CPT® Code 64415

Quick Reference

• Code definition: CPT 64415 covers a single-injection or bolus brachial plexus nerve block (interscalene, supraclavicular, or infraclavicular approach) using an anesthetic agent and/or steroid, with imaging guidance included in the code when performed.
• Imaging guidance bundled: Do not separately report 76942 or 77002 with 64415. Effective January 1, 2023, the AMA revised the 64415 descriptor to include imaging guidance, and CMS NCCI confirms both imaging codes are bundled. This is a hard edit with no modifier override.
• Key billing rule: Report one unit per brachial plexus per session regardless of the number of passes or injections made. The descriptor reads "Injection(s)" to capture multiple passes at the same target; MUE = 1 per side.
• Modifier essentials: Use RT or LT for laterality (required by most payers). Bilateral blocks use modifier 50 (150% payment applies per the bilateral surgery indicator) or two line items with RT and LT per payer preference.
• Documentation must-have: The procedure note must identify the specific approach (interscalene, supraclavicular, or infraclavicular), the agent name with concentration and volume, and if imaging was used, the modality and confirmation of real-time guidance with stored images.
• Top confusion point: An axillary-approach brachial plexus block for hand surgery is still reported with 64415. CPT 64417 is reserved for injection of the axillary nerve itself, a structurally distinct target.
• Catheter distinction: When the technique involves catheter placement for continuous infusion, use 64416. These two codes are mutually exclusive for the same side on the same date.

When to Use This Code

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:

• Preoperative regional anesthesia for shoulder arthroplasty, rotator cuff repair, humeral ORIF, or elbow, forearm, and wrist surgery
• Single-shot postoperative pain block performed at procedure conclusion
• Pain management injection for brachial plexus disorders (G54.0), thoracic outlet syndrome, or cervical radiculopathy with upper extremity symptoms (M54.12)
• Diagnostic block to localize the brachial plexus as the pain source

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 Differentiation Table

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]

Billing and Modifier Rules

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:

• Use RT or LT to specify side. Most payers require laterality modifiers for unilateral nerve blocks; missing laterality commonly triggers claim suspension or processing as a single unspecified service.
• For bilateral blocks, the Medicare bilateral surgery indicator for 64415 is 1 (150% payment rule). Report with modifier 50 (one line, 150% of the single-side rate) or as two line items with RT and LT per payer preference. Confirm individually: some commercial payers do not accept modifier 50 and require separate line items.

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.

Documentation Essentials

Required elements for 64415:

1. Indication with diagnosis: Clinical reason for the block (preoperative anesthesia, postoperative pain, pain management, diagnostic) with a supporting ICD-10-CM code
2. Specific approach: Interscalene, supraclavicular, infraclavicular, or axillary approach to the plexus; "brachial plexus block" without approach detail is suboptimal and may trigger audit inquiry
3. Agent(s) injected: Drug name, concentration, and volume; for steroid injections, the corticosteroid name and dose must be specified
4. Imaging guidance record: If imaging was used: type (ultrasound or fluoroscopy), statement that real-time guidance was performed, and a permanently stored image or documented findings; if imaging was not used, the note should not assert that it was
5. Single injection versus catheter technique: The note must make the technique unambiguous; "bolus injection" versus "catheter placed for continuous infusion" drives 64415 versus 64416 selection and is a primary audit target
6. Laterality: Left, right, or bilateral must be explicit to support modifier usage

Audit red flags:

• Claim includes 76942 or 77002 with 64415 on any date of service after January 1, 2023: automatic NCCI denial, not appealable on the merits
• Procedure note documents catheter placement but 64415 is reported: upcoding or documentation inconsistency finding on retrospective audit
• More than one unit of 64415 billed for the same side: automatic MUE denial at adjudication
• Imaging guidance stated in the note but no permanent record of images stored: documentation deficiency that undermines the "when performed" qualifier

Medicare, Commercial and Medicaid Payer Rules

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.

Common Denials and Prevention

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.

Coding Scenarios

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.

Related Codes

• 64416 (CPT) Brachial plexus, continuous catheter infusion: use when catheter is placed for extended infusion rather than single bolus
• 64417 (CPT) Axillary nerve, single injection: use only when targeting the axillary nerve itself, not the plexus
• 01996 (CPT) Daily hospital management, continuous drug administration: reported for inpatient days after 64416 catheter placement; not applicable to single-injection 64415
• 76942 (CPT) Ultrasound guidance for needle placement: bundled with 64415 post-2023; not separately reportable
• 77002 (CPT) Fluoroscopic guidance for needle placement (add-on): bundled with 64415 post-2023; not separately reportable
• G54.0 (ICD-10-CM) Brachial plexus disorders: primary pain management diagnosis supporting medical necessity
• M54.12 (ICD-10-CM) Radiculopathy, cervical region: common diagnosis for blocks addressing cervical root symptoms
• S14.3XXA (ICD-10-CM) Injury of brachial plexus, initial encounter: traumatic plexus injury supporting block necessity

Sources

1. CPT 64415 official descriptor, MUE, global days, bilateral surgery indicator, ASC status, code history — Coding Ahead CPT database, verified 2026-03-18
2. CPT codebook guideline for 76942: "Do not report 76942 in conjunction with... 64415" — Coding Ahead CPT database (source: AMA CPT codebook guideline for 76942), verified 2026-03-18 [2]
3. CPT section guideline: "Imaging guidance and any injection of contrast are inclusive components of 64415, 64416, 64417..." — Coding Ahead CPT database (source: AMA CPT Introduction/Injection of Anesthetic Agent section guidelines), verified 2026-03-18 [3]
4. CPT 64415 code history: description changed 2023-01-01 — Coding Ahead CPT database, verified 2026-03-18 [4]