circumcision revision plus block

Keeping in mind the Surgical Guidelines that state local anesthesia infusion or digital blocks are included in the surgical package, when the surgeon performs a penile block prior to repairing an incomplete circumcision, can the surgeon bill 64450 separately or should modifier 47 be appended to 54163?

Thank you!

Penile nerve block

Medicare bundles code 64450 into code 54163 for a related block. Many payers consider code 54163 a cosmetic, non-therapeutic procedure. Payment will be based on medical necessity and payer policy.