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NIA Sympathetic Nerve Block Notification Letter

October 31, 2022

Dear Provider Partner,

Effective 1/1/2023, NIA will be updating the current Interventional Pain Management list of managed codes with the below addition of Sympathetic Nerve Blocks that require authorization. Below are the Sympathetic Nerve Blocks, the primary code, and the allowable billed groupings.

INTERVENTIONAL PAIN MANAGEMENT (Expanded Procedures)
Primary Request Primary CPT Code Primary Allowable Billed Groupings Ancillary Procedures/Codes
These codes do not require prior authorization. If the main procedure is approved, these codes area understood to be included in conjunction and do not require precertification from the health plan.
*Please note: This is not an all-inclusive list of every ancillary code.
Sympathetic Nerve Block 64510 64510, 64517, 64520, 64530 77003

For any additional information, please contact NIA:

  • Medicaid: 1-866-249-1585; or
  • Medicare: 1-800-424-5388

Again, we thank you for your commitment to the care and well-being of our members and to the communities we serve. Please don’t hesitate to reach out to Provider Services at 1-888-453-2534 with any questions that you may have.

Sincerely,
WellCare of New Jersey

www.wellcare.com/New-Jersey

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Y0020_WCM_134133E Last Updated On: 11/6/2023