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.
- 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.
- 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.
|APC||#5443 Level II Nerve Injections|
|APC||#5431 Level I Nerve Procedure|
|Total Non-Facility RVUs||7.37|
|Total Facility RVUs||3.50|
|Physician Fee Schedule (non-facility)||$243.66|
|Physician Fee Schedule (facility)||$115.71|
|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 1/1/2023. CMS 2023 (national average) final fee schedules, based on a 2023 Conversion Factor of 33.8872.
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.
Got questions? Call us!
We’re ready to help answer your questions and guide you through the reimbursement process.
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
- 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.