Summary & Overview
CPT 64494: Lumbar/Sacral Image-Guided Facet Injection, Second Level
Headline: CPT 64494: Lumbar/Sacral Image-Guided Paravertebral Facet Injection (Second Level)
CPT 64494 identifies an image-guided diagnostic or therapeutic injection to a second lumbar or sacral paravertebral facet (zygapophyseal) joint or the nerves serving that joint, billed in addition to the primary level. This interventional spine procedure is an important tool in the assessment and management of axial and radicular low back pain, enabling targeted delivery of anesthetic or steroid under fluoroscopy or CT to improve diagnostic specificity and therapeutic precision. Nationally, accurate coding for additional levels influences clinical documentation, billing clarity, and payer authorization workflows.
Major payers addressed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise review of code scope and clinical context, guidance on typical sites of service, common associated diagnoses, and how this level-based code relates to adjacent CPT entries used for single, bilateral, and additional levels. The publication outlines practical billing considerations such as image guidance requirements and level-specific reporting relationships to related codes. It also summarizes typical clinical indications and where this code fits in the sequence of interventional spine procedures. Data not available in the input is noted where applicable.
CPT Code Overview
CPT 64494 describes an image-guided injection of a diagnostic or therapeutic agent into a lumbar or sacral paravertebral facet (zygapophyseal) joint or the nerves that innervate that joint, reported for a second level when billed in addition to the primary procedure. This procedure falls under pain management / interventional spine procedures and is typically performed in an image-guided interventional setting, such as an office or outpatient hospital equipped for fluoroscopy or CT guidance. The code denotes a level-based, targeted lumbar or sacral facet injection performed with imaging to confirm needle placement and agent delivery.
Clinical & Coding Specifications
Clinical Context
A patient in their 50s presents to an interventional spine clinic with chronic axial low back pain and intermittent lumbar radicular symptoms refractory to conservative care (physical therapy, oral analgesics, and activity modification). Diagnostic imaging (lumbar MRI) demonstrates facet arthropathy at multiple lumbar levels and degenerative disc changes. The pain management physician schedules an image-guided lumbar facet joint injection with fluoroscopy to deliver a diagnostic and/or therapeutic agent to the affected zygapophyseal joint or the medial branch nerves. The procedure is performed in an outpatient imaging-capable setting (office or hospital outpatient), with pre-procedure consent, sterile preparation, localization using fluoroscopy or CT, contrast confirmation of intra-articular or periarticular needle position, injection of anesthetic and/or corticosteroid, and post-procedure monitoring for recovery and immediate response for diagnostic correlation.
Coding Specifications
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Modifier
50: Used when bilateral injections are performed at the same spinal level. Reported in addition to the primary procedure code when separate bilateral work is performed. -
Associated provider taxonomies and specialties:
| Taxonomy Code | Specialty |
|---|---|
207L00000X | Anesthesiology |
208VP0000X | Pain Medicine Physician |
207XS0117X | Orthopaedic Surgery of the Spine |
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Notes on use:
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Use the primary lumbar/sacral facet injection code for the first level and append the appropriate add-on codes for additional levels as indicated (
64493,64494,64495relationship described in Related CPT Codes). -
Use
50when bilateral procedures are performed at the same level; document bilateral needle placements and separate work performed for each side.
Related Diagnoses
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M54.5— Low back painLow back pain is a common indication for lumbar facet joint or medial branch injections to diagnose facet-mediated pain or provide therapeutic relief.
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M47.816— Spondylosis without myelopathy or radiculopathy, lumbar regionDegenerative spondylosis can contribute to facet joint arthropathy and low back pain targeted by facet injections.
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M51.36— Other intervertebral disc degeneration, lumbar regionDisc degeneration may coexist with facet joint pathology and is part of the degenerative pain complex evaluated during diagnostic injections.
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M54.16— Radiculopathy, lumbar regionLumbar radiculopathy symptoms may prompt targeted diagnostic or therapeutic injections when facet-mediated pain is suspected or to differentiate pain generators.
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M53.3— Sacrococcygeal disorders, not elsewhere classifiedSacrococcygeal region disorders can present with low back or sacral pain where sacral facet or adjacent injections may be clinically relevant.
Related CPT Codes
| CPT Code | Description |
|---|---|
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 |
64494 | Injection(s), 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) |
64495 | Injection(s), 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) |
64493is the primary single-level code used when only one lumbar or sacral facet level is injected.64494is reported in addition to64493when a second level is treated.64495is used for the third and any subsequent levels and is listed separately in addition to the primary procedure.64490is the cervical or thoracic single-level code and is referenced when procedures cross the thoracolumbar junction (for example, reporting injections that include both thoracic/cervical and lumbar levels may require use of64490in conjunction with64494).- These codes are commonly used together when multiple contiguous levels are treated during the same session;
64493as the primary code followed by64494and64495as add-on codes for the 2nd and 3rd+ levels respectively.
National Reimbursement Benchmarks
National Medicare mean rates for 64494 are lower than the BUCA (average commercial) mean by about $13.85, with Medicare at $99.22 and BUCA at $113.07. Commercial payers show a range of mean rates above and below BUCA: UnitedHealth Group and Cigna report the highest means, while Blue Cross Blue Shield and Medicare report lower means.
Dispersion measured as the difference between the 75th and 25th percentiles varies across payers. UnitedHealth Group has one of the widest spreads at $73.67 (P75 $163.00 minus P25 $89.33), and Cigna is also wide at $67.00. Medicare is the tightest with a spread of $10.00 (P75 $103.00 minus P25 $93.00). The table and chart below present the full breakdown.
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