LCD Reference Article Billing and Coding Article

Billing and Coding: Cryoneurolysis Instructions

A59753

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Source Article ID
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Article ID
A59753
Original ICD-9 Article ID
Not Applicable
Article Title
Billing and Coding: Cryoneurolysis Instructions
Article Type
Billing and Coding
Original Effective Date
01/01/2024
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Article Text

Cryoneurolysis a medical treatment which has been proposed to be a mechanism for relieving pain by freezing the affected peripheral nerves.

One manufacturer of this system, Iovera, instructs providers on their website to bill the treatment with Current Procedural Terminology (CPT) 64640 (Destruction by neurolytic agent; other peripheral nerve or branch) or CPT code 64624 (Destruction by neurolytic agent, genicular nerve branches including imaging guidance, when performed). Codes 64640 and 64624 require the destruction of target nerve(s). The Iovera system is temporary and not destructive. Therefore, CPT codes 64640 and 64624 are not appropriate for Medicare billing. 

While there is no specific CPT code for cryoneurolysis, Noridian has determined the most appropriate codes for this technology are represented by codes 0440T, 0441T and 0442T, until a permanent CPT code is provided.

  • 0440T - Ablation, percutaneous, cryoablation, including image guidance; upper extremity distal/peripheral nerve
  • 0441T - Ablation, percutaneous, cryoablation, including image guidance; lower extremity distal/peripheral nerve
  • 0442T - Ablation, percutaneous, cryoablation, including image guidance; nerve plexus or truncal nerve (e.g. Brachial plexus, pudendal nerve)

Use 0441T for the Iovera system for use in the knee.

Note: Noridian may request additional documentation and review on case-to-case basis for medical necessity.

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Associated Documents

Medicare BPM Ch 15.50.2 SAD Determinations
Medicare BPM Ch 15.50.2
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Updated On Effective Dates Status
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