Facet Injections

Facet Injections

Facet injections involve injection of an anesthetic agent or a steroid into the facets of the spine to relieve pain.

Facet Injections CPT Codes for cervical or thoracic level,

For the first level in the cervical or thoracic region, report 64490

For a second level in the cervical or thoracic region, report add on code 64491

For the third level and beyond, report add on code 64492.

CPT : 64490 - Injections, diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), cervical or thoracic, single level.

Procedure Description:

The physician preps and anesthetizes the patient for a facet joint injection. The physician then inserts the needle through the skin, and he advances it to the proper position within the joint using either fluoroscopy or CT imaging guidance. He then injects the therapeutic or diagnostic agent, like a steroid or anesthetic mixture. He then removes the needle and ensures that the site obtains hemostasis. 

CPT : 64491 - Injections, diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), cervical or thoracic; second level (List separately in addition to code for primary procedure) 

CPT : 64492 - Injections, diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), cervical or thoracic; third and any additional level(s) (List separately in addition to code for primary procedure)

Do not separately code for multiple injections at the same spinal level. 

Report code 64490 once for the first level, example C3 to C4, 

Report add on code 64491 once for the second level, example C4 to C5, and 

Report add on code 64492 once for any additional levels.

Facet Injections CPT Codes for lumbar or sacral,

For the first level in the lumbar or sacral, report 64493

For a second level in the cervical or thoracic region, report add on code 64494

For the third level and beyond, report add on code 64495. 

CPT : 64493 - Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), lumbar or sacral; single level 

Procedure Description:  

In this service, the physician preps and anesthetizes the patient for a facet joint injection. The physician then inserts the needle through the skin, and he advances it to the proper position within the joint using either fluoroscopy or CT imaging guidance. He then injects the therapeutic or diagnostic agent, like a steroid or anesthetic mixture. He then removes the needle and ensures that the site obtains hemostasis.

CPT : 64494 - Injections, diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), lumbar or sacral; second level (List separately in addition to code for primary procedure) 

CPT : 64495 - Injections, diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), lumbar or sacral; third and any additional level(s) (List separately in addition to code for primary procedure) 

Do not separately code for multiple injections at the same spinal level. 

Report code 64493 once for the first level, example L3 to L4, 

Report add on code 64494 once for the second level, example L4 to L5, and 

Report add on code 64495 once for any additional levels.

Notes:

If one side is treated in a region, use the code once. If both sides are treated, Use a 50 modifier.

Fluoroscopy or CT guidance are bundled into facet blocks. 

Injection of small amount of contrast to confirm the needle position is also included can not be coded separately.

Use codes 0213T-0218T for ultrasound guided facet or medial nerve root blocks.

Use unlisted code 64999 to describe injection of botulism toxin into a facet joint.

Use unlisted code 64999 for injecting an anesthetic agent around implanted spinal hardware.