2023 Payment Changes for Anesthesia and Pain Services

While there will be no changes in how you report your anesthesia services; there are some changes to the pain codes in 2023.

Somatic Nerve Injection CPT codes 64415, 64416, 64417, 64445, 64446, 64447, and 64448 describe only injection of an anesthetic agent in the area of the peripheral nerve and/or catheter placement for postoperative pain management. Starting January 1, 2023, somatic nerve injection codes will be bundled with imaging services.

In recent years, these codes have been frequently reported with imaging (CPT code 76942 (Ultrasound image guidance)). Due to the frequent reporting of imaging, these codes were identified by the CPT Editorial Panel and the RVS Update Committee (RUC) to be revised and imaging was bundled into the procedure codes.

Table 1 lists the new code descriptions for Somatic Nerve Injection codes.

This change also affects the reimbursement rates of the Somatic Nerve Injection codes. After the codes were reviewed at the RUC in October 2021, the Centers for Medicare & Medicaid (CMS) rejected the RUC recommendations for codes 64415, 64416, 64445, and 64446. Instead, CMS proposed values below those recommended by the RUC in the 2023 Medicare Physician Fee Schedule (MPFS) proposed rule.

ASA met with CMS in August to advocate for higher values and explained how the intensity of the procedure does not decrease because the physicians performing the injection are assisted with the ultrasound guidance. ASA also sent a letter in response to the proposed rule. ASA is pleased with the CMS announcement to accept RUC recommended values in the 2023 final MPFS rule. Overall, ASA’s efforts have lessened the severity of the cuts.

As shown in Table 2, the payment rates for the bundled codes will be lower compared to the payment rates when imaging used to be reported separately.

Furthermore, the National Correct Coding Initiative (NCCI) edit will also become effective on January 1, 2023, to ensure that the somatic injection codes are not reported together with imaging codes. As a result, if you submit the new somatic codes with imaging codes, your claim will be denied. Imaging guidance may be separately reported, when performed with the other nerve injection services that are reported, using codes 64405, 64408, 64420, 64421, 64425, 64430, 64435, and 64449. For further information, refer to a table on page 479 of the 2023 CPT Professional Edition to help you distinguish reporting for nerve injection procedures that include imaging guidance and those codes that do not include imaging guidance.