28 Apr 2016

How to code Facet Joint Injections (64490 - 64495)

Facet joint injection is a minimally invasive procedure that can temporarily relieve neck or back pain caused by inflamed facet joints.

Facet Joint Injections technique: The physician preps and anaesthetizes the patient inserts the needle through the skin and advances it to the proper position within the joint using either fluoroscopy or CT imaging guidance. He then injects the therapeutic or diagnostic agent, like a steroid or anaesthetic mixture. He then removes the needle and ensures that the site obtains hemostasis.

The codes are divided based on the Vertebral region, 

            1.  Cervical or Thoracic  (64490 – 64492)

           2.  Lumbar or Sacral (64493 – 64495)

Facet Joint Injection - Cervical or Thoracic region,

   CPT 64490 - Injection(s), Paravertebral facet joint with image guidance (fluoroscopy or CT), cervical or thoracic; Single level

       + 64491 - Second level

       + 64492 - Third and any additional level(s) 

Facet Joint Injection - Lumbar or Sacral region,

  CPT 64493 - Injection(s), Paravertebral facet joint with image guidance (fluoroscopy or CT), lumbar or sacral; single level

       + 64494 - Second level

       + 64495 - Third and any additional level(s)

If ultrasound guidance is used, report 0213T- 0218T (Category III Codes) 

  For Cervical or Thoracic

   0213T Injection(s), Paravertebral facet joint with ultrasound guidance, cervical or thoracic; single level

  0214T - second level

  0215T - third and any additional level(s)

  For Lumbar or Sacral 

  0216T - Injection(s), Paravertebral facet joint with ultrasound guidance, lumbar or sacral; single level

  0217T - second level

  0218T third and any additional level(s)

Note:   Medicare won't cover category III codes; some of the commercial insurance would cover these services. Check with your payer for coverage.  

Coding Guidelines: 

A. For bilateral Para-vertebral facet injection procedures, append modifier 50 with CPT 64490 / 64493.

We can’t append modifier 50 with the following +add on codes 64491, 64492, 64494, 64495 instead bill with unit 2 if performed bilaterally.  

B. Image guidance like CT (77012) / fluoroscopy (77003) is required to perform Paraverterbral facet joint injections but inclusive with CPT 64490 - 64495, hence imaging guidance won't be separately reported.  

    If imaging is not used then report the service with CPT 20552 – 20553.


Eg # 1: Facet joint injections (L1-L2 and L2-L3) totally two levels. 

              Ans: 64493, +64494

     Rationale: CPT 64493 is used for the first level, and CPT 64494 is for second level.

Eg # 2: Facet joint injections (L1-L2, L2-L3 and L3-L4) totally three levels. 

              Ans: 64493, +64494, +64495

    Rationale: Codes are not indented codes to give one code for three levels; we should use primary code plus +add on code to indicate the second level and third level (Any further levels are included in the last +add on code 64495). Each code represent one level, 64493 (First level) 64494 (Second level) and 64495 (Third and any additional levels). 

  If we look at the description of CPT +64495 it’s not three-level CPT its third level.

Eg # 3: Facet joint injections (L1-L2, L2-L3, L3-L4 and L4-L5) totally four levels. 

              Ans: 64493, +64494, +64495

    Rationale: CPT 64495 includes the third and fourth level.