CPT 64490: Cervical/Thoracic Facet Joint Image-Guided Injection
Medicare pays $213 and commercial payers pay $605 on average nationally for this procedure.
CPT code 64490 describes an image-guided injection of a diagnostic or therapeutic agent into a single cervical or thoracic paravertebral facet (zygapophyseal) joint or the nerve supplying that joint, performed with fluoroscopy or computed tomography; service type: image-guided facet joint injection; typical site of service: outpatient procedural setting such as an ambulatory surgical center or hospital outpatient department.
For related coverage guidance, see recent payer policy updates: Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric or Substance Use Disorders, Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric or Substance Use Disorders, Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric or Substance Use Disorders.
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National Reimbursement Benchmarks
Commercial averages sit well above Medicare: Blue Cross Blue Shield and BUCA exhibit notably higher means compared with Medicare’s mean of $212.7. BUCA’s mean is $605.1, roughly $392.4 higher than Medicare, while Blue Cross Blue Shield’s mean of $859.1 is about $646.4 above Medicare, indicating a substantial premium in commercial contracting versus the Medicare baseline.
Dispersion varies across payers. Blue Cross Blue Shield has the widest interquartile spread (P75–P25 = $735.6), signaling substantial variability among commercial rates, while Aetna and UnitedHealth Group show moderate spreads (Aetna IQR = $151.2; UnitedHealth Group IQR = $163.7). Cigna’s IQR is $148.5, slightly tighter than UnitedHealth Group. BUCA’s IQR is $518.7, indicating broad variation around its $605.1 mean despite being presented as an average.