2025 CPT code 64491
(Active) Effective Date: N/A Surgery - Surgical Procedures on the Nervous System Feed
Injection of diagnostic or therapeutic agent into the paravertebral facet joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), cervical or thoracic; second level.
Modifier 50 is not applicable to this add-on code. Use modifier 50 with the primary code (64490) for bilateral procedures.
Medical necessity must be supported by documentation showing that the patient has chronic pain, likely originating from the facet joints, and that conservative treatments have been unsuccessful. Pre-authorization may be required by some payers.
The physician performs the injection using imaging guidance (fluoroscopy or CT) to ensure accurate placement of the needle within the facet joint or adjacent nerves. The procedure includes prepping and anesthetizing the injection site, inserting the needle, injecting the agent, and ensuring hemostasis.
- Extracranial Nerves, Peripheral Nerves, and Autonomic Nervous System; Introduction/Injection of Anesthetic Agent (Nerve Block), Diagnostic or Therapeutic
In simple words: A procedure where the doctor injects medicine into the joints of your neck or upper back to diagnose or treat pain, using a special x-ray or CT scan to guide the needle. This code is used for the second joint injected during the same visit.
This add-on code describes the injection of a diagnostic or therapeutic agent into a paravertebral facet joint (or nerves innervating that joint) in the cervical or thoracic region of the spine, using image guidance (fluoroscopy or CT). It is reported for the second level injected during the same session, in addition to the primary procedure code (64490).
Example 1: A patient presents with chronic neck pain at the C5-C6 and C6-C7 levels. Following a diagnostic block at C5-C6 (64490), a therapeutic injection is also performed at C6-C7 during the same session. Code 64491 is reported in addition to 64490., A patient experiences pain in the upper back radiating to the right side. The physician performs a diagnostic block at T3-T4 using CT guidance (64490). In the same session, a therapeutic injection is performed at T4-T5 for pain relief. Code 64491 is reported in addition to 64490., A patient has chronic pain at multiple cervical levels. During a single session, the physician performs therapeutic injections at C4-C5 (64490), C5-C6 (64491), and C6-C7 (64492). Codes 64491 and 64492 are reported as add-on codes in addition to 64490.
Documentation should include details of the patient's pain, medical history, physical exam findings, imaging results, informed consent, type and amount of agent injected, levels injected, and confirmation of image guidance.
** For bilateral procedures at different levels, use modifier 50 with 64490 and report 64491 for each additional level injected (report 64491 twice if both sides are injected at the different level.) For injections of the T12-L1 joint, use 64490/64493 and 64491/64494.
- Payment Status: Active
- Modifier TC rule: Not applicable.
- Specialties:Pain Management, Anesthesiology, Orthopedic Surgery, Physiatry, Radiology
- Place of Service:Office, Ambulatory Surgical Center, Outpatient Hospital