07/16/2018

Payment for CPT Code 64455-Excellus

64455 - am being told by Excellus that per AMA guidelines this code is to be paid only once - is this correct? seems absurd to have the patient return multiple times for multiple injections - have continual problems getting paid for more than one injection

It seems that there was an error in explaining the frequency that the injection would be covered. The Medicare LCD follows the AMA guidelines for the service. Below are the guidelines to consider for payment based on the policy that Excellus uses as a model for payment:

• One neuroma injection would be payable per day without review of documentation
• More than one injection is payable on a DOS, but notes would need to be submitted for a bilateral injection, or multiple injections performed on the same foot to justify medical necessity
• Subsequent injections are payable, but are limited to three injections of the same neuroma every six months