Find policies, billing codes, payers, states, and providers
CPT 64490: Cervical/Thoracic Facet Joint Injection, Image-Guided
CPT code 64490 denotes an image-guided injection of a diagnostic or therapeutic agent into a single cervical or thoracic paravertebral facet (zygapophyseal) joint or the nerves that supply that joint, billed for one level on one side. This procedure is commonly used for diagnostic pain localization and therapeutic relief in patients with axial neck or thoracic spine pain and is widely performed in ambulatory surgery centers, hospital outpatient departments, and office settings equipped with fluoroscopy or CT.
Key payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, United Healthcare, and Medicare. The publication summarizes coverage considerations, coding relationships to adjacent levels (64491, 64492, 64494), and clinical context for use in cervical and thoracic dorsopathies. Readers will find benchmarks for utilization and billing patterns, clarification of service definition and site of service, and a concise review of common clinical indications tied to relevant ICD-10 diagnoses such as M54.2 and M54.6.
The report is intended for coding professionals, payers, and clinical administrators seeking a clear, national-level reference for billing and clinical classification of cervical and thoracic facet joint injections with image guidance. Data not available in the input for specific reimbursement amounts or payer-specific policy language is identified where applicable.
Customize your policy alerts
Sign up for cpt 64490 policy alerts
Get alerted when payer policies referencing 64490 are released or updated.
Monitor payer policy activity
Billing Code Overview
CPT code 64490 describes the injection of a diagnostic or therapeutic substance into a single cervical or thoracic paravertebral facet (zygapophyseal) joint, or into the nerves supplying that joint, performed with imaging guidance (fluoroscopy or computed tomography). The code represents the service provided at one facet joint level on one side.
Service type: Image-guided paravertebral facet joint injection (diagnostic or therapeutic)
Typical site of service: Ambulatory surgical centers, hospital outpatient departments, or physician offices with imaging capability, where fluoroscopy or CT guidance is available.
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.