Diagnostic Ultrasound Reimbursement for nerve blocks

edematous foot without being able to palpate structure(s) a great example of medical necessity

To answer this question, one needs to know which nerve block code(s) you are intending to use.

Some such as 64450 (injection into peripheral nerve) , do not have an imaging section within their narrative and also do not have an NCCI edit precluding performing the diagnostic guidance (76942) . Others such as 64445 INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; SCIATIC NERVE, INCLUDING IMAGING GUIDANCE, WHEN PERFORMED, which is typically used by anesthesiologists pre or post operative pain or pain managment physicians for pain relief, have as noted an imaging guidance within their narrative and also an NCCI edit precluding its use. The CPT book also precluedes the narrative.

For Morton's neuroma injections (64455) there is no narrative preclusion, however interestingly enough there is an NCCI edit precluding billing 64455 with 76000 (fluroscopy) and both ultrasound follow up (76970) and 76998 (ultrasound guidance intraoperative). There is no preclusion from billing the Morton's neuroma injection with 76942 (diagnostic guidance). However, the latter 76942 would be inappropriate if the diagnosis has already been confirmed either clinically (alone) or with diagnostic imaging.

The last issue to consider is the medical necessity for use of any guidance technique in particular for injections into superficial tissue structures which can easily be palpated.