CPT 62267 Reimbursement Benchmarks & Policy

CPT code 62267 covers diagnostic aspiration of intervertebral discs or adjacent paravertebral soft tissues, including aspiration of nucleus pulposus when indicated to identify infectious or inflammatory causes of disc pathology. The code is clinically important for distinguishing infectious discitis from degenerative or inflammatory causes and guiding targeted antimicrobial or surgical management.

Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise national overview of clinical context, typical places of service, and operational considerations tied to this procedure. The publication outlines billing and coding context, common modifiers in use (listed separately), and implications for documentation and claims submission.

This analysis provides benchmarks and practical guidance on charge and reimbursement variability across major payers, highlights recent policy and coverage trends affecting percutaneous spinal procedures, and summarizes clinical indications that commonly support medical necessity. The content is intended for revenue cycle leaders, clinicians, and compliance teams seeking a compact reference on coding, payer coverage patterns, and key considerations when billing CPT code 62267 on a national scale.

Billing Code Overview

CPT code 62267 describes an aspiration procedure in which a provider removes fluid or tissue from the intervertebral disc space or adjacent paravertebral soft tissues. The procedure may target the nucleus pulposus (the gel-like center of a spinal disc) or aspirate fluid from the soft pads between vertebrae to obtain diagnostic material for laboratory analysis, including evaluation for bacterial or fungal infection.

Service type: Diagnostic aspiration of intervertebral disc or paravertebral tissue
Typical site of service: Hospital outpatient department, ambulatory surgery center, or other facility capable of image guidance and sterile spinal procedures

Clinical Context

A 54-year-old patient presents with progressive low back pain, fever, and focal paraspinal tenderness after recent bacteremia. MRI shows T2 hyperintensity and fluid in the intervertebral disc space suspicious for discitis/vertebral osteomyelitis. The interventional spine team schedules a CT- or fluoroscopy-guided intervertebral disc aspiration/biopsy to obtain fluid and tissue for Gram stain, culture, fungal and mycobacterial studies, and targeted pathology. The procedure is performed in an outpatient interventional radiology suite or hospital procedure area under conscious sedation or local anesthesia. The provider uses sterile technique, advances a spinal needle into the disc space or adjacent paravertebral soft tissue, aspirates fluid or nucleus pulposus, collects specimens in appropriate transport media, documents imaging guidance, specimen handling, and any immediate complications, and communicates results to the referring physician for directed antimicrobial therapy planning.

Coding Specifications

Modifier	Description	When to Use
`11`	Normal/standard service	Use when service is performed as usual without unusual circumstances.
`22`	Increased procedural services

Taxonomy Code	Specialty	Notes
`2080S00000X`	Radiology - Diagnostic & Interventional	Interventional radiologists commonly perform image-guided disc/paravertebral aspirations.
`261QR0400X`	Pain Medicine	Pain management specialists perform diagnostic or therapeutic disc procedures.
`207L00000X`	Orthopedic Surgery	Spine surgeons may perform aspiration intraoperatively or in clinic for diagnosis.
`2084P0800X`	Physical Medicine & Rehabilitation	PM&R specialists involved in spine diagnostics and interventions.
`2085R0200X`	Neurological Surgery	Neurosurgeons perform spine aspirations in select cases.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`M46.4`	Discitis, unspecified	Direct indication for disc aspiration to identify infectious etiology.
`M46.2`	Vertebral osteomyelitis	Often associated with disc infection; aspiration helps obtain cultures for targeted therapy.
`M51.27`	Other intervertebral disc displacement, lumbar region with radiculopathy	Disc aspiration may be diagnostic when infection vs. degenerative disease is in question.
`G06.1`	Intraspinal abscess and granuloma	Paravertebral aspiration may assist in diagnosing adjacent infectious collections.
`A41.9`	Sepsis, unspecified organism	When bacteremia/sepsis source is suspected in the spine, aspiration guides source control.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`62267`	Aspiration or biopsy, intervertebral disc and/or paravertebral tissue; diagnostic	Primary procedure: obtains disc or paravertebral fluid/tissue for microbiologic and pathologic diagnosis.
`77012`	CT guidance for needle placement (e.g., biopsy, aspiration), radiological supervision and interpretation	Used when CT guidance is employed to localize and guide the needle during disc/paravertebral aspiration.
`77002`	Fluoroscopic guidance for needle placement (e.g., biopsy, aspiration), radiological supervision and interpretation	Used when fluoroscopy is used to guide needle placement for aspiration.
`99152`	Moderate sedation services provided by the same physician performing the procedure (initial 15 minutes)	Used when the performing physician provides moderate sedation for the procedure (document time).
`99070`	Supplies and materials provided by physician over and above those usually included with the office visit or procedure	Used to report specialized supplies or transport media not included in procedural fee according to payer policy.

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Summary & Overview

CPT 62267: Aspiration of Intervertebral Disc or Paravertebral Tissue