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Occipital Nerve Injections or Radiofrequency Ablation (RFA) to treat Cervicogenic Headache and Occipital Neuralgia

These services may or may not be covered by your HealthPartners plan. Please see your plan documents for your specific coverage information. If there is a difference between this general information and your plan documents, your plan will be used to determine your coverage.

Administrative process

Radiofrequency ablation (RFA) requires prior authorization.

Occipital nerve injections do not require prior authorization.

Radiofrequency ablation (RFA) is generally not covered because there is insufficient evidence to support its effectiveness. It is considered investigational and experimental.

Occipital nerve injections are covered.

Radiofrequency ablation (denervation) - an invasive procedure in which radiofrequency energy is applied via a percutaneous probe in order to irreversibly destroy the occipital nerve and thus relieve pain.

Occipital nerve injections - a local injection into the occipital nerve of steroids or other medications in order to relieve the nerve induced pain.

If available, codes are listed below for informational purposes only, and do not guarantee member coverage or provider reimbursement. The list may not be all-inclusive.

Requires prior authorization

64600 - Destruction by neurolytic agent, trigeminal nerve; supraorbital, infraorbital, mental,
or inferior alveolar branch

Covered without prior authorization:

64405 - Injection, anesthetic agent; greater occipital nerve

CPT Copyright American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.

Products

This information is for most, but not all, HealthPartners plans. Please read your plan documents to see if your plan has limits or will not cover some items. If there is a difference between this general information and your plan documents, your plan documents will be used to determine your coverage. These coverage criteria may not apply to Medicare Products if Medicare requires different coverage. For more information regarding Medicare coverage criteria or for a copy of a Medicare coverage policy, contact Member Services at 952-883-7979 or 1-800-233-9645.