness of the procedure. The injection is performed with the arm positioned in a specific manner—abducted with the elbow flexed and the hand elevated above the shoulder—to facilitate access to the brachial plexus. It is important to note that this code is reported only once, regardless of the number of injections administered to the brachial plexus during the procedure.
© Copyright 2026 Coding Ahead. All rights reserved.
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