CPT Code 64447: Femoral nerve block billing guide 2026

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Key takeaways

CPT Code 64447 covers a single injection of anesthetic agent and/or steroid into the femoral nerve, with imaging guidance bundled when performed.

Billing 76942 or 77002 alongside 64447 triggers an NCCI bundling edit, and no modifier overrides it.

Use 64448 only when a continuous infusion catheter stays at the femoral nerve. CPT 64447 covers single-injection technique.

Medicare pays about $134 in the office and about $61 in a facility for 2026, on the same work RVU of 1.31.

Practice management software like Pabau flags bundling conflicts before submission, so fewer nerve block claims come back denied.

CPT Code 64447 is the billing code for a single injection of anesthetic, steroid, or both into the femoral nerve.

Imaging guidance is part of the code, so ultrasound and fluoroscopy are never billed alongside it. The code covers single-shot technique only. If a catheter stays in place for continuous infusion, 64448 applies instead.

For 2026, Medicare pays roughly $134 in the office and roughly $61 in a facility. Both settings carry the same work RVU of 1.31, so practice expense accounts for the whole difference. Local rates move with your MAC’s geographic adjustment.

The rest of this guide covers the fee schedule, the bundling rule, and code selection against 64448 and 64450. It then works through supporting ICD-10 codes and documentation.

CPT Code 64447: Official description and clinical definition

The American Medical Association’s CPT code set carries the official descriptor for every procedure code. For 64447 it reads:

Official descriptor: “Injection(s), anesthetic agent(s) and/or steroid; femoral nerve, including imaging guidance, when performed.”

Three elements define scope. First, this is a single-injection procedure, not a catheter placement. Second, the agent may be a local anesthetic, a steroid, or both. Third, imaging guidance is included in the code itself when used, so it cannot be reported separately.

CPT 64447 falls within the peripheral nerve block family (CPT range 64400-64530). It is anatomically specific to the femoral nerve. That makes it distinct from the catch-all code 64450, which covers “other peripheral nerve or branch” blocks with no code of their own.

Femoral nerve block procedure overview

The femoral nerve originates from the lumbar plexus (L2-L4) and supplies the anterior thigh and medial leg. Blocking it reduces pain signals from the knee, hip, and proximal thigh. That makes the technique especially useful in orthopedic and trauma settings.

Common clinical indications for a femoral nerve block billed under CPT Code 64447 include:

• Postoperative analgesia following total knee arthroplasty
• Acute hip fracture pain management in the emergency setting
• Quadriceps tendon or patellar tendon repair analgesia
• Anterior femur fracture pain control prior to surgical fixation
• Diagnostic nerve block to confirm femoral neuropathy

Ultrasound guidance is now the dominant technique, because it shows the nerve, the nearby vessels, and the needle as the block is placed. That guidance is bundled into 64447, so the code applies whether imaging is used or not. “Including imaging guidance, when performed” means the same code is billed either way.

CPT 64447 fee schedule and Medicare reimbursement 2026

Medicare payment for CPT Code 64447 varies by setting and by MAC locality. The figures below are 2026 national averages from the CMS Physician Fee Schedule lookup tool, priced at the $33.4009 conversion factor. Check them against your own MAC’s published schedule before you bill.

Both settings share the same work and malpractice RVUs. The entire payment difference sits in practice expense. An office absorbs the supplies, staff time, and room cost that a facility bills on its own claim. The chart below breaks the two totals into their components.

Geographic adjustment factors then move each component by locality, and they hit practice expense hardest. Commercial payer rates often differ from Medicare too, so check your contracted rates before you treat the Medicare figure as a proxy.

Is imaging guidance bundled in CPT 64447?

Yes, without exception. This is the single most billing-relevant fact about CPT Code 64447, and it is the source of the code’s most common denial.

The official descriptor contains the phrase “including imaging guidance, when performed.” That language makes imaging part of the procedure’s value, whether you use ultrasound (76942) or fluoroscopy (77002). Submitting either code alongside 64447 for the same nerve on the same claim triggers an NCCI bundling edit.

No modifier overrides this bundling rule. The payer will deny or reduce the imaging line whatever you attach to it. Document that imaging was used in the procedure note, then leave the imaging code off the claim.

CPT 64447 vs 64448: Single injection vs continuous infusion

The distinction between 64447 and 64448 is technique-based rather than anatomical. Both target the femoral nerve. What separates them is whether a single bolus was injected or a catheter was placed for continuous infusion.

A common error is billing 64448 for a single-injection case. The provider threaded a catheter to deliver the drug, then removed it. If the catheter came out at the time of the block, 64447 is the correct code.

Related peripheral nerve block CPT codes

Femoral nerve blocks sit inside a broader family of peripheral nerve block codes, and choosing the wrong sibling is a common audit trigger. The table below covers the codes most often confused with CPT Code 64447.

The AAPC Codify CPT lookup tool lists the full sibling hierarchy for the peripheral nerve injection family. It is useful when you audit code selection across several nerve targets at once.

ICD-10 codes linked to CPT 64447

Medical necessity requires a supporting ICD-10-CM diagnosis code on the claim. Medicare and most commercial payers cross-reference the submitted diagnosis against an approved list for peripheral nerve blocks. The diagnoses below are commonly paired with CPT Code 64447, though payer LCDs and clinical criteria ultimately govern coverage.

Always check the diagnosis code against the current payer LCD before submitting. CMS article A57452 governs Medicare coverage for peripheral nerve blocks and lists the covered diagnoses for this code family.

Medicare coverage and payer policies for peripheral nerve blocks

Medicare coverage for CPT Code 64447 sits under the CMS coding and billing framework. Billing and Coding Article A57452 covers peripheral nerve blocks specifically. Your MAC’s Local Coverage Determination carries the jurisdiction-specific criteria on top of that.

Key coverage requirements under Medicare:

• The procedure must be medically necessary for the patient’s documented diagnosis
• In non-acute pain, conservative treatment such as oral analgesics or physical therapy should be documented as tried or contraindicated
• For acute postoperative or fracture pain, that conservative treatment documentation is generally not required
• The performing provider must be a physician or a qualified non-physician practitioner working within their state scope of practice
• Place of service must match the clinical setting, since the facility and non-facility rates differ

Commercial payers follow their own clinical policy bulletins. Aetna sets separate criteria in its nerve block bulletin (CPB 0863), and United Healthcare and Blue Cross plans may require prior authorization for non-acute indications. Review each payer’s policy before you schedule an elective femoral nerve block.

Documentation requirements for a femoral nerve block claim

Incomplete documentation is the second most common cause of 64447 denials, after the imaging unbundling error. Every element below belongs in the procedure note before the claim goes out. Miss one and the payer has grounds to downcode or deny.

• Clinical indication: the diagnosis justifying the block, with the specific ICD-10-CM code in the record
• Nerve targeted: an explicit statement that the femoral nerve was the target, not “lower extremity nerve block”
• Technique: single injection or catheter, stated plainly, plus a note of any ultrasound or fluoroscopy used
• Agent administered: the local anesthetic or steroid by name, with concentration and volume injected
• Provider credentials: the performing provider’s name, credentials, and attestation, plus the supervising attending’s co-signature where a resident or CRNA performed the block
• Patient response: a brief post-procedure note on how the patient responded and any complications
• Imaging notation: confirmation that imaging was performed and is included in the procedure code rather than billed separately

Structured note templates cut the risk of an omission. The required fields are captured at the point of care, not reconstructed a week later. That is what turns a nerve block into a clean claim on first submission.

Common billing errors and denial reasons

Femoral nerve block claims fail for a short list of predictable reasons, which makes them avoidable. Knowing which errors generate the highest denial volume for this code is where a denial workflow starts.

• Unbundling imaging guidance: billing 76942 or 77002 alongside CPT 64447 is the leading cause of NCCI edit denials. The imaging is included, so take it off the claim.
• Using 64450 instead of 64447: when the femoral nerve is the documented target, 64450 is wrong. Audit for this substitution in pain management and emergency settings, where coders may default to the catch-all.
• Selecting 64448 for a single-injection case: check the operative note. If no catheter was left in place, 64448 is wrong however the drug was delivered.
• Thin medical necessity documentation: a claim with no supporting ICD-10 code, or a diagnosis outside the payer LCD, is denied as not medically necessary.
• Incorrect place of service code: a 64447 performed in a hospital outpatient department but billed with POS 11 mismatches the facility’s claim. That generates a coordination edit.
• Duplicate billing with 64448: billing both codes for the same nerve at the same encounter is never appropriate. One code describes the technique used.

Each of those maps to a specific remittance code on the way back. Our reference on denial codes covers what each one means and the appeal route that fits it.

How Pabau keeps femoral nerve block claims clean

The errors in this guide share one cause. Bundling edits, wrong sibling codes, and thin notes all depend on an individual coder catching every rule on every claim. Practice management software like Pabau moves that check into the workflow instead.

Pabau connects the clinical note to claim preparation in one platform. Document a femoral nerve block with its procedure and diagnosis, and our tools for accurate claims management flag known bundling conflicts. That check runs before the claim leaves the practice. So you fix the imaging line once, rather than appealing it a month later.

Claims then route through the Claim.MD clearinghouse, which validates them against thousands of US payers before adjudication. Eligibility checks run at the point of scheduling, so coverage for the patient’s diagnosis is confirmed before the block is performed rather than after.

Reduce nerve block claim denials before they happen

Pabau’s claims workflow flags bundling conflicts, checks code and diagnosis pairings, and routes clean claims to the clearinghouse before submission. See how anesthesia and pain management practices use Pabau to protect reimbursement.

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Conclusion

CPT Code 64447 is a well-defined code that still gets miscoded often. Two errors drive most of the denials, and both are settled before the claim is built. Did imaging go on a separate line, and did the catheter stay in?

Fix those at the note, not at the appeal. A note that names the nerve, the technique, and the agent leaves your coder no room to guess. It also survives the audit that follows a high-volume block program.

The setting matters just as much for the money. Same work, very different payment, so place of service deserves the same care as the code itself. Book a demo to see how Pabau validates nerve block claims before they reach the payer.

Continue your research

Need to understand how clearinghouse validation works? Medical claims clearinghouse guide explains how electronic claim routing reduces denials at the payer gateway.

Want to improve your first-pass claim acceptance rate? Electronic remittance advice (ERA) guide covers how to read remittance data to diagnose denial patterns systematically.

Credentialing with insurers for nerve block procedures? Insurance credentialing guide walks through the enrollment process for Medicare and commercial payers.

Frequently asked questions