2025 CPT code 64495
(Active) Effective Date: N/A Surgery - Nervous System Feed
Injection of diagnostic or therapeutic agent into paravertebral facet joint(s) (or nerves innervating that joint) with image guidance (fluoroscopy or CT), lumbar or sacral; third and any additional level(s).
Medical necessity must be established for this procedure.This generally requires documentation of chronic back pain that has not responded to conservative treatments, with the facet joints identified as the source of pain.The documentation should demonstrate how the injection(s) will assist in diagnosis or treatment.
The physician performs the injection after prepping and anesthetizing the injection site(s).Imaging guidance (fluoroscopy or CT) is used to direct the needle into the facet joint or the nerves innervating the joint. A diagnostic or therapeutic agent is injected. Hemostasis is achieved. The procedure aims to treat or diagnose back pain.
- Surgery; Nervous System; Extracranial Nerves, Peripheral Nerves, and Autonomic Nervous System; Introduction/Injection of Anesthetic Agent (Nerve Block), Diagnostic or Therapeutic
In simple words: This procedure involves injecting medication into the joints of your lower back or sacrum to diagnose or treat pain. The doctor uses imaging to guide the needle into the correct location. This code is used for the third and any subsequent injections given during the same procedure.
This add-on code describes the injection of a diagnostic or therapeutic agent into the paravertebral facet joint(s) or the nerves that innervate these joints at the lumbar or sacral levels, using image guidance (fluoroscopy or CT). It is used for the third and any additional levels injected during the same session, following the primary procedure codes (64493) and the second level add-on code (64494).Imaging guidance is included in the code.
Example 1: A patient presents with chronic low back pain radiating to the right leg. After conservative treatment fails, a decision is made to perform a diagnostic paravertebral facet joint injection at the L3-L4, L4-L5, and L5-S1 levels using fluoroscopic guidance.64493, 64494, and 64495 would be reported., A patient with lumbar spinal stenosis undergoes therapeutic facet joint injections at L4-L5, L5-S1 and S1-S2 levels using CT guidance. The patient received injections at 3 levels. Codes 64493, 64494 and 64495 would be reported., A patient experiences persistent pain following a lumbar fusion. The physician performs a series of paravertebral facet joint nerve blocks at the L2-L3, L3-L4 and L4-L5.Image guidance via CT is utilized. 64493, 64494, and 64495 would be reported.
Documentation should include: informed consent, type of imaging guidance used (fluoroscopy or CT), level(s) of injection, medication(s) injected, response to the injection(s), and any complications. Pre- and post-injection pain assessment should be clearly recorded. The medical necessity for the procedure and documentation supporting that the injection(s) were for the third and any additional levels should also be included.
- Payment Status: Active
- Specialties:Pain Management, Anesthesiology, Radiology, Orthopedic Surgery, Neurosurgery, Physical Medicine and Rehabilitation
- Place of Service:Office, Outpatient Hospital, Ambulatory Surgical Center