In simple words: This procedure involves injecting medication into the facet joints in your neck or upper back to diagnose or treat pain.The doctor uses a special x-ray or CT scan to guide the needle. This code is used when injections are done at three or more levels in the same visit.

This add-on code describes the injection of a diagnostic or therapeutic agent into the paravertebral facet joint or into the nerves that innervate that joint at the cervical or thoracic level, 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 (64490, 64493) and the second level add-on codes (64491, 64494).

Example 1: A patient with chronic neck pain at C5-C6, C6-C7, and C7-T1 receives image-guided injections at all three levels during the same session. 64490, 64491, and 64492 would be reported., A patient presents with pain at the T1-T2, T2-T3, T3-T4, and T4-T5 facet joints. Injections are performed at all four levels under fluoroscopic guidance. 64490, 64491, and 64492 would be reported., A patient has thoracic facet joint pain at multiple levels. The physician performs diagnostic injections at T2-T3, T3-T4, and T4-T5 under CT guidance. 64490, 64491, and 64492 are reported.

Documentation should include: medical history, physical exam findings (including facet loading maneuvers), prior treatments, imaging results, location of injections (side and level), type of imaging guidance used, and response to previous injections (if applicable).

** For bilateral procedures at different levels, report the primary code for each level with modifier 50 for the bilateral level, and the add-on code(s) for the unilateral level(s).