Find policies, billing codes, payers, states, and providers
CPT 64494: Image-Guided Lumbar/Sacral Facet Joint Injection, Second Level
CPT code 64494 denotes an image-guided, add-on injection of a diagnostic or therapeutic agent into a lumbar or sacral paravertebral facet (zygapophyseal) joint or the nerves supplying that joint, representing the second level treated on one side. This add-on procedure is commonly used in the evaluation and management of low back pain and related lumbar spine disorders and is relevant to clinicians and payers because it affects procedure reporting, bundling decisions, and payment for multi-level interventions.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, United Healthcare, and Medicare. Readers will find an overview of the clinical context for use of 64494, how it relates to adjacent CPT codes for single and additional levels, and the typical sites of service for the procedure. The publication also summarizes payer coverage considerations, common billing modifiers that may accompany image-guided facet injections, and typical ICD-10 diagnoses used to support medical necessity for lumbar and sacral facet procedures.
This piece is designed to help coding professionals, clinical administrators, and policy analysts understand the code’s clinical purpose, reporting relationship to related codes, and areas where payer policies commonly focus such as medical necessity documentation and level-based reporting for multi-level procedures.
Customize your policy alerts
Sign up for cpt 64494 policy alerts
Get alerted when payer policies referencing 64494 are released or updated.
Monitor payer policy activity
Billing Code Overview
CPT code 64494 describes an add-on image-guided injection of a diagnostic or therapeutic agent into a single lumbar or sacral paravertebral facet (zygapophyseal) joint, or into the nerves that supply that joint. This code specifically represents the service performed at a second facet joint level on one side, reported in addition to the primary single-level procedure.
Service type: Image-guided diagnostic or therapeutic paravertebral facet injection (add-on, lumbar/sacral, second level)
Typical site of service: Outpatient procedural settings or ambulatory surgery centers using fluoroscopy or computed tomography (CT) guidance, and other facilities where image-guided spine injections are performed.
National Reimbursement Benchmarks
Medicare’s mean of $99.20 sits well below BUCA’s average commercial mean of $311.60, indicating a substantial gap between federal reimbursement and this commercial benchmark—BUCA’s mean is roughly three times higher than Medicare’s. This gap highlights the difference in payment levels that providers can expect between Medicare and certain commercial arrangements.
Dispersion varies notably across payers. Blue Cross Blue Shield shows the widest interquartile spread (P75–P25 = $125.00), followed by BUCA with a spread of $129.00; UnitedHealth Group has a moderate spread of $82.10. Aetna and Cigna are among the tightest, with spreads of $108.50 and $76.20 respectively, indicating relatively less variability in negotiated rates for those carriers.