Summary & Overview
CPT 64484: Transforaminal Epidural Injection, Lumbar/Sacral Additional Level
CPT code 64484 denotes a transforaminal epidural injection of an anesthetic agent and/or steroid in the lumbar or sacral spine for each additional level treated beyond the initial level. This procedure is widely used in interventional pain management to target nerve root–mediated radicular pain and can influence utilization, prior authorization, and bundling policies across payers. Nationally, accurate use of this code affects claims adjudication and selection of facility versus office payment settings.
Key payers addressed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication provides a concise overview of clinical context for transforaminal epidural injections, describes common sites of service, and outlines how payers typically classify and process add-on level services.
Readers will learn benchmarks and policy-relevant points such as typical settings where the service is rendered, payer coverage considerations, and coding context for additional-level billing. Where specific payer policy language or comparative rates are not provided in the input, the report indicates that data is not available. The content is intended to support coding accuracy, administrative clarity, and operational planning for providers and billing teams that manage interventional spine procedures.
Billing Code Overview
CPT code 64484 describes an injection of an anesthetic agent and/or steroid as a transforaminal epidural injection in the lumbar or sacral region, billed for each additional spinal level after the initial level. This procedure is a type of interventional pain management service.
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Service type: Image-guided transforaminal epidural injection (therapeutic/anesthetic and/or steroid)
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Typical site of service: Ambulatory surgical center, hospital outpatient department, or physician office with image-guidance capability
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 52-year-old patient with chronic unilateral left L5 radicular leg pain refractory to conservative care (physical therapy, NSAIDs, and activity modification) presents for a lumbar transforaminal epidural injection for diagnostic and therapeutic purposes. The patient has focal radiographic foraminal narrowing at L5–S1 on MRI consistent with the distribution of symptoms. After informed consent and procedural timeout, the patient is placed prone on the fluoroscopy table. IV access is available, standard monitoring is applied, and sterile technique is used. Under fluoroscopic guidance, the interventional pain physician advances a spinal needle into the left L5–S1 neural foramen, confirms needle position with contrast, and injects a corticosteroid mixed with local anesthetic. The procedure targets the inflamed exiting nerve root; post-procedure the patient is observed in recovery for vital signs and neurologic status before discharge with activity precautions and a plan for follow-up.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
59 | Distinct Procedural Service | Use when a transforaminal epidural injection is performed at a separate anatomic site or on a different day and must be reported as distinct from other services. |
76 |