CPT 64435, in plain terms, covers Anesthetic or steroid injection of the paracervical nerves around the uterus and cervix. CPT 64435 is referenced in 4 tracked payer policy changes from Aetna, Sentara Health Plans, and 2 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 64435 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.
Official descriptor: CPT 64435 on AAPC
Aetna's spinal ultrasound policy (CPT 76800) is now restricted to newborns and infants for specific clinical indications only. Spinal ultrasound for adults—including evaluation of back pain, radiculopathy, scoliosis, epidural abscess, and anesthesia guidance—is classified as experimental/investigational and is NOT covered. Billing teams must immediately identify and deny or redirect adult spinal ultrasound claims to ensure compliance.
Sentara Health Plans' authorization updates effective November 1, 2025 archived the Apixaban (Eliquis) Drug Level policy (Medical 303), Corneal Procedures (Surgical 55) and Percutaneous Transluminal Coronary Lithotripsy for all lines of business, and archived Injectable Hormone Pellets (Medical 157) for Commercial and Medicaid. The same date archived the Substernal Implantable Cardioverter-Defibrillator (Surgical 130) and Thermal Intradiscal Procedures (Surgical 79) policies for Commercial and Medicaid, renamed the subcutaneous defibrillator policy Subcutaneous and Substernal Implantable Cardioverter-Defibrillator, and set authorization required (Y) for codes 28446 and 29891 and for J8597 (Commercial). Criteria were also updated for Commercial and Medicaid for compression stockings, leadless cardiac pacemakers, skin and tissue substitutes, and spinal and other pain management procedures.
Management of postoperative pain after surgery is included in the attending physician's evaluation and management services, and those charges should not be billed separately. When an anesthesiologist provides continuous or intermittent epidural management, 62318 is payable once on the first day of service and 01996 covers daily management after that day, but both cannot be paid on the same day. IV-PCA is included in the global fee for general anesthesia and its professional services may not be billed separately, while a single narcotic injection given immediately before or after general anesthesia can be billed separately.
New Jersey Medicaid has updated specific HCPCS codes and fee allowances for abortion-related procedures billed on a fee-for-service basis. The policy clarifies billing procedures for ultrasounds, surgical pathology, RhoGam injections, and other services related to elective abortions for Medicaid and NJ KidCare beneficiaries.
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