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Interactions: Inform patients that certain drugs (antibiotics, methotrexate) can affect B12 testing, but generally B12 injections have no major drug interactions

Key Facts About CPT 64450 Service type: Therapeutic/diagnostic procedure (injection) Procedure: Peripheral nerve or branch injection Medication: Local anesthetic/steroid (reported separately if applicable) Guidance: May be performed with or without imaging (e.g., ultrasound) Setting: Office, outpatient, or facility Provider type: Physicians and qualified healthcare professionals Common clinical indications: Acute or chronic pain management Diagnostic nerve blocks to identify pain source Neuropathic pain conditions Musculoskeletal pain syndromes Pre- or post-procedural anesthesia When to Use CPT 64450 CPT 64450 is appropriate when: Injecting an anesthetic agent into a peripheral nerve or branch The nerve targeted does not have a more specific CPT code The procedure is performed for diagnostic or therapeutic purposes The injection is medically necessary for pain management or evaluation Examples: Peripheral nerve block for localized pain not tied to a named nerve code Diagnostic injection to determine the source of neuropathic pain Local anesthetic injection for minor procedures or pain relief Treating focal nerve-related pain syndromes Documentation Requirements To support CPT 64450 billing, documentation should include: Patient identifiers and date of service Clinical indication for the injection Specific nerve or anatomical site targeted Medication used, dosage, and concentration Technique (including whether imaging guidance was used) Laterality (if applicable) Patient response and tolerance Post-procedure instructions and follow-up Provider signature and credentials Clear identification of the nerve/branch treated is essential for accurate coding

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I generally use an 18-gauge needle to draw the fluid into a 3ml syringe