Reimbursement Information
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 such as shoulder pain, contact the Reimbursement Helpline. Contact information below.
REIMBURSEMENT RESOURCES
Go-to resources to stay up to date on the latest reimbursement data and tools to assist with payor documentation.
Coding and Reimbursement Guide
An overview of how to get reimbursed for cryoneurolysis with iovera°.
Letter of Medical Necessity Template
Request prior authorization and/or a determination of medical necessity on behalf of your patient.
Smart Tip 2190 EMR Treatment Note Template
Suggested language to supplement your own EMR documentation.
Smart Tip 2309 EMR Treatment Note Template
Suggested language to supplement your own EMR documentation.
Guide to Reporting CPT Code 64640
Clarified guidance regarding the use of CPT code 64640.
Patient Appeal Letter Template
Create your own patient appeal letter when your patient is denied coverage.
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 | $175.42 |
| HOPD Fee | $868.45 |
| 64624 | |
| APC | #5431 Level I Nerve Procedure |
| ASC Fee | $897.67 |
| HOPD Fee | $1839.63 |
Professional Component
| 64640 | |
|---|---|
| Total Non-Facility RVUs | 7.37 |
| Total Facility RVUs | 3.50 |
| Physician Fee Schedule (non-facility) | $248.32 |
| Physician Fee Schedule (facility) | $118.50 |
| 64624 | |
| Total Non-Facility RVUs | 11.64 |
| Total Facility RVUs | 4.31 |
| Physician Fee Schedule (non-facility) | $388.13 |
| Physician Fee Schedule (facility) | $145.13 |
Source: CMS, as of 10/1/2024. CMS 2024 (national average) final fee schedules, based on a 2024 Conversion Factor of $33.2875.
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
Got questions? Call us!
We’re ready to help answer your questions and guide you through the reimbursement process.
Implement patient pay into your practice
Take advantage of resources that make it easier for patients who want to participate.
ORDERING iovera° SYSTEM COMPONENTS
Customer Service, Product Ordering, and Billing
- Phone: 800-442-0989
- Fax: 833-958-2048
- Email address: 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 |
| 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 |
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.
See iovera° in action
Help patients find you
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
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