CPT Codes for Cervical and Thoracic Facet Injections
The CPT codes for cervical and thoracic facet injections are bundled with image guidance and limited to a maximum of three levels per session since 2010. 1
Cervical Facet Injection CPT Codes
- 64490: Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), cervical or thoracic; single level 1
- 64491: Injection(s), diagnostic or therapeutic agent, paravertebral facet joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), cervical or thoracic; second level 1
- 64492: Injection(s), diagnostic or therapeutic agent, paravertebral facet joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), cervical or thoracic; third and any additional level(s) 1
Thoracic Facet Injection CPT Codes
- The same codes (64490,64491,64492) are used for thoracic facet injections as they are bundled together with cervical facet injections 1
Important Coding Considerations
- These codes include image guidance (fluoroscopic or CT) as part of the bundled service 1
- Providers can only bill for a maximum of three levels per session 1
- The codes apply to both diagnostic and therapeutic injections 1
- These codes were implemented in 2010 as part of CMS efforts to control utilization and ensure appropriate image guidance 1
Clinical Context
- Facet injections are commonly used for both diagnostic and therapeutic purposes in managing chronic spinal pain 2
- Diagnostic facet blocks using the double-injection technique with an improvement threshold of 80% are recommended to establish the diagnosis of facet-mediated pain (Grade B recommendation) 3
- Ultrasound guidance can be used for cervical facet injections with 78-98% accuracy, though fluoroscopy remains the standard 4, 5
- Ultrasound-guided thoracic facet injections have shown 80% accuracy in cadaveric studies 6
Impact of CPT Code Changes
- After the 2010 CPT code bundling, there was a 15% drop in cervical-thoracic facet injections and a 14% drop in lumbosacral facet injections per 100,000 Medicare beneficiaries 1
- Prior to this change, facet injections had been growing at an average rate of 15% per year for cervical-thoracic and 11% per year for lumbosacral regions 1
Documentation Requirements
- Medical necessity must be established using appropriate ICD-10 diagnostic codes 3
- Specific documentation in the medical record is necessary to provide support for the procedure 3
- For proper reimbursement, the documentation should specify the exact levels injected and confirm the use of image guidance 3, 1
When billing for these procedures, it's essential to understand that the codes cover both the injection and the imaging guidance, with limitations on the number of spinal levels that can be billed per session.