CPT 64491: Cervical/Thoracic Paravertebral Facet Injection, Second Level
Medicare pays $105 and commercial payers pay $317 on average nationally for this procedure.
CPT code 64491 describes an add-on diagnostic or therapeutic injection of an anesthetic or other agent into a single cervical or thoracic paravertebral facet (zygapophyseal) joint or the nerves supplying that joint using imaging guidance (fluoroscopy or CT); service type: image-guided paravertebral facet joint injection (add-on) provided in an outpatient procedure suite, ambulatory surgery center, or hospital setting.
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
Nationwide commercial means exceed Medicare: Blue Cross Blue Shield and BUCA show notably higher average rates than Medicare, with BUCA averaging $317.10 versus Medicare’s mean of $105.30. Blue Cross Blue Shield’s mean is $450.50, Cigna and Aetna sit nearer Medicare but still above it at $135.50 and $132.60 respectively, while UnitedHealth Group averages $150.10.
Dispersion varies across payers when measured as the P75–P25 interquartile spread. Blue Cross Blue Shield has the widest IQR at $213.70 ($547.20–$345.50), followed by UnitedHealth Group at $99.20 ($189.40–$95.20) and BUCA at $152.40 ($386.60–$234.20). The tightest commercial spread is Cigna at $86.70 ($170.30–$84.30), with Aetna’s IQR at $79.90 ($157.60–$77.70). Medicare’s IQR is narrow at $10.00 ($109–$99).