CPT Codes for Lumbar Facet Injections
The CPT codes for single and multiple lumbar facet injections are differentiated based on the number of joints injected, with 64493 for a single level, 64494 for a second level, and 64495 for each additional level beyond two.
Lumbar Facet Injection CPT Codes
- For single level lumbar facet joint injections (one joint), use CPT code 64493 1
- For second level lumbar facet joint injections (two joints), use CPT code 64494 in addition to 64493 1
- For third or additional level lumbar facet joint injections, use CPT code 64495 for each additional level beyond the second level 1
Documentation Requirements
- Medical necessity must be established using appropriate ICD-10 diagnostic codes 1
- Specific documentation in the medical record is necessary to provide support for the procedure 1
- Documentation should include evidence of facet-mediated pain with appropriate diagnostic testing 2
Diagnostic Criteria for Facet Joint Injections
- The double-injection technique with an improvement threshold of 80% or greater is recommended to establish the diagnosis of lumbar facet-mediated pain (Grade B recommendation) 3, 2
- Diagnostic facet blocks are an option for predicting a favorable response to facet medial nerve ablation by thermocoagulation for facet-mediated chronic low back pain 3
- Single intraarticular facet joint blocks have been shown to lack reliability and validity as a diagnostic tool 4
Clinical Considerations
- Facet joint injections are not recommended for chronic low-back pain without radiculopathy from degenerative disease of the lumbar spine as long-lasting benefit has not been demonstrated 3
- Diagnostic facet blocks have not been proven to predict lumbar fusion outcomes in patients with chronic low-back pain from degenerative lumbar disease 3
- Common inciting events for facet joint pain include falls (11%), motor vehicle collisions (11%), and sports-related injuries (11%, with weightlifting accounting for 62% of these) 5
Alternative Treatment Considerations
- Facet medial nerve blocks are considered for short-term pain relief rather than intra-articular injections 2
- Facet medial nerve ablation has moderate evidence supporting its use for short-term decrease of facet-mediated chronic low back pain 2
- For radiofrequency procedures, recommendations generally support their use only after positive response to medial branch blocks 3
Common Pitfalls to Avoid
- Proceeding with interventional procedures before completing an adequate trial of conservative management (at least 6 weeks) 2
- Relying solely on imaging findings of facet arthropathy to justify interventional treatment 2
- Confusing the diagnostic utility of facet blocks with their therapeutic value 2
- Failing to distinguish between different types of facet interventions 2