Summary & Overview
CPT 64479: Transforaminal Epidural Injection, Cervical or Thoracic, Single Level
CPT code 64479 is a critical billing code in interventional pain management and anesthesiology, representing the injection of an anesthetic agent and/or steroid into the transforaminal epidural space of the cervical or thoracic spine at a single level, with image guidance. This procedure is widely used to manage acute and chronic pain, particularly following surgical interventions or in cases of nerve root irritation. The code is relevant for both hospital outpatient and office settings, reflecting its versatility in clinical practice.
Major national payers, including Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare, provide coverage for this procedure, making it a significant focus for policy and reimbursement analysis. Readers will gain insights into payer coverage, clinical indications, and the procedural context for 64479. The publication also addresses related codes, common modifiers, and associated clinical taxonomies, offering a comprehensive overview for stakeholders interested in coding, billing, and policy trends. Benchmarks and policy updates are included to inform healthcare professionals, administrators, and analysts about the evolving landscape of interventional pain management services.
CPT Code Overview
CPT code 64479 describes the injection of an anesthetic agent and/or steroid into the transforaminal epidural space of the cervical or thoracic spine, performed at a single level. This procedure is conducted with image guidance, such as fluoroscopy or CT, to ensure accurate placement. It is commonly utilized in interventional pain management and anesthesiology to address acute or chronic pain conditions related to the cervical or thoracic regions. Typical sites of service include hospital outpatient departments (place of service 22) and physician offices (place of service 11).
Clinical & Coding Specifications
Clinical Context
A patient presents with acute post-thoracotomy pain or other acute postprocedural pain localized to the cervical or thoracic spine. The provider, typically an anesthesiologist, pain medicine physician, or spine surgeon, determines that a transforaminal epidural injection is indicated to manage the pain. The procedure involves injecting an anesthetic agent and/or steroid into the epidural space at a single cervical or thoracic level, using image guidance such as fluoroscopy or CT to ensure accurate placement. The service is performed in a hospital outpatient setting (POS 22) or office (POS 11).
Coding Specifications
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Modifiers:
50: Bilateral procedure indicator; used when the injection is performed on both sides at the same level, appended on one line.KX: Used when the procedure is a diagnostic selective nerve root block (DSNRB) to distinguish it from a therapeutic epidural injection.RT/LT: Right or Left side; for Ambulatory Surgery Center (ASC) reporting, each side must be billed on separate lines.
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Provider Taxonomies:
| Taxonomy Code | Specialty Name |
|---|---|
| 207L00000X | Anesthesiology |
| 208VP0000X | Pain Medicine Physician |
| 207XS0117X | Orthopaedic Surgery of the Spine |
These taxonomies represent the specialties commonly performing this procedure.
Related Diagnoses
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G89.12: Acute post-thoracotomy pain- Relevant for patients experiencing pain following thoracic surgery, which may be managed with a transforaminal epidural injection.
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G89.18: Other acute postprocedural pain- Applies to patients with acute pain after procedures other than thoracotomy, indicating a need for interventional pain management such as an epidural injection.
Related CPT Codes
| CPT Code | Description |
|---|---|
64480 | Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with image guidance; cervical/thoracic, each additional level |
64483 | Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with image guidance; lumbar/sacral, single level |
64484 | Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with image guidance; lumbar/sacral, each additional level |
64480is used when additional cervical or thoracic levels are injected during the same session as64479.64483and64484are used for similar injections in the lumbar or sacral regions, with64483for a single level and64484for each additional level.- These codes may be used together when multiple levels or regions are treated in a single clinical workflow.
National Reimbursement Benchmarks
For CPT code 64479, the national mean rate for Medicare is $296.25, while the BUCA (average commercial) mean rate is $281.11. This places Medicare slightly above the commercial average, with individual commercial payers such as UnitedHealth Group and Cigna showing higher mean rates at $390.99 and $339.84, respectively.
Rate dispersion, measured by the difference between the 75th and 25th percentiles, varies significantly across payers. Medicare exhibits the tightest range at $33.00, indicating relatively consistent reimbursement rates. In contrast, UnitedHealth Group has the widest range at $200.00, reflecting greater variability in commercial payments. Cigna and Blue Cross Blue Shield also show substantial dispersion, with ranges of $172.50 and $144.50, respectively.
The table and chart below present the full breakdown of national benchmarks for each payer, including mean rates and percentile values.
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