2025 CPT code 64494
(Active) Effective Date: N/A Revision Date: N/A Surgical Procedures on the Nervous System - Injection Surgery Feed
Injection of diagnostic or therapeutic agent into lumbar or sacral paravertebral facet joint (or nerves innervating that joint) with image guidance; second level.
Modifier 50 (bilateral procedure) should not be appended to 64494.Modifier -59 (distinct procedural service) may be considered in certain circumstances; refer to CPT guidelines for clarification.
Medical necessity requires documentation of failed conservative treatment for chronic lower back pain, originating from a facet joint, and localization of the pain via imaging or other diagnostic means.The injections should provide therapeutic benefit.
The physician is responsible for the precise placement of the needle into the targeted facet joint or nerve using imaging guidance.They must select and administer the appropriate anesthetic or diagnostic agent, and ensure appropriate post-procedure care.
In simple words: This code describes a second injection into a joint in your lower back (lumbar or sacral spine) to help diagnose or treat back pain.A special imaging technique (X-ray or CT scan) is used to guide the injection precisely. It's an additional injection after a first one, and both are done during the same visit. The doctor injects medicine to relieve pain or find out what's causing it.
This CPT code 64494 represents the injection of a diagnostic or therapeutic agent into a paravertebral facet joint (or nerves innervating the joint) at the lumbar or sacral level.The procedure requires image guidance (fluoroscopy or CT scan) and is reported as an add-on code to the primary procedure code (64493) for the initial level.Multiple nerves at the same level are considered a single level.This injection targets the facet joint connecting two spinal vertebrae. The agent may be a steroid or anesthetic, aimed at treating spinal pain or identifying its source.
Example 1: A patient presents with chronic lower back pain radiating into the right leg. After a failed conservative treatment, a single-level lumbar facet joint injection is performed (64493).Due to persistent pain, a second injection at a different level is needed during the same session, requiring code 64494., A patient presents with chronic lower back pain.A diagnostic injection is performed at a single level (64493) using fluoroscopy. The injection yields a positive response, and another injection is needed to determine if the pain is also originating from a nearby joint. Code 64494 is then reported to reflect the second level injection., A patient with multi-level lower back pain undergoes bilateral facet injections at one level (64493 with modifier 50).After assessment, a second level of injection is needed unilaterally; hence, 64494 is added to the claim.
* Detailed history of present illness, including location, character, duration, and severity of pain.* Physical examination findings, including neurological exam.* Results of imaging studies (X-ray, MRI, CT) to identify the target level(s).* Documentation of previous treatments and their effectiveness or lack thereof.* Physician’s plan for the injections, including level(s), side(s), and type of agent used.* Documentation of procedure performed, including technique and amount of medication injected.* Post-procedure assessment of pain relief.
** The number of levels injected determines the number of units reported.The code may only be reported once per day for each patient, and there are annual session limits for these procedures.
- Revenue Code: Check payer-specific guidelines.
- RVU: Consult the CMS relative value units (RVUs) for the most up-to-date information.
- Global Days: This is an add-on code; the global period is determined by the primary procedure code.
- Payment Status: Active
- Modifier TC rule: Not applicable.This code describes a complete procedure, not a technical component.
- Fee Schedule: Consult payer-specific fee schedules for historical data.Information is not available from provided sources.
- Specialties:Anesthesiology, Pain Management, Orthopedic Surgery, Neurosurgery
- Place of Service:Office, Outpatient Hospital, Ambulatory Surgical Center