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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

For CPT codes for other iovera° applications such as shoulder pain, contact the Reimbursement Helpline. Contact information below.

ANTERIOR 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
  • Lateral Femoral Cutaneous Nerve
  • Intermediate Lateral Femoral Cutaneous Nerve
  • Anterior Femoral Cutaneous Nerve
  • Medial Femoral Cutaneous Nerve
  • Intermediate Medial Femoral Cutaneous Nerve
  • Supra-Patellar Branch of the Saphenous Nerve
  • Superior Branch of the Infrapatellar Branch of the Saphenous Nerve
  • Inferior Branch of the Infrapatellar Branch of the Saphenous Nerve

POSTERIOR KNEE PAIN CODING

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.

posterior
  • Superolateral (superolateral articulating branch of the common peroneal nerve)
  • Superomedial (superomedial articulating branch of the tibial nerve)
  • Inferomedial (inferomedial articulating branch of the tibial nerve)

When iovera° is used for posterior (deep genicular) knee pain, CPT code 64624 can be used to indicate treatment of the following associated nerves:

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 $171.92
HOPD Fee $852.18
64624
APC #5431 Level I Nerve Procedure
ASC Fee $854.03
HOPD Fee $1797.52

Professional Component

64640
Total Non-Facility RVUs 7.37
Total Facility RVUs 3.50
Physician Fee Schedule (non-facility) $243.66
Physician Fee Schedule (facility) $115.71
64624
Total Non-Facility RVUs 11.64
Total Facility RVUs 4.31
Physician Fee Schedule (non-facility) $384.83
Physician Fee Schedule (facility) $142.49

Source: CMS, as of 1/1/2022. CMS 2022 (national average) final fee schedules, based on a 2022 Conversion Factor of 33.59.

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)

REIMBURSEMENT HELPLINE

Got questions? Call us!

We’re ready to help answer your questions and guide you through the reimbursement process.

ORDERING iovera° SYSTEM COMPONENTS

Customer Service, Product Ordering, and Billing

IN GOVERNMENT FACILITIES

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
Part Number Gen 1 Product Description
IST0221 iovera° System Handpiece and Docking Station
STT0309-5 iovera° 309 Smart Tips, 5-pack 3 x 8.5 mm per Smart Tip
STT0801-5 iovera° 190 Smart Tips, 5-pack 1 x .90 mm per Smart Tip
STT0811-5 iovera° 190 Smart Tips with Nerve Stim, 5-pack 1 x .90 mm
CRX0111-10 iovera° Cartridges, 10-pack
CRX0111-20 iovera° Cartridges, 20-pack

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.

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.

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.

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Indication

The iovera° system is used to destroy tissue during surgical procedures by applying freezing cold. It can also be used to produce lesions in peripheral nervous tissue by the application of cold to the selected site for the blocking of pain. It is also indicated for the relief of pain and symptoms associated with osteoarthritis of the knee for up to 90 days. The iovera° system is not indicated for treatment of central nervous system tissue.

When stimulation compatible components are used, the iovera° system can also facilitate target nerve location by conducting electrical nerve stimulation from a compatible 3rd party nerve stimulator.

Important Safety Information

Contraindications

The iovera° system is contraindicated for use in patients with the following:

  • Cryoglobulinemia, paroxysmal cold hemoglobinuria, cold urticaria, Raynaud’s disease, and open and/or infected wounds at or near the treatment site

Potential Complications

As with any surgical treatment that uses needle-based therapy and local anesthesia, there is a potential for site-specific reactions, including, but not limited to:

  • Ecchymosis, edema, erythema, local pain and/or tenderness, and localized dysesthesia

Proper use of the device as described in the User Guide can help reduce or prevent the following complications:

  • At the treatment site(s): injury to the skin related to application of cold or heat, hyper- or hypopigmentation, and skin dimpling
  • Outside the treatment site(s): loss of motor function
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Indication

The iovera° system is used to destroy tissue during surgical procedures by applying freezing cold. It can also be used to produce lesions in peripheral nervous tissue by the application of cold to the selected site for the blocking of pain.

Important Safety Information