What is CPT 20526, 28899, 64450 and 64455

All the above mentioned CPTs are related to Injections 

Injection of a carpal tunnel may be indicated for the patient with carpal tunnel syndrome if oral agents and orthoses have failed or are contraindicated, or as adjunctive therapy to systemic agents for an inflammatory arthritis when those agents have not yet become effective and the patient experiences a relative entrapment syndrome manifested by moderate to severe pain. Note that this procedure has its own CPT code, 20526. Injection of a tarsal tunnel is indicated for the patient with tarsal tunnel syndrome if oral agents have failed or are contraindicated, or as adjunctive therapy to systemic agents for an inflammatory arthritis when those agents have not yet become effective and the patient experiences a relative entrapment syndrome manifested by moderate to severe pain. Though there are many similarities between this and carpal tunnel syndrome, the best apparent CPT code for tarsal tunnel injection is 28899.

64450 & 64455 – Nerve block injections 

Note: Use 28899 for Tarsal Tunnel Syndrome along with the verbiage "Tarsal Tunnel Syndrome"

20526	INJECTION, THERAPEUTIC (EG, LOCAL ANESTHETIC, CORTICOSTEROID), CARPAL TUNNEL
28899	UNLISTED PROCEDURE, FOOT OR TOES
64450	INJECTION, ANESTHETIC AGENT; OTHER PERIPHERAL NERVE OR BRANCH
64455	INJECTION(S), ANESTHETIC AGENT AND/OR STEROID, PLANTAR COMMON DIGITAL NERVE(S) (EG, MORTON’S NEUROMA)

ICD-9 Codes that Support Medical Necessity

It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-9-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted

NOTE: It may be appropriate to report 355.5 for Tarsal Tunnel Syndrome (along with CPT code 28899).

Coverage for 20526 is limited to the following code:

354.0	CARPAL TUNNEL SYNDROME

Coverage for 64455 is limited to the following code:

355.6*	LESION OF PLANTAR NERVE

*Use 355.6 for Morton's metatarsalgia, neuralgia, or neuroma.

Diagnoses that Support Medical Necessity

N/A

ICD-9 Codes that DO NOT Support Medical Necessity

All those not listed under the “ICD-9 Codes that Support Medical Necessity” section of this policy.
The Contractor has the following Non Coverage for CPT Codes 64450 and 28899 (when used to describe an injection procedure other than tarsal tunnel syndrome):

249.00 - 250.93	SECONDARY DIABETES MELLITUS WITHOUT MENTION OF COMPLICATION, NOT STATED AS UNCONTROLLED, OR UNSPECIFIED - DIABETES WITH UNSPECIFIED COMPLICATION, TYPE I [JUVENILE TYPE], UNCONTROLLED
272.1	PURE HYPERGLYCERIDEMIA
274.9	GOUT UNSPECIFIED
354.0	CARPAL TUNNEL SYNDROME
355.6	LESION OF PLANTAR NERVE
715.35	OSTEOARTHROSIS LOCALIZED NOT SPECIFIED WHETHER PRIMARY OR SECONDARY INVOLVING PELVIC REGION AND THIGH
715.36	OSTEOARTHROSIS LOCALIZED NOT SPECIFIED WHETHER PRIMARY OR SECONDARY INVOLVING LOWER LEG
715.91	OSTEOARTHROSIS UNSPECIFIED WHETHER GENERALIZED OR LOCALIZED INVOLVING SHOULDER REGION
715.95	OSTEOARTHROSIS UNSPECIFIED WHETHER GENERALIZED OR LOCALIZED INVOLVING PELVIC REGION AND THIGH
716.87	OTHER SPECIFIED ARTHROPATHY INVOLVING ANKLE AND FOOT
716.97	UNSPECIFIED ARTHROPATHY INVOLVING ANKLE AND FOOT
719.41	PAIN IN JOINT INVOLVING SHOULDER REGION
719.45	PAIN IN JOINT INVOLVING PELVIC REGION AND THIGH
719.46	PAIN IN JOINT INVOLVING LOWER LEG
719.47	PAIN IN JOINT INVOLVING ANKLE AND FOOT
719.57	STIFFNESS OF JOINT NOT ELSEWHERE CLASSIFIED INVOLVING ANKLE AND FOOT
719.85	OTHER SPECIFIED DISORDERS OF JOINT OF PELVIC REGION AND THIGH
719.87	OTHER SPECIFIED DISORDERS OF ANKLE AND FOOT JOINT
719.95	UNSPECIFIED DISORDER OF JOINT OF PELVIC REGION AND THIGH
719.97	UNSPECIFIED DISORDER OF ANKLE AND FOOT JOINT
720.2	SACROILIITIS NOT ELSEWHERE CLASSIFIED
726.2	OTHER AFFECTIONS OF SHOULDER REGION NOT ELSEWHERE CLASSIFIED
726.5	ENTHESOPATHY OF HIP REGION
726.70 - 726.73	ENTHESOPATHY OF ANKLE AND TARSUS UNSPECIFIED - CALCANEAL SPUR
726.79	OTHER ENTHESOPATHY OF ANKLE AND TARSUS
726.90	ENTHESOPATHY OF UNSPECIFIED SITE
726.91	EXOSTOSIS OF UNSPECIFIED SITE
727.00 - 727.06	SYNOVITIS AND TENOSYNOVITIS UNSPECIFIED - TENOSYNOVITIS OF FOOT AND ANKLE
727.09	OTHER SYNOVITIS AND TENOSYNOVITIS
727.82	CALCIUM DEPOSITS IN TENDON AND BURSA
727.9	UNSPECIFIED DISORDER OF SYNOVIUM TENDON AND BURSA
728.4	LAXITY OF LIGAMENT
728.85	SPASM OF MUSCLE
729.1	MYALGIA AND MYOSITIS UNSPECIFIED
729.79	NONTRAUMATIC COMPARTMENT SYNDROME OF OTHER SITES
729.90	DISORDERS OF SOFT TISSUE, UNSPECIFIED
756.9	OTHER AND UNSPECIFIED CONGENITAL ANOMALIES OF MUSCULOSKELETAL SYSTEM
840.4	ROTATOR CUFF (CAPSULE) SPRAIN