64405 CPT® code: payer coverage and prior authorization11 of 11 payer prior-auth lists that name 64405 require prior authorization or set conditions: Molina Healthcare of Illinois, Oxford Health Plans, UnitedHealthcare, UnitedHealthcare Community Plan.
64405 appears in 31 coverage policies from Aetna, Anthem, Blue Cross & Blue Shield of Mississippi, Blue Cross NC, Capital Blue Cross, Centene, Cigna, UnitedHealthcare.
| Payer | Policy | Role in policy | Reviewed | Document |
|---|---|---|---|---|
| Aetna | Complex Regional Pain Syndrome (CRPS): Treatments (0447) | listed, no stance (range 64400-64455) | Jul 16, 2026 | payer document |
| Aetna | Diabetic Neuropathy: Selected Treatments (0729) | not covered | Feb 24, 2026 | payer document |
| Aetna | Headaches: Invasive Procedures (0707) | covered if criteria are met | Jul 23, 2026 | payer document |
| Aetna | Headaches: Invasive Procedures (0707) | not covered | Jul 23, 2026 | payer document |
| Aetna | Headaches: Nonsurgical Management (0462) | not covered | Jul 23, 2026 | payer document |
| Aetna | Infusion Pumps (0161) | covered if criteria are met (range 64400-64530) | Mar 31, 2026 | payer document |
| Aetna | Intravenous Iron Therapy (0575) | listed, no stance (range 61000-64999) | Jul 1, 2026 | payer document |
| Aetna | Nerve Blocks (0863) | covered if criteria are met (range 64400-64450) | Jul 23, 2026 | payer document |
| Aetna | Nerve Blocks (0863) | covered if criteria are met | Jul 23, 2026 | payer document |
| Aetna | Nerve Blocks (0863) | not covered | Jul 23, 2026 | payer document |
| Aetna | Respiratory Devices: Incentive Spirometers, Vaporizers and Intermittent Positive Pressure Breathing Machines (0479) | listed, no stance (range 61000-64999) | Jul 9, 2026 | payer document |
| Aetna | Spinal Ultrasound (0628) | listed, no stance (range 64400-64530) | Sep 11, 2026 | payer document |
| Aetna | Thermal Perfusion Probe for Monitoring Regional Cerebral Blood Flow (0703) | listed, no stance (range 61000-64999) | Nov 24, 2025 | payer document |
| Aetna | Ultrasound Guidance – Selected Indications (0952) | not covered | Apr 27, 2026 | payer document |
| Anthem | Occipital and Sphenopalatine Ganglion Nerve Block Therapy for the Treatment of Headache and Neuralgia (SURG.00144) | unproven / investigational | Aug 13, 2026 | payer document |
| Blue Cross & Blue Shield of Mississippi | Postoperative Pain Management (L.7.02.401) | not covered | payer document | |
| Blue Cross NC | Injection Therapy for Headache (Migraine and Other) and Non-Spine Management | listed, no stance | Oct 1, 2025 | payer document |
| Capital Blue Cross | Neural Therapy (MP 8.012) Procedure codes | unproven / investigational | Feb 1, 2026 | payer document |
| Centene | Nerve Blocks and Neurolysis for Pain Management Reference Number: CP.MP.170 (CP.MP.170) | covered if criteria are met | Feb 1, 2025 | payer document |
| Cigna | Headache, Occipital, and/or Trigeminal Neuralgia Treatment (0063) | not covered | Jun 15, 2026 | payer document |
| UnitedHealthcare | Occipital Nerve Injections and Ablation (Including Occipital Neuralgia and Headache) (CS086.AC) | listed, no stance | Sep 1, 2026 | payer document |
| UnitedHealthcare | Occipital Nerve Injections and Ablation (Including Occipital Neuralgia and Headache) (2026T0080TT) | listed, no stance | Sep 10, 2026 | payer document |
| UnitedHealthcare | Occipital Nerve Injections and Ablation (Including Occipital Neuralgia and Headache) (for Idaho Only) (CS086ID.B) | listed, no stance | Feb 1, 2026 | payer document |
| UnitedHealthcare | Occipital Nerve Injections and Ablation (Including Occipital Neuralgia and Headache) (for Kansas Only) (CS086KS.03) | listed, no stance | Sep 1, 2026 | payer document |
| UnitedHealthcare | Occipital Nerve Injections and Ablation (Including Occipital Neuralgia and Headache) (for Kentucky Only) (CS086KY.13) | listed, no stance | Sep 1, 2026 | payer document |
| UnitedHealthcare | Occipital Nerve Injections and Ablation (Including Occipital Neuralgia and Headache) (for Louisiana Only) (CS086LA.W) | listed, no stance | Nov 1, 2025 | payer document |
| UnitedHealthcare | Occipital Nerve Injections and Ablation (Including Occipital Neuralgia and Headache) (for Nebraska Only) (CS086NE.AC) | listed, no stance | Sep 1, 2026 | payer document |
| UnitedHealthcare | Occipital Nerve Injections and Ablation (Including Occipital Neuralgia and Headache) (for New Jersey Only) (CS086NJ.Y) | listed, no stance | Sep 1, 2026 | payer document |
| UnitedHealthcare | Occipital Nerve Injections and Ablation (Including Occipital Neuralgia and Headache) (for New Mexico Only) (CS086NM.D) | listed, no stance | Sep 1, 2026 | payer document |
| UnitedHealthcare | Occipital Nerve Injections and Ablation (Including Occipital Neuralgia and Headache) (for North Carolina Only) (CSNCT0080.06) | listed, no stance | Sep 1, 2026 | payer document |
| UnitedHealthcare | Occipital Nerve Injections and Ablation (Including Occipital Neuralgia and Headache) (for Ohio Only) (CS086OH.E) | listed, no stance | Dec 1, 2025 | payer document |
| UnitedHealthcare | Occipital Nerve Injections and Ablation (Including Occipital Neuralgia and Headache) (for Pennsylvania Only) (CS086PA.Z) | listed, no stance | Sep 1, 2026 | payer document |
| UnitedHealthcare | Occipital Nerve Injections and Ablation (Including Occipital Neuralgia and Headache) (for Tennessee Only) (CS086TN.AA) | listed, no stance | Sep 1, 2026 | payer document |
| UnitedHealthcare | Pain Management (MMP070.12) Injection, Anesthetic Agent, Greater Occipital Nerve | listed, no stance | Sep 1, 2026 | payer document |
From payers' published prior-auth lists, coverage policies and state Medicaid fee schedules, updated Oct 16, 2026. The role is what the policy's own code table or text says about the code. Not a guarantee of coverage or payment; verify with the payer. CPT® is a registered trademark of the American Medical Association.