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CPT 64491: Cervical/Thoracic Facet Joint Injection, Add-On, Second Level
Headline: CPT code 64491 — Add‑on, image‑guided injection at a second cervical or thoracic facet joint
Lead: CPT code 64491 denotes an add‑on procedure for the injection of a diagnostic or therapeutic agent into a second cervical or thoracic paravertebral (zygapophyseal) joint or the nerves that supply that joint, performed under fluoroscopic or CT guidance. The code is commonly billed alongside a primary single‑level facet injection to report an additional level treated on the same side.
What it represents and national relevance: This CPT add‑on code captures incremental work and resources when multiple adjacent cervical or thoracic facet levels are treated during a single session. Accurate use of 64491 affects national data on utilization of interventional spine procedures, claims processing, and aggregate procedural cost measurement.
Key payers covered: Analysis typically includes major national payers: Aetna; Blue Cross Blue Shield; Cigna Health; UnitedHealthcare; and Medicare.
What readers will learn: The publication explains the clinical context for targeting cervical and thoracic facet joints, clarifies when an add‑on code is used versus a primary single‑level code, summarizes payer coverage patterns and common billing modifiers (listed elsewhere), and outlines related services for multi‑level injections. The report provides benchmarks and policy considerations relevant to coding accuracy, medical necessity review, and claims adjudication for image‑guided facet injections.
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Billing Code Overview
CPT code 64491 describes an add‑on injection procedure targeting a second cervical or thoracic paravertebral facet (zygapophyseal) joint or the nerves supplying that joint. The service involves the introduction of a diagnostic or therapeutic substance into a single facet joint or its innervating nerves using imaging guidance such as fluoroscopy or computed tomography (CT).
Service type: Image‑guided diagnostic or therapeutic paravertebral facet (zygapophyseal) injection — add‑on, second level on one side.
Typical site of service: Ambulatory surgical center or hospital outpatient department; may also be performed in other procedural settings that provide fluoroscopy or CT guidance.
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).