Coding and Reimbursement Guide
An overview of how to get reimbursed for cryoneurolysis with iovera°.
Coding Overview
Cryoneurolysis with iovera° is reimbursed in the Hospital Outpatient Department, Ambulatory Surgery Center, and Physician Office.
64640
Destruction by neurolytic agent;
other peripheral nerve or branch
64624
Destruction by neurolytic agent; genicular nerve branches including imaging; destruction of each of the following genicular nerve branches: superolateral, superomedial, and inferomedial
Knee pain coding
Anterior knee pain commonly involves the femoral nerve and most commonly the AFCN and 2 branches of the ISN. Other superficial nerves that innervate the knee such as the LFCN may also be involved. CPT code 64640 is applicable to iovera° treatments applied to peripheral nerves and is used to bill for EACH of the peripheral nerve branches treated.
Posterior, or deeper knee pain, can involve the following genicular nerves: superolateral (superolateral articulating branch of the common peroneal nerve), superomedial (superomedial articulating branch of the tibial nerve), and inferomedial (inferomedial articulating branch of the tibial nerve). CPT 64624 defines all 3 of the specified nerves as 1 billable unit and is used for iovera° treatments of the referenced nerves. In the event that all 3 nerves are not treated, a modifier is to be used. Contact the Reimbursement Helpline for additional information.
For CPT codes for other iovera° applications, contact the Reimbursement Helpline. Contact information below.
iovera° is part of
the NOPAIN Act
Did you know that Medicare provides separate reimbursement for iovera° in outpatient settings (both ASC and HOPD) when using code C9809?
Learn more
Reimbursement resources
Go-to resources to stay up to date on the latest reimbursement data and tools to assist with payor documentation.
Coding Guidance
Letter of Medical Necessity
EMR Treatment Notes
Reimbursement fee schedules
CPT code 64640 can be billed for up to 5 nerves or nerve branches.
Facility component
| 64640 | |
|---|---|
| APC | #5443 Level II Nerve Injections |
| ASC Fee | $197.04 |
| HOPD Fee | $903.63 |
| 64624 | |
| APC | #5431 Level I Nerve Procedure |
| ASC Fee | $948.66 |
| HOPD Fee | $1995.02 |
CMS Outpatient Prospective Payment System (OPPS) and the Medicare Ambulatory Surgical Center (ASC) payment system for calendar year 2026, https://public-inspection.federalregister.gov/2025-20907.pdf
Professional Component
| 64640 | |
|---|---|
| Total Non-Facility RVUs | 8.02 |
| Total Facility RVUs | 3.34 |
| Physician Fee Schedule (non-facility) | $269.21 |
| Physician Fee Schedule (facility) | $112.12 |
| 64624 | |
| Total Non-Facility RVUs | 12.32 |
| Total Facility RVUs | 3.99 |
| Physician Fee Schedule (non-facility) | $413.55 |
| Physician Fee Schedule (facility) | $133.93 |
Source: Centers for Medicare and Medicaid Services. Medicare and Medicaid Programs; CY 2026 Payment Policies Under the Physician Fee Schedule and Other Changes to Part B Payment and Coverage Policies; Federal Register (90 FR 49266) https://www.cms.gov/medicare/payment/fee-schedules/physician/federal-regulation-notices/cms-1832-f
Subject to change based on CMS updates.
Facility refers to HOPDs or ASCs, while non-facility refers to an office or a clinic that is not provider based (eg, hospital)
This information is provided for general reference and informational purposes only. Each health care provider is ultimately responsible for determining the appropriate codes, coverage, and payment for individual patients. Pacira does not guarantee third party coverage or payment for the iovera° treatment or reimburse for claims that are denied by third-party payers.
Reimbursement helpline
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We’re ready to help answer your questions and guide you through the reimbursement process.
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Ordering iovera° system components
Customer Service, Product Ordering, and Billing
- Phone: 800-442-0989
- Fax: 833-958-2048
- Email: ioveraCS@icsconnect.com
See iovera° in action
Government Affairs
Department of Defense (DOD) and other federal agencies can now order iovera° through the ECAT online ordering system. iovera° is a percutaneous treatment using proven cold therapy (cryoanalgesia) designed to relieve pain associated with chronic osteoarthritis
- Immediate, safe, and effective1,2
- Non-systemic3
- Long-lasting nerve block1
- Cleared by the US Food and Drug Administration (FDA)
iovera° is appropriate for surgical (ie, pre-TKA) and non-surgical chronic OA pain patients including
- Patients who chronically cycle through nonsteroidal anti-inflammatory drugs, injections, and opioids
- Patients who hesitate to have surgery
- Patients with whom you need to first address risk factors before they are ready for surgery
The following iovera° system components from Pacira BioSciences, Inc. are available via:
ECAT contract # SPE2DE-21-D-7004:
| Part Number | Gen 2 Product Description |
|---|---|
| IST2221 | Gen 2, iovera° System Handpiece and Docking Station |
| STT2309-5 | Gen 2, iovera° 309 Smart Tips, 5-pack 3 x 8.5 mm per Smart Tip |
| STT2190-5 | Gen 2, iovera° 190 Smart Tips, 5-pack 1 x .90 mm per Smart Tip |
| CRX2111-10 | Gen 2, iovera° Cartridges, 10-pack |
| STT2190STIM-5 | Gen2, iovera° 190 Smart Tips with Nerve Stim, 5-pack 15.5 x 7.5mm per Smart Tip |
| STT21180STIM-5 | Gen2, iovera° 1180 Smart Tips with Nerve Stim, 5-pack 16.6 x 7.5mm per Smart Tip |
It is the sole responsibility of the health care provider to correctly report all procedures and therapies. The information above is shared solely for informational and educational purposes. Information provided for general reference only. Pacira does not guarantee third-party coverage or payment and provides no reimbursement for denied claims.
APC=ambulatory payment classification; ASC=ambulatory surgery center; CMS=Centers for Medicare and Medicaid Services; CPT=Current Procedural Terminology; HOPD=hospital outpatient department; ICD-10-CM=International Classification of Diseases, Tenth Revision, Clinical Modification; ISN=infrapatellar saphenous nerve; RVU=relative value unit; TKA=total knee arthroplasty.
CPT code selection is based on clinician determination.
EMR=electronic medical record.
- References:
- 1. Radnovich R et al. Osteoarthritis Cartilage. 2017;25(8):1247-1256.
- 2. Dasa V et al. Knee. 2016;23(3):523-528.
- 3. Ilfeld BM et al. Expert Med Devices. 2016;13(8):713-725.