Summary & Overview
CPT 64490: Cervical or Thoracic Facet Joint Injection with Imaging Guidance
CPT code 64490 is a critical billing code in pain management and interventional radiology, representing the injection of a diagnostic or therapeutic agent into the cervical or thoracic paravertebral facet joint or associated nerves, with image guidance. This procedure is widely used to treat patients suffering from neck and upper back pain, often resulting from conditions such as cervicalgia or thoracic spondylosis. The code is relevant for office and outpatient settings where fluoroscopy or CT imaging is available.
Major national payers, including Aetna, Blue Cross Blue Shield, Cigna Health, Medicare, and UnitedHealthcare, recognize and reimburse for this procedure, making it a key focus for providers and billing teams. The publication provides an overview of clinical indications, payer coverage, and policy updates related to 64490. Readers will gain insight into current benchmarks, coding practices, and the clinical context for this injection, including its role in managing chronic spinal pain. The summary also highlights related codes and modifiers, offering a comprehensive view of how 64490 fits within broader pain management strategies and billing workflows.
CPT Code Overview
CPT code 64490 describes the injection of a diagnostic or therapeutic agent into the paravertebral facet (zygapophyseal) joint or the nerves innervating that joint in the cervical or thoracic spine, performed at a single level. This procedure utilizes image guidance, such as fluoroscopy or CT, to ensure accurate placement. It is commonly used in pain management and interventional radiology settings to address spinal pain and related conditions. The typical site of service for this procedure is an office or outpatient facility equipped with imaging capabilities.
Clinical & Coding Specifications
Clinical Context
A patient presents to a pain management clinic with persistent neck or upper back pain that has not responded to conservative treatments such as physical therapy or medications. The pain is suspected to originate from the cervical or thoracic facet (zygapophyseal) joints. After clinical evaluation and imaging, the provider determines that a diagnostic or therapeutic injection is appropriate. The procedure involves injecting a diagnostic or therapeutic agent into the paravertebral facet joint or the nerves innervating that joint, using image guidance (fluoroscopy or CT) to ensure accurate placement. The service is performed in an office or outpatient facility equipped with imaging capabilities. The goal is to relieve pain and confirm the source of symptoms, guiding further management.
Coding Specifications
- Modifier
50(Bilateral procedure modifier):- Used when the procedure is performed on both sides of the cervical or thoracic spine during the same session.
| Provider Taxonomy Code | Specialty Name |
|---|---|
208VP0000X | Pain Medicine Physician |
207LP2900X | Physical Medicine & Rehabilitation Physician |
207RA0401X | Anesthesiology Pain Medicine Physician |
- These taxonomies represent providers specializing in pain management, physical medicine and rehabilitation, and anesthesiology with pain medicine focus.
Related Diagnoses
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M54.2- Cervicalgia- Indicates neck pain, commonly treated with cervical facet joint injections.
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M54.6- Pain in thoracic spine- Refers to upper back pain, relevant for thoracic facet joint injections.
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M47.812- Spondylosis without myelopathy or radiculopathy, cervical region- Describes degenerative changes in the cervical spine, often associated with facet joint pain.
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M47.814- Spondylosis without myelopathy or radiculopathy, thoracic region- Indicates degenerative changes in the thoracic spine, which may cause facet joint pain.
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M53.82- Other specified dorsopathies, cervical region- Covers other specified disorders of the cervical spine, potentially leading to facet-mediated pain.
Related CPT Codes
| CPT Code | Description |
|---|---|
64491 | Injection(s), diagnostic or therapeutic agent, paravertebral facet joint with image guidance, cervical or thoracic; second level |
64492 | Injection(s), diagnostic or therapeutic agent, paravertebral facet joint with image guidance, cervical or thoracic; third and any additional level |
64494 | Injection(s), diagnostic or therapeutic agent, paravertebral facet joint with image guidance, lumbar or sacral; second level |
64491is used when the injection is performed at a second cervical or thoracic level during the same session as64490.64492is used for the third and any additional cervical or thoracic levels.64494is used for injections at the lumbar or sacral facet joints, typically in a separate clinical scenario.64490,64491, and64492are commonly used together when multiple levels require injection in the cervical or thoracic region.
National Reimbursement Benchmarks
For CPT code 64490, the national mean rate for Medicare is $212.70, while the average commercial mean rate (BUCA) is $236.30. Commercial payers such as UnitedHealth Group and Cigna show higher mean rates, with UnitedHealth Group at $299.92 and Cigna at $269.16, compared to Medicare.
Rate dispersion, measured by the difference between the 75th and 25th percentiles, varies across payers. Medicare has the tightest range at $24.00, indicating less variability in rates. In contrast, UnitedHealth Group exhibits the widest range at $157.33, reflecting greater variability in commercial reimbursement. Cigna and Blue Cross Blue Shield also show substantial dispersion, with ranges of $144.00 and $115.75, respectively.
The table and chart below present a detailed breakdown of national benchmarks for each payer, including mean rates and percentile values.
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