Summary & Overview
CPT 64495: Lumbar/Sacral Facet Joint Injection, Add-On Third Level
CPT code 64495 is an add-on CPT code for image-guided diagnostic or therapeutic injections targeting lumbar or sacral paravertebral facet (zygapophyseal) joints or the nerves supplying those joints, representing the third treated facet joint level and any additional levels on one side. This procedure is clinically important for evaluation and management of axial low back pain where targeted diagnostic blocks or therapeutic injections guide further treatment decisions. Nationally, use of this code reflects patterns in interventional pain management and imaging utilization for spine care.
Key payers in the coverage landscape include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical intent and typical sites of service, comparisons of payer coverage approaches and billing requirements, and benchmarks for documentation and coding practices tied to image-guided lumbar/sacral facet interventions. The publication also highlights common modifier usage and coding considerations when reporting multiple levels, and outlines where data is limited or varies by payer.
This summary is intended for billing managers, interventional pain clinicians, and policy analysts seeking a national-level briefing on coding and coverage issues related to image-guided lumbar/sacral facet joint injections at multiple levels.
Billing Code Overview
CPT code 64495 describes an add-on fluoroscopic or CT-guided injection of a diagnostic or therapeutic substance into a lumbar or sacral paravertebral facet (zygapophyseal) joint or into the nerves that supply that joint. This code represents the service performed at a third facet joint level and any additional levels on one side.
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Service type: Image-guided diagnostic or therapeutic injection of lumbar/sacral facet joint or medial branch nerves (add-on at third and subsequent levels, unilateral).
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Typical site of service: Ambulatory surgery center, hospital outpatient department, or office setting where fluoroscopy or computed tomography (CT) imaging guidance is available.
Clinical & Coding Specifications
Clinical Context
A 56-year-old patient with chronic low back pain and focal lumbar paraspinal facet-mediated pain presents for diagnostic and possible therapeutic injection. The patient has focal pain localized to the right lower lumbar region with reproducible pain on extension and rotation and pain referral consistent with the L4–L5 and L5–S1 facet complexes. Prior conservative measures (physical therapy, oral analgesics, activity modification) produced inadequate relief. The interventional pain specialist performs image-guided lumbar facet joint and/or medial branch nerve injections under fluoroscopic guidance. Procedural workflow includes informed consent, pre-procedure time-out, local skin anesthesia, placement of needles into the targeted facet joint(s) or medial branch nerves at selected lumbar or sacral levels, contrast confirmation of needle position, and injection of diagnostic local anesthetic ± corticosteroid for therapeutic effect. 64495 is reported as an add-on for the third and any additional lumbar or sacral facet joint level injected on one side; the primary base code for the first one or two levels is reported separately. Typical monitoring occurs in an ambulatory surgical center or hospital outpatient department with post-procedure observation for hemodynamic stability and post-injection pain response assessment to guide further management.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
25 | Significant, separately identifiable evaluation and management service by the same physician on the day of the procedure |