CPT 64493: Lumbar/Sacral Facet Joint Injection, Image-Guided

Medicare pays $198 and commercial payers pay $588 on average nationally for this procedure.

CPT code 64493 describes injection of a diagnostic or therapeutic substance into a single lumbar or sacral paravertebral facet (zygapophyseal) joint or the nerves supplying that joint using imaging guidance (fluoroscopy or CT); this is an image-guided interventional pain procedure (facet joint injection) typically performed in an outpatient procedure suite, ambulatory surgical center, or hospital outpatient department for evaluation or management of lumbar or lumbosacral pain.

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National Reimbursement Benchmarks

Medicare’s mean of $197.6 sits well below BUCA’s commercial average of $588.2, indicating a sizable gap between government and that commercial benchmark for CPT 64493. The difference of $390.6 highlights how reimbursement for this code can vary depending on payer type, with BUCA centered in the upper-mid commercial range while Medicare aligns near the low end of national means.

Examining dispersion via the interquartile spread (P75 minus P25) highlights concentration differences: Blue Cross Blue Shield shows the widest IQR at $802.5 ($1,206.80 − $415.30), reflecting substantial variability among its rates, followed by BUCA at $525.2 ($825.00 − $297.80). The tightest distributions are Aetna at $183.9 ($311.80 − $130.90) and Cigna at $171.6 ($293.80 − $132.20). UnitedHealth Group’s IQR is $182.4 ($342.50 − $160.10), placing it near the lower-dispersion group.

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CPT 64493: Lumbar/Sacral Facet Joint Injection, Image-Guided

Medicare pays $198 and commercial payers pay $588 on average nationally for this procedure.

Customize your policy alerts

Sign up for cpt 64493 policy alerts

Get alerted when payer policies referencing 64493 are released or updated.

Monitor payer policy activity

Receive email alerts as soon as relevant payer policies are published or updated.

National Reimbursement Benchmarks

National Payer Mean Reimbursement Rates

Clinical & Coding Specifications

Clinical Context

A 56-year-old patient with chronic axial low back pain and imaging-confirmed lumbar facet arthropathy (e.g., degenerative changes at the L4–L5 facet joint) is referred to interventional pain management after conservative care (physical therapy, NSAIDs) provided incomplete relief. The patient reports focal unilateral lumbar pain exacerbated by extension and rotation. Examination localizes pain to the paraspinal region without radiculopathy or myelopathic signs.

The clinical workflow: the interventional pain specialist performs informed consent and verifies indication (diagnostic or therapeutic facet joint or medial branch injection). The patient is positioned prone in a fluoroscopy suite or CT suite. Conscious sedation or monitored anesthesia care is provided as indicated. Under sterile technique and image guidance (fluoroscopy or CT), the provider advances a needle to the targeted lumbar or sacral facet joint or adjacent medial branch nerve and injects a diagnostic anesthetic and/or therapeutic agent (local anesthetic with or without corticosteroid). Post-procedure, the patient is recovered in the ambulatory recovery area, monitored for immediate complications, and given post-procedure instructions including activity restrictions and signs of infection or neurologic change. If diagnostic, pain response is documented to guide further treatments (e.g., medial branch radiofrequency ablation). Typical sites of service are an ambulatory surgical center, hospital outpatient department, or radiology/interventional suite within a clinic using fluoroscopy or CT imaging.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`64494`	Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint ... lumbar or sacral; second level	Used when a second lumbar or sacral facet joint (same or opposite side) is injected during the same session
`64495`	Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint ... lumbar or sacral; third and any additional level(s)	Used when a third or additional lumbar/sacral facet level is injected during the same session

Related Modifiers

10 rows

Modifier	Description	When to Use
26	Modifier 26 (Professional Component) identifies and bills only the professional portion of a split service — the physician’s interpretation, report, and medical judgment — when the technical…	- Use CPT Modifier -26 when you are billing only the professional component (PC) of a split‑bill eligible service—i.e., you performed the physician interpretation, medical judgment and prepared a…
50	Modifier –50 (Bilateral Procedure) is appended to a CPT code when an identical procedure is performed on paired anatomical structures during the same operative session. The AMA states to add…	- Use modifier -50 when the same CPT surgical, diagnostic, or radiology procedure is performed on paired anatomical structures (both sides of the body) during the same operative/session by the same…
51	Modifier –51 (Multiple Procedures) is used when the same provider performs multiple procedures in the same session to identify secondary, non‑exempt procedures and indicate payment reduction logic…	- Use modifier -51 when the same provider performs multiple distinct procedures during the same patient encounter: report the highest‑valued procedure first (no modifier) and append -51 to…
52	Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…	- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
53	Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…	- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
59	Modifier 59 indicates a distinct procedural service when two procedures that are not normally billed together are clinically and procedurally separate. The CPT definition (as reiterated by CMS)…	- Use modifier -59 to report a distinct procedural service when documentation supports that the procedure reported is not normally billed together with another service on the same day because of a…
76	Modifier -76, Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional, is appended when the same provider performs an identical, medically necessary procedure or…	- Use modifier -76 when the same physician or other qualified health care professional performs an identical procedure or service a second (or subsequent) time on the same date of service and the…
77	Modifier 77 indicates that a previously performed procedure or service was legitimately repeated by a different physician or other qualified health care professional. The AMA’s CPT definition…	- Use modifier 77 when a basic procedure or service already performed is repeated by a different physician or other qualified health care professional (for example, a second provider independently…
78	CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…	- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…
79	Modifier 79 indicates a surgical procedure performed during the postoperative global period of a prior surgery that is unrelated to the original procedure. Per AMA/CPT and CMS guidance, it is…	- Use modifier 79 when the same physician (or same‑specialty physician in the same group) performs a surgical procedure during the postoperative global period of a prior surgery and the new procedure…

Related Provider Taxonomies

8 rows

Taxonomy Code	Specialty	Notes
207K00000X	Allergy & Immunology Physician	An allergist-immunologist is trained in evaluation, physical and laboratory diagnosis, and management of disorders involving the immune system. Select…
261QC1800X	Corporate Health Clinic/Center	Ambulatory Health Care Facilities · Clinic/Center
207LP2900X	Pain Medicine (Anesthesiology) Physician	An anesthesiologist who provides a high level of care, either as a primary physician or consultant, for patients experiencing problems with acute, chr…
332U00000X	Home Delivered Meals	Home-delivered meals are those services or activities designed to prepare and deliver one or more meals a day to an individual's residence in order to…
363LC1500X	Community Health Nurse Practitioner	Physician Assistants & Advanced Practice Nursing Providers · Nurse Practitioner
364SN0800X	Neuroscience Clinical Nurse Specialist	Physician Assistants & Advanced Practice Nursing Providers · Clinical Nurse Specialist
103TE1100X	Exercise & Sports Psychologist	A psychologist with a proficiency in sports psychology that uses psychological knowledge and skills to address optimal performance and well-being of a…
246QH0600X	Histology Specialist/Technologist	Technologists, Technicians & Other Technical Service Providers · Specialist/Technologist, Pathology

Related Payer Policy Updates

Specialty: Anesthesiology1 / 3

10 rows

Policy	Payer	Effective Date
Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric or Substance Use Disorders	Premera Bluecross	2026-07-01
Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric or Substance Use Disorders	Premera Bluecross	2026-07-01
Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric or Substance Use Disorders	Premera Bluecross	2026-07-01
Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric or Substance Use Disorders	Premera Bluecross	2026-07-01
Elective Inpatient Services (for Idaho Only)	UnitedHealthcare	2026-06-01
Sites of Service	priority health	2026-06-01
Coverage for Ambulatory Surgery Unit (ASU)/Outpatient Facility and Anesthesia for Dental Services	univerahealthcare	2026-05-21
Mm_0579_Coveragepositioncriteria_Anesthesia_Services_Selected_Nerve_Blocks	Cigna	2026-05-15
Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric Disorders	Blue Cross Blue Shield - North Carolina	2026-04-01
Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric Disorders	Blue Cross Blue Shield - North Carolina	2026-04-01

CPT 64490: Cervical/Thoracic Facet Joint Image-Guided Injection

CPT-64491-CERVICAL-THORACIC-FACET-JOINT-INJECTION-ADD-ON-SECOND-LEVEL

CPT 64491: Cervical/Thoracic Paravertebral Facet Injection, Second Level

CPT-64492-CERVICAL-THORACIC-FACET-JOINT-ADD-ON-INJECTION-THIRD-LEVEL

CPT 64492: Cervical/Thoracic Facet Joint Injection, 3rd Level and Additional Levels

CPT-64494-LUMBAR-SACRAL-FACET-JOINT-INJECTION-SECOND-LEVEL

CPT 64494: Lumbar/Sacral Facet Joint Injection, Second Level

CPT-64495-LUMBAR-SACRAL-FACET-JOINT-INJECTION-ADD-ON-THIRD-LEVEL

CPT 64495: Lumbar/Sacral Facet Joint or Medial Branch Injection (Add‑On)

Frequently Asked Questions

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

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Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

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Clinical & Coding Specifications

Clinical Context

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`64494`	Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint ... lumbar or sacral; second level	Used when a second lumbar or sacral facet joint (same or opposite side) is injected during the same session
`64495`	Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint ... lumbar or sacral; third and any additional level(s)	Used when a third or additional lumbar/sacral facet level is injected during the same session

Related Modifiers

10 rows

Modifier	Description	When to Use
26	Modifier 26 (Professional Component) identifies and bills only the professional portion of a split service — the physician’s interpretation, report, and medical judgment — when the technical…	- Use CPT Modifier -26 when you are billing only the professional component (PC) of a split‑bill eligible service—i.e., you performed the physician interpretation, medical judgment and prepared a…
50	Modifier –50 (Bilateral Procedure) is appended to a CPT code when an identical procedure is performed on paired anatomical structures during the same operative session. The AMA states to add…	- Use modifier -50 when the same CPT surgical, diagnostic, or radiology procedure is performed on paired anatomical structures (both sides of the body) during the same operative/session by the same…
51	Modifier –51 (Multiple Procedures) is used when the same provider performs multiple procedures in the same session to identify secondary, non‑exempt procedures and indicate payment reduction logic…	- Use modifier -51 when the same provider performs multiple distinct procedures during the same patient encounter: report the highest‑valued procedure first (no modifier) and append -51 to…
52	Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…	- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
53	Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…	- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
59	Modifier 59 indicates a distinct procedural service when two procedures that are not normally billed together are clinically and procedurally separate. The CPT definition (as reiterated by CMS)…	- Use modifier -59 to report a distinct procedural service when documentation supports that the procedure reported is not normally billed together with another service on the same day because of a…
76	Modifier -76, Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional, is appended when the same provider performs an identical, medically necessary procedure or…	- Use modifier -76 when the same physician or other qualified health care professional performs an identical procedure or service a second (or subsequent) time on the same date of service and the…
77	Modifier 77 indicates that a previously performed procedure or service was legitimately repeated by a different physician or other qualified health care professional. The AMA’s CPT definition…	- Use modifier 77 when a basic procedure or service already performed is repeated by a different physician or other qualified health care professional (for example, a second provider independently…
78	CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…	- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…
79	Modifier 79 indicates a surgical procedure performed during the postoperative global period of a prior surgery that is unrelated to the original procedure. Per AMA/CPT and CMS guidance, it is…	- Use modifier 79 when the same physician (or same‑specialty physician in the same group) performs a surgical procedure during the postoperative global period of a prior surgery and the new procedure…

Related Provider Taxonomies

8 rows

Taxonomy Code	Specialty	Notes
207K00000X	Allergy & Immunology Physician	An allergist-immunologist is trained in evaluation, physical and laboratory diagnosis, and management of disorders involving the immune system. Select…
261QC1800X	Corporate Health Clinic/Center	Ambulatory Health Care Facilities · Clinic/Center
207LP2900X	Pain Medicine (Anesthesiology) Physician	An anesthesiologist who provides a high level of care, either as a primary physician or consultant, for patients experiencing problems with acute, chr…
332U00000X	Home Delivered Meals	Home-delivered meals are those services or activities designed to prepare and deliver one or more meals a day to an individual's residence in order to…
363LC1500X	Community Health Nurse Practitioner	Physician Assistants & Advanced Practice Nursing Providers · Nurse Practitioner
364SN0800X	Neuroscience Clinical Nurse Specialist	Physician Assistants & Advanced Practice Nursing Providers · Clinical Nurse Specialist
103TE1100X	Exercise & Sports Psychologist	A psychologist with a proficiency in sports psychology that uses psychological knowledge and skills to address optimal performance and well-being of a…
246QH0600X	Histology Specialist/Technologist	Technologists, Technicians & Other Technical Service Providers · Specialist/Technologist, Pathology

Related Payer Policy Updates

Specialty: Anesthesiology1 / 3

10 rows

Policy	Payer	Effective Date
Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric or Substance Use Disorders	Premera Bluecross	2026-07-01
Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric or Substance Use Disorders	Premera Bluecross	2026-07-01
Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric or Substance Use Disorders	Premera Bluecross	2026-07-01
Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric or Substance Use Disorders	Premera Bluecross	2026-07-01
Elective Inpatient Services (for Idaho Only)	UnitedHealthcare	2026-06-01
Sites of Service	priority health	2026-06-01
Coverage for Ambulatory Surgery Unit (ASU)/Outpatient Facility and Anesthesia for Dental Services	univerahealthcare	2026-05-21
Mm_0579_Coveragepositioncriteria_Anesthesia_Services_Selected_Nerve_Blocks	Cigna	2026-05-15
Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric Disorders	Blue Cross Blue Shield - North Carolina	2026-04-01
Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric Disorders	Blue Cross Blue Shield - North Carolina	2026-04-01

CPT 64490: Cervical/Thoracic Facet Joint Image-Guided Injection

CPT-64491-CERVICAL-THORACIC-FACET-JOINT-INJECTION-ADD-ON-SECOND-LEVEL

CPT 64491: Cervical/Thoracic Paravertebral Facet Injection, Second Level

CPT-64492-CERVICAL-THORACIC-FACET-JOINT-ADD-ON-INJECTION-THIRD-LEVEL

CPT 64492: Cervical/Thoracic Facet Joint Injection, 3rd Level and Additional Levels

CPT-64494-LUMBAR-SACRAL-FACET-JOINT-INJECTION-SECOND-LEVEL

CPT 64494: Lumbar/Sacral Facet Joint Injection, Second Level

CPT-64495-LUMBAR-SACRAL-FACET-JOINT-INJECTION-ADD-ON-THIRD-LEVEL

CPT 64495: Lumbar/Sacral Facet Joint or Medial Branch Injection (Add‑On)

Frequently Asked Questions

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

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Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

OpenPayer

CPT 64493: Lumbar/Sacral Facet Joint Injection, Image-Guided

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National Reimbursement Benchmarks

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CPT 64493: Lumbar/Sacral Facet Joint Injection, Image-Guided

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National Reimbursement Benchmarks

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related Payer Policy Updates

Related Codes

References

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related Payer Policy Updates

Related Codes

References

CPT 64493: Lumbar/Sacral Facet Joint Injection, Image-Guided

Sign up for cpt 64493 policy alerts

National Reimbursement Benchmarks

CPT 64493: Lumbar/Sacral Facet Joint Injection, Image-Guided

Sign up for cpt 64493 policy alerts

National Reimbursement Benchmarks

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related Payer Policy Updates

Related Codes

What does CPT 64493 describe?

In what clinical scenario is CPT 64493 typically used?

How does CPT 64493 relate to CPT 64494 and 64495?

What related diagnoses support the use of CPT 64493?

Where are typical sites of service for CPT 64493 and what imaging guidance is used?

References

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related Payer Policy Updates

Related Codes

What does CPT 64493 describe?

In what clinical scenario is CPT 64493 typically used?

How does CPT 64493 relate to CPT 64494 and 64495?

What related diagnoses support the use of CPT 64493?

Where are typical sites of service for CPT 64493 and what imaging guidance is used?

References