Summary & Overview
CPT 64642: Neurolytic Destruction of Somatic Nerves in One Extremity
CPT code 64642 is a nationally recognized billing code for the destruction of somatic nerves in one extremity using neurolytic agents, such as chemical, thermal, electrical, or radiofrequency techniques. This procedure is primarily utilized in the management of spasticity and movement disorders, offering relief for patients with conditions that cause abnormal muscle tone or involuntary movements. The code is relevant to both Physical Medicine & Rehabilitation and Neurology specialties, and is typically performed in office or outpatient hospital settings.
Major payers covering this procedure include Aetna, Blue Cross Blue Shield, Cigna Health, Medicare, and UnitedHealthcare. The publication provides a comprehensive overview of payer coverage, clinical indications, and related billing codes. Readers will gain insights into national benchmarks, policy updates, and the clinical context for the use of 64642, including its relationship to other neurolytic destruction codes and common diagnoses such as spasticity, dystonia, and multiple sclerosis. The summary also highlights the importance of understanding payer requirements and coding nuances for accurate billing and reimbursement.
This article serves as a resource for healthcare professionals, administrators, and policy analysts seeking up-to-date information on the utilization and coverage of CPT code 64642 across major payers, as well as its clinical applications and associated procedures.
CPT Code Overview
CPT code 64642 describes the destruction of somatic nerves in one extremity using a neurolytic agent, such as chemical, thermal, electrical, or radiofrequency methods. This procedure is commonly performed to address conditions like spasticity and is part of the Physical Medicine & Rehabilitation and Neurology service types. Typical sites of service include the office (Place of Service 11) and outpatient hospital (Place of Service 22). The procedure is designed to help manage abnormal muscle tone and movement disorders by targeting specific nerves in the upper or lower limbs.
Clinical & Coding Specifications
Clinical Context
A typical patient scenario involves an adult presenting with spasticity or dystonia affecting one extremity, such as the arm or leg. The patient may have underlying neurological conditions like multiple sclerosis, hereditary spastic paraplegia, or dystonia. After evaluation by a pain medicine physician or a physical medicine & rehabilitation specialist, the patient is scheduled for a neurolytic destruction procedure targeting somatic nerves in the affected extremity. The procedure is performed in an office or outpatient hospital setting, using chemical, thermal, electrical, or radiofrequency methods to reduce spasticity and improve function. Documentation includes pre-procedure assessment, informed consent, and post-procedure follow-up for efficacy and adverse effects.
Coding Specifications
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Modifier
50(Bilateral Procedure): Used when the procedure is performed on both extremities during the same session. -
Modifier
59(Distinct Procedural Service): Used to indicate that the procedure is distinct from other services performed on the same day, such as when multiple neurolytic destruction procedures are performed on different nerves or anatomical sites.
| Provider Taxonomy Code | Specialty Name |
|---|---|
208VP0000X | Pain Medicine Physician |
207LP2900X | Physical Medicine & Rehabilitation Physician |
207R00000X | Internal Medicine Physician |
These taxonomies represent the specialties typically performing or supervising the procedure described by CPT code 64642.
Related Diagnoses
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M62.411— Spasm of muscle- Relevant for patients with spasticity secondary to spastic hemiplegia and hemiparesis, often treated with neurolytic destruction.
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M62.838— Spasm of other muscle- Used for spasticity in muscles not otherwise specified, also treated by neurolytic procedures.
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G11.4— Hereditary spastic paraplegia- Indicates a genetic disorder causing lower limb spasticity, a target for neurolytic intervention.
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G24.1— Genetic torsion dystonia- Represents dystonia of genetic origin, which may require neurolytic treatment for symptom control.
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G24.2— Idiopathic nonfamilial dystonia- Used for dystonia without a familial or genetic cause, relevant for neurolytic procedures.
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G24.8— Other dystonia- Covers dystonia types not specified elsewhere, potentially treated with neurolytic destruction.
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G24.9— Dystonia, unspecified- Used when dystonia is present but not further classified, may be treated with this procedure.
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G25.89— Other specified extrapyramidal and movement disorders- Includes movement disorders that may cause spasticity or dystonia, relevant for neurolytic treatment.
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G35.A— Relapsing‑remitting multiple sclerosis- Patients with MS may develop spasticity in extremities, treated with neurolytic procedures.
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G35.B0— Primary progressive multiple sclerosis, unspecified- Progressive MS can cause spasticity, making neurolytic destruction appropriate.
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G35.B1— Active primary progressive multiple sclerosis- Active disease phase may require intervention for spasticity.
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G35.B2— Non‑active primary progressive multiple sclerosis- Even in non-active phases, spasticity may persist and require treatment.
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G35.C0— Secondary progressive multiple sclerosis, unspecified- Secondary progressive MS often leads to chronic spasticity.
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G35.C1— Active secondary progressive multiple sclerosis- Active phase may necessitate neurolytic intervention.
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G35.C2— Non‑active secondary progressive multiple sclerosis- Spasticity may be present regardless of disease activity.
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G35.D— Multiple sclerosis, unspecified- Used when MS is diagnosed but not further classified; spasticity may be treated.
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G36.0— Neuromyelitis optica [Devic]- This demyelinating disorder can cause spasticity, relevant for neurolytic procedures.
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G36.1— Acute and subacute hemorrhagic leukoencephalitis [Hurst]- Rare demyelinating disease that may result in spasticity requiring intervention.
Related CPT Codes
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64643: Destruction by neurolytic agent (eg, chemical, thermal, electrical or radiofrequency) procedures on the somatic nerves; each additional extremity (List separately in addition to code for primary procedure)- Used when the procedure is performed on more than one extremity; billed in addition to
64642.
- Used when the procedure is performed on more than one extremity; billed in addition to
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64644: Destruction by neurolytic agent ... trunk; 1–5 muscles- Used for neurolytic destruction procedures targeting muscles in the trunk, not extremities.
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64645: Destruction by neurolytic agent ... trunk; each additional 5 muscles (List separately in addition to code for primary procedure)- Used in conjunction with
64644when more than 5 trunk muscles are treated.
- Used in conjunction with
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64646: Destruction by neurolytic agent ... trunk muscle(s); 1–5 muscles- Alternative code for trunk muscle neurolytic destruction, similar to
64644.
- Alternative code for trunk muscle neurolytic destruction, similar to
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64647: Destruction by neurolytic agent ... trunk muscle(s); each additional 5 muscles (List separately in addition to code for primary procedure)- Used with
64646for additional trunk muscles beyond the initial 1–5.
- Used with
Codes 64643, 64645, and 64647 are commonly used together with their respective primary codes (64642, 64644, 64646) when procedures are performed on additional extremities or muscles.
National Reimbursement Benchmarks
For CPT code 64642, the national mean rate for Medicare is $167.52, while the average commercial benchmark (BUCA) is higher at $186.63. Among individual commercial payers, UnitedHealth Group has the highest mean rate at $241.59, and Aetna has the lowest at $159.32.
Rate dispersion, measured by the difference between the 75th and 25th percentiles, varies significantly across payers. Medicare exhibits the tightest range ($18.00), indicating relatively consistent reimbursement rates. In contrast, UnitedHealth Group shows the widest range ($137.22), reflecting greater variability in commercial payments. Cigna also demonstrates a broad range ($121.00), while Aetna and Blue Cross Blue Shield have moderate dispersion.
The table and chart below present a detailed breakdown of national mean rates and percentile values for each payer.
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.