Summary & Overview
CPT 64494: Lumbar/Sacral Image-Guided Facet Injection, Second Level
Headline: CPT 64494: Lumbar/Sacral Image-Guided Paravertebral Facet Injection (Second Level)
CPT 64494 identifies an image-guided diagnostic or therapeutic injection to a second lumbar or sacral paravertebral facet (zygapophyseal) joint or the nerves serving that joint, billed in addition to the primary level. This interventional spine procedure is an important tool in the assessment and management of axial and radicular low back pain, enabling targeted delivery of anesthetic or steroid under fluoroscopy or CT to improve diagnostic specificity and therapeutic precision. Nationally, accurate coding for additional levels influences clinical documentation, billing clarity, and payer authorization workflows.
Major payers addressed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise review of code scope and clinical context, guidance on typical sites of service, common associated diagnoses, and how this level-based code relates to adjacent CPT entries used for single, bilateral, and additional levels. The publication outlines practical billing considerations such as image guidance requirements and level-specific reporting relationships to related codes. It also summarizes typical clinical indications and where this code fits in the sequence of interventional spine procedures. Data not available in the input is noted where applicable.
CPT Code Overview
CPT 64494 describes an image-guided injection of a diagnostic or therapeutic agent into a lumbar or sacral paravertebral facet (zygapophyseal) joint or the nerves that innervate that joint, reported for a second level when billed in addition to the primary procedure. This procedure falls under pain management / interventional spine procedures and is typically performed in an image-guided interventional setting, such as an office or outpatient hospital equipped for fluoroscopy or CT guidance. The code denotes a level-based, targeted lumbar or sacral facet injection performed with imaging to confirm needle placement and agent delivery.
Clinical & Coding Specifications
Clinical Context
A patient in their 50s presents to an interventional spine clinic with chronic axial low back pain and intermittent lumbar radicular symptoms refractory to conservative care (physical therapy, oral analgesics, and activity modification). Diagnostic imaging (lumbar MRI) demonstrates facet arthropathy at multiple lumbar levels and degenerative disc changes. The pain management physician schedules an image-guided lumbar facet joint injection with fluoroscopy to deliver a diagnostic and/or therapeutic agent to the affected zygapophyseal joint or the medial branch nerves. The procedure is performed in an outpatient imaging-capable setting (office or hospital outpatient), with pre-procedure consent, sterile preparation, localization using fluoroscopy or CT, contrast confirmation of intra-articular or periarticular needle position, injection of anesthetic and/or corticosteroid, and post-procedure monitoring for recovery and immediate response for diagnostic correlation.
Coding Specifications
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Modifier
50: Used when bilateral injections are performed at the same spinal level. Reported in addition to the primary procedure code when separate bilateral work is performed. -
Associated provider taxonomies and specialties:
| Taxonomy Code | Specialty |
|---|---|
207L00000X |