2025 CPT code 64493
(Active) Effective Date: N/A Revision Date: N/A Surgery - Surgical Procedures on the Nervous System Surgery Feed
Injection of diagnostic or therapeutic agent into a single lumbar or sacral paravertebral facet joint (or nerves innervating that joint) with image guidance.
Modifiers 50 (bilateral procedure) may be applied as appropriate.Consult CPT guidelines and NCCI edits for other potentially applicable modifiers.
Medical necessity is established by documentation of persistent lower back pain localized to a specific level.Conservative treatment options should have been attempted and failed.The clinical presentation should warrant the use of this diagnostic or therapeutic procedure.
The physician is responsible for patient preparation, anesthesia administration (local), precise needle placement under imaging guidance, injection of the medication, and ensuring hemostasis at the injection site. Post-procedure monitoring may also be included depending on the patient's clinical status and facility guidelines.
In simple words: This procedure involves injecting medicine into a joint in your lower back to help diagnose or treat pain.A doctor uses imaging (like X-rays) to guide the injection.
This CPT code describes the injection of a diagnostic or therapeutic agent into a single lumbar or sacral paravertebral facet joint (or nerves innervating that joint) under imaging guidance (fluoroscopy or CT).The procedure involves using image guidance to accurately position a needle into the target joint or nerve, followed by the injection of the chosen agent. This can be a single injection or involve multiple injections at the same level, but this code covers only a single level. Multiple levels would require additional codes.
Example 1: A patient presents with chronic lower back pain localized to the L4-L5 level.A diagnostic injection of local anesthetic is performed under fluoroscopic guidance to determine if the facet joint is the source of their pain.If the injection provides pain relief, this code is used., A patient experiencing chronic lower back pain is given a therapeutic injection containing a corticosteroid and local anesthetic into the L5-S1 facet joint. This procedure is performed under CT guidance to accurately target the joint. This code applies., A patient presents with lower back pain radiating to the leg (radiculopathy). An injection into the L3-L4 facet joint is performed using fluoroscopy to confirm proper needle placement. A therapeutic mixture of corticosteroid and anesthetic is injected. Code 64493 would be used.
Detailed history and physical exam documenting the location and characteristics of the pain.Imaging reports (fluoroscopy or CT) showing the needle placement within the target joint.Documentation of the type and amount of medication administered.Note of any complications encountered. Post-procedure evaluation and patient instructions.
** For procedures involving multiple levels or bilateral injections at different levels, refer to CPT guidelines for appropriate code selection and modifier usage.Always ensure accurate documentation to support medical necessity and code selection.
- Payment Status: Active
- Modifier TC rule: Not applicable.
- Specialties:Anesthesiology, Pain Management, Orthopedic Surgery, Radiology (Interventional)
- Place of Service:Office, Outpatient Hospital, Ambulatory Surgery Center