2025 CPT code 64451
(Active) Effective Date: N/A Revision Date: N/A Surgical Procedures on the Nervous System - Nerve Blocks Surgery Feed
Injection(s) of anesthetic and/or steroid into nerves innervating the sacroiliac joint, with image guidance (fluoroscopy or CT).
Modifier 50 (Bilateral Procedure) should be appended when the procedure is performed bilaterally.Modifiers LT (Left) and RT (Right) may be used in some settings (e.g., ASC) to indicate the side of the injection, rather than Modifier 50.
Medical necessity for sacroiliac joint injection is established based on clinical findings, including appropriate documentation of symptoms indicative of SI joint pain (e.g., localized pain, exacerbated by certain movements), physical examination, and possibly imaging studies to rule out other causes. The procedure should only be performed when conservative treatment options have failed or are not appropriate.
The physician or qualified healthcare professional is responsible for performing the injection, including patient assessment, selecting the appropriate anesthetic and steroid agents, image guidance, and post-procedure care. The physician should accurately document the procedure, including the type of imaging guidance used, the location and number of injections performed, and the patient's response.
In simple words: The doctor injects medicine to numb and/or reduce inflammation in the nerves around the sacroiliac joint (a joint in the pelvis) using X-ray or CT scan guidance to help manage pain in that area.This is a single procedure code, even if multiple injections are given.
This CPT code 64451 describes the injection of anesthetic agent(s) and/or steroid(s) into the nerves that supply the sacroiliac (SI) joint.The procedure includes image guidance, either fluoroscopy or computed tomography (CT).The injection is performed to diagnose and/or treat pain in the sacroiliac joint.Imaging guidance and any contrast injection are inclusive components of this code and are not reported separately. One unit is reported per procedure, regardless of the number of injections.If the procedure is performed bilaterally, modifier 50 should be appended.
Example 1: A 45-year-old female presents with chronic low back pain radiating to her right buttock and leg, suspected to originate from the sacroiliac joint.The physician performs a diagnostic and therapeutic sacroiliac joint injection with fluoroscopic guidance, using lidocaine and a corticosteroid., A 60-year-old male with a history of sacroiliitis experiences acute exacerbation of SI joint pain.The physician performs a bilateral sacroiliac joint injection with CT guidance using bupivacaine and methylprednisolone.Modifier 50 is appended., A 30-year-old female post-partum reports persistent lower back pain.Physical examination and imaging studies suggest sacroiliac joint involvement. A unilateral sacroiliac joint injection with fluoroscopy guidance and lidocaine is performed. This treatment is considered successful if there is pain relief for at least 12 hours.
Detailed medical history including pain characteristics and location, physical examination findings, imaging studies (if performed prior to the injection), informed consent, precise description of the injection procedure (including type of imaging guidance, needle placement, agents injected, and volume), and patient response to the injection (immediate and follow-up).
** Appropriate documentation is critical for accurate coding and reimbursement.Always refer to the most up-to-date CPT manual and payer guidelines for the latest coding rules and regulations.Local Coverage Determinations (LCDs) may also impact the billing and coding of this procedure.
- Revenue Code: P6C (Medicare Fee Schedule: Minor Procedures - Other)
- RVU: The relative value units (RVUs) for CPT code 64451 will vary depending on the geographic location and other factors.Consult the relevant fee schedule for the specific RVU values.
- Global Days: The global period is not specified for CPT code 64451. This implies that further services related to the injection may be billed separately, depending on medical necessity and the payer's policies.
- Payment Status: Active
- Modifier TC rule: No TC (Technical Component) modifier is applicable to CPT code 64451 as the code encompasses the entire procedure.
- Fee Schedule: Fee schedules vary based on payer and geographic location.Consult relevant fee schedules for historical data.Information from the date of code implementation (January 1, 2020) onwards should be reviewed.
- Specialties:Pain Management, Anesthesiology, Orthopedic Surgery, Rheumatology
- Place of Service:Office, Outpatient Hospital, Ambulatory Surgical Center