Summary & Overview
CPT 64491: Paravertebral Nerve Block Injection, Second Level
CPT code 64491 represents the injection of an anesthetic agent for a nerve block at the second level of the cervical or thoracic paravertebral spinal nerves. This procedure is a critical component in pain management, particularly for patients suffering from conditions such as cervicalgia and thoracic spine pain. The code is used as an add-on to the primary nerve block procedure, allowing for expanded treatment across multiple spinal levels.
Major national payers, including Aetna, Blue Cross Blue Shield, Cigna Health, Medicare, and UnitedHealthcare, recognize and reimburse for this code, reflecting its widespread clinical and billing relevance. The publication provides a comprehensive overview of payer coverage, clinical indications, and typical sites of service for CPT 64491. Readers will gain insight into current benchmarks, policy updates, and the clinical context surrounding this interventional pain management procedure. The analysis also highlights associated diagnoses and related CPT codes, offering a clear understanding of how CPT 64491 fits into broader pain management strategies and billing practices.
This summary equips healthcare professionals, administrators, and policy stakeholders with essential information to navigate the complexities of coding, coverage, and clinical application for paravertebral nerve block procedures.
CPT Code Overview
CPT 64491 is used to report the introduction or injection of an anesthetic agent for a nerve block, specifically targeting the paravertebral spinal nerves and branches in the cervical or thoracic regions. This code is designated as an add-on procedure for the second level, meaning it is billed in addition to a primary procedure. The service is commonly performed as part of pain management or interventional pain procedures. Typical sites of service include outpatient hospital settings and physician offices, such as Office (POS 11) and Outpatient Hospital (POS 19/22).
Clinical & Coding Specifications
Clinical Context
A patient presents to the outpatient clinic or hospital with persistent neck or upper back pain, such as cervicalgia or thoracic spine pain, that has not responded to conservative treatments. The provider, specializing in pain management or physical medicine and rehabilitation, determines that a paravertebral nerve block is indicated for diagnostic or therapeutic purposes. The procedure involves injecting an anesthetic agent at the cervical or thoracic paravertebral spinal nerves. After performing the primary injection at the first level (coded with 64490), the provider proceeds to inject at a second level, which is reported with add-on code 64491. This workflow is typical for patients with multi-level spinal pain requiring targeted nerve blocks for pain relief or diagnostic evaluation.
Coding Specifications
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Modifier
+- Indicates that
64491is an add-on code and must be used in conjunction with the primary procedure code64490. It is not reported alone.
- Indicates that
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Associated Provider Taxonomies:
| Taxonomy Code | Specialty Name |
|---|---|
2084P0800X | Pain Management |
208D00000X | Physical Medicine & Rehabilitation |
- Specialties Represented:
- Pain Management
- Physical Medicine & Rehabilitation
Related Diagnoses
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M54.2- Cervicalgia- Indicates neck pain, commonly treated with cervical paravertebral nerve blocks.
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M54.6- Pain in thoracic spine- Represents upper back pain, relevant for thoracic paravertebral nerve blocks.
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M47.812- Spondylosis without myelopathy or radiculopathy, cervical region- Describes degenerative changes in the cervical spine, often associated with chronic neck pain.
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M47.814- Spondylosis without myelopathy or radiculopathy, thoracic region- Refers to degenerative changes in the thoracic spine, linked to upper back pain.
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M53.82- Other specified dorsopathies, cervical region- Covers other specified disorders of the cervical spine, which may warrant nerve block intervention.
Related CPT Codes
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64490- Introduction/Injection of Anesthetic Agent (Nerve Block), Diagnostic or Therapeutic Procedures on the Paravertebral Spinal Nerves and Branches, cervical or thoracic; single level- Used for the initial injection at the first cervical or thoracic level.
64491is always reported in addition to64490when a second level is treated.
- Used for the initial injection at the first cervical or thoracic level.
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64492- Introduction/Injection of Anesthetic Agent (Nerve Block), Diagnostic or Therapeutic Procedures on the Paravertebral Spinal Nerves and Branches (add‑on), cervical or thoracic; third and any additional level(s) (List separately in addition to code for primary procedure)- Used for injections at the third and subsequent levels. It is also an add-on code and is reported with
64490and/or64491as appropriate.
- Used for injections at the third and subsequent levels. It is also an add-on code and is reported with
-
Clinical Workflow:
64490is performed first for the initial level.64491is used for the second level.64492is used for the third and any additional levels.- These codes are commonly used together in multi-level nerve block procedures.
National Reimbursement Benchmarks
For CPT code 64491, UnitedHealth Group has the highest national mean rate at $153.58, while Medicare's mean rate is $105.26. The average commercial mean rate, represented by BUCA, is $124.09, which is $18.83 higher than Medicare. Blue Cross Blue Shield and Aetna also have mean rates above Medicare, but below Cigna and UnitedHealth Group.
Rate dispersion varies significantly across payers. Medicare shows the tightest range, with a difference of only $10.00 between the 75th and 25th percentiles. In contrast, Cigna and UnitedHealth Group exhibit the widest dispersions, with Cigna's range at $74.50 and UnitedHealth Group's at $81.00. This indicates greater variability in commercial payer rates compared to Medicare.
The table and chart below present the full breakdown of national benchmarks for each payer, including mean rates and percentile values.
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.