Summary & Overview
CPT 0628T: Lumbar Disc Cellular or Tissue Injection, Additional Level
CPT code 0628T captures fluoroscopically guided injections of cellular or tissue–based products into lumbar intervertebral discs for each additional level treated beyond the first level. As emerging biologic and cell-based spinal therapies expand, accurate coding for multi-level procedures is important for clinical documentation, payer adjudication, and national utilization monitoring. This code is relevant to hospital outpatient departments and ambulatory surgery centers where image-guided spinal interventions are performed.
Key payers addressed in national coverage discussions include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the clinical service and coding scope, payer coverage context, and common billing considerations. The publication summarizes benchmarks and utilization patterns where available, highlights recent policy updates affecting biologic spinal injections, and situates 0628T within the broader interventional spine service line. The content is intended to inform coding professionals, billing administrators, and policy analysts about how this per-additional-level code is used and billed in contemporary practice. Data not available in the input for payor-specific rates, taxonomies, and ICD-10 pairings.
Billing Code Overview
CPT code 0628T describes an image-guided injection of a cellular or tissue–based product into a lumbar intervertebral disc performed under fluoroscopic guidance. This code specifically reports each additional lumbar disc level injected after the first level; the injection may be performed on one side or both sides of the disc.
Service type: Injectable biologic/interventional spinal procedure
Typical site of service: Hospital outpatient department or ambulatory surgery center
Clinical & Coding Specifications
Clinical Context
A typical patient is a 40–65-year-old adult with chronic axial low back pain and focal radicular symptoms attributable to a degenerative lumbar intervertebral disc confirmed by history, physical exam, and imaging (MRI or CT). Conservative care — activity modification, physical therapy, nonsteroidal anti-inflammatory drugs, and selective epidural steroid injections — has failed to provide durable relief. The patient is evaluated in an interventional spine clinic; informed consent is obtained discussing risks and benefits of a biologic intradiscal injection under fluoroscopic guidance. On the day of service the patient is positioned prone, monitored, and prepped in an ambulatory surgery center or hospital outpatient department. Under sterile technique, fluoroscopy localizes the target lumbar disc level. A spinal needle is advanced into the nucleus pulposus, and the cellular or tissue–based product is injected under live fluoroscopic visualization. The code 0628T is reported for each additional lumbar level injected after the first level. Typical workflow includes pre-procedure imaging review, procedural sedation or local anesthesia, fluoroscopic guidance, post-procedure recovery and discharge with activity and follow-up instructions, and documentation of levels treated, laterality (one side or both), amount and type of product, and any immediate complications.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when work or complexity is substantially greater than typical for the procedure (document justification). |
23 | Unusual anesthesia | Use if general anesthesia is medically necessary for this procedure. |
52 | Reduced services | Use when the procedure is partially reduced or not completed as originally intended. |
53 | Discontinued procedure | Use when the procedure is terminated due to extenuating circumstances after it was started. |
62 | Two surgeons | Use when two surgeons work together as primary surgeons during the procedure. |
66 | Surgical team | Use when a surgical team (supervising surgeon with assistants) performs the procedure. |
73 | Discontinued outpatient hospital/ASC — before anesthesia administration | Use when the outpatient procedure is discontinued prior to administration of anesthesia. |
78 | Unplanned return to the OR by the same physician following initial procedure | Use for return trips to the operating room for related procedures. |
80 | Assistant surgeon | Use when an assistant surgeon is present and meets payer criteria for assistant billing. |
81 | Minimum assistant surgeon | Use when a minimum assistant is required and permitted by payer rules. |
82 | Assistant surgeon (substantial absence) | Use when a qualified resident is not available and a nonqualified assistant is used. |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
2084P0800X | Pain Medicine | Interventional pain specialists commonly perform fluoroscopically guided intradiscal biologic injections. |
207RC0000X | Physical Medicine & Rehabilitation | Physiatrists perform image-guided spine procedures in ambulatory and hospital settings. |
2085P0222X | Anesthesiology - Pain Management | Anesthesiologists with pain fellowship training provide procedural sedation and interventions. |
207L00000X | Neurological Surgery | Neurosurgeons may perform intradiscal biologic injections in operative settings. |
207T00000X | Orthopaedic Surgery | Orthopedic spine surgeons perform image-guided disc interventions and related procedures. |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
M51.26 | Other intervertebral disc displacement, lumbar region | Disc displacement causing persistent pain and candidate for intradiscal biologic treatment. |
M51.27 | Other intervertebral disc degeneration, lumbar region | Degenerative disc disease of the lumbar spine often targeted by intradiscal cellular or tissue–based injections. |
M54.16 | Radiculopathy, lumbar region | Lumbar radiculopathy from disc pathology may be an indication when focal discogenic pain is present. |
M51.36 | Other intervertebral disc degeneration, lumbosacral region | Degenerative changes at the lumbosacral disc level relevant to treatment planning. |
M54.5 | Low back pain | Symptom code commonly listed with more specific lumbar disc diagnoses when documenting reason for the procedure. |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
22526 | Arthrodesis, anterior interbody lumbar; each additional interspace | May be performed later if intradiscal biologic therapy fails and fusion is indicated. |
22558 | Arthrodesis, combined posterior or posterolateral technique with posterior interbody technique including laminectomy and/or discectomy when performed; lumbar | Related spine surgical code for more extensive decompression/fusion procedures following failed conservative and biologic treatments. |
20610 | Arthrocentesis, aspiration and/or injection; major joint or bursa (e.g., shoulder, hip, knee) — without ultrasound guidance | Analogous injection technique; included for coding context though intradiscal injections require image guidance. |
77002 | Fluoroscopic guidance for needle placement (single or multiple levels) | CPT code representing fluoroscopic guidance service commonly reported with image-guided intradiscal procedures when applicable. |
22551 | Arthrodesis, anterior or anterolateral approach lumbar; discectomy | Surgical option if biologic injection is unsuccessful and fusion is required. |