CPT Codes for Physical Medicine and Interventional Pain Management

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Disclaimer:  The information here is NOT meant to replace the sound advice of a billing and coding expert.

Below is a list of the most common CPT codes (procedure codes) used in a PM&R and interventional pain management clinic.  Electrodiagnostic (EMG/NCS) codes are also included.  These have all been updated for the most recent 2015 changes.  Feel free to make coding tips in the comments below.

Remember:  Use the -50 modifier when performing BILATERAL procedures below. Note:  Fluoro needle guidance is built in to SI joint (27096), transforaminal and interlaminar ESIs, medial branch blocks, radiofrequency ablation (RFA) and facet injections; therefore, you can NOT bill for fluoro separately for these procedures.  But you CAN bill separate fluoro guidance codes (77002 for non-spinal) for peripheral joints/ligaments/bursa (hips, shoulders, iliolumbar ligament, troch bursa, etc.)

Joints and Bursa – Injection or Aspiration

  • Major joint/bursa:  20610 (knee, hip, shoulder, trochanteric bursa, subacromial bursa, pes anserine bursa)
  • Intermediate joint/bursa:  20605 (temporomandibular, acromioclavicular, wrist, elbow, ankle, olecranon bursa)
  • Minor joint/bursa:  20600 (fingers [PIP, DIP], toes)
  • Sacroiliac joint (SIJ) with fluoroscopy:  27096
  • Sacroiliac joint (SIJ) without fluoroscopy:  20552 (billed as a trigger point injection)
  • Fluoroscopic  needle guidance (non-spinal):  77002
  • Shoulder arthrogram injection:  23350 (+77002)
  • Hip arthrogram injection:  27093 (+77002)
  • Genicular nerve blocks:  64450 x3 units
  • Genicular nerve RFA:  64640, 64640-59, 64640-59

Tendons, Ligaments, and Muscle Injections

  • Tendon sheath or Ligament:  20550 (iliolumbar ligament, trigger finger, De Quervain’s tenosynovitis, plantar fascia)
  • Tendon origin/insertion:  20551
  • Trigger point injection (1 or 2 muscles):  20552
  • Trigger point injection (3 or more muscles):  20553
  • Sacroiliac joint (SIJ) without fluoroscopy:  20552 (billed as a trigger point injection)
  • Intramuscular injections:  96372
  • Fluoroscopic  needle guidance (non-spinal):  77002

Nerve Blocks

  • Greater occipital nerve block:  64405
  • Lesser occipital nerve block:  64450
  • Other peripheral nerve:  64450 (I use this for superior cluneal nerve blocks, and genicular nerve blocks)
  • Other peripheral nerve:  64640 (used for S1, S2, S3 lateral branches during RFA)
  • Suprascapular nerve:  64418
  • Intercostal nerve (single):  64420
  • Intercostal nerve (multiple):  64421
  • Ilioinguinal and Iliohypogastric nerve:  64425
  • Trigeminal nerve (any branch):  64400
  • Sphenopalatine ganglion:  64505
  • Stellate ganglion (cervical sympathetic):  64510
  • Superior hypogastric plexus:  64517
  • Thoracic or lumbar paravertebral sympathetic or ganglion impar block:  64520
  • Celiac plexus:  64530
  • Plantar common digital nerve (Morton’s neuroma):  64455
  • Unlisted procedure:  64999

Epidural Steroid Injections (ESI)

  • Interlaminar
    • Interlaminar – cervical or thoracic62310
    • Interlaminar – lumbar or sacral (caudal)62311
    • Fluoroscopic  needle guidance (Spinal):  77003
  • Transforaminal
    • Transforaminal – cervical or thoracic (first level):  64479
    • Transforaminal – cervical or thoracic (each additional level):  64480
    • Transforaminal – lumbar or sacral (first level):  64483
    • Transforaminal – lumbar or sacral (each additional level):  64484
    • Remember: Fluoro can NOT be billed separately for these.
    • Ex:  A bilateral L5 TF ESI would be billed as 64483 -50.

Facet Joint Procedures

  • Intraarticular Joint or Medial Branch Block
    • Intraarticular joint or medial branch block (MBB) – cervical or thoracic (1st level):  64490
    • Intraarticular joint or medial branch block (MBB) – cervical or thoracic (2nd level):  64491
    • Intraarticular joint or medial branch block (MBB) – cervical or thoracic (3rd level):  64492
    • Intraarticular joint or medial branch block (MBB) – lumbar or sacral (1st level):  64493
    • Intraarticular joint or medial branch block (MBB) – lumbar or sacral (2nd level):  64494
    • Intraarticular joint or medial branch block (MBB) – lumbar or sacral (3rd level):  64495
    • Note:  You can bill for bilateral facets or MBB at the same levels (with the -50 modifier), but you will NOT typically get reimbursed for over 3 facet joints or medial branches on the same side.
    • Note:  For medial branch blocks, the proper billing is to bill for each complete facet joint blocks (see example below)
    • Ex:  Bilateral L3, L4, L5 MBBs would be billed as 64493 -50, 64494 -50.
    • Note:  The third occipital nerve (TON) partially innervates the C2/3 facet joint, so along with a C3 MBB, this would be billed as one full joint (64490)
    • Ex:  Right TON, C3, C4, C5 blocks = Three full facet joints (C2/3, C3/4, C4/5) = 64490, 64491, 64492
    • Remember:  Fluoro can NOT be billed separately for these.
  • Radiofrequency Ablation (RFA) / “Destruction” of Facet Joint
    • Radiofrequency ablation (RFA) – cervical or thoracic (1st joint):  64633
    • Radiofrequency ablation (RFA) – cervical or thoracic (each additional joint):  64634
    • Radiofrequency ablation (RFA) – lumbar or sacral (1st joint):  64635
    • Radiofrequency ablation (RFA) – lumbar or sacral (each additional joint):  64636
    • Remember:  Fluoro can NOT be billed separately for these.

Sacroiliac Joint

  • Sacroiliac joint (SIJ) without fluoroscopy:  20552 (billed as a trigger point injection)
  • Sacroiliac joint (SIJ) with fluoroscopy:  27096
  • Sacral lateral branch blocks:  64450 (remember to bill 77003 with these, but not with the 64493 code)
  • Radiofrequency Ablation (RFA) of the Sacroiliac Joint
    • RF of L5 dorsal primary ramus:  64635
    • RF of S1 lateral branches:  64640
    • RF of S2 lateral branches:  64640
    • RF of S3 lateral branches:  64640
    • Fluoroscopic  needle guidance (Spinal):  77003 (for the S1-S3 nerve lateral branches, not the L5)
    • Note:  Use 724.6 (Disorder of the sacrum) and 721.3 (lumbar spondylosis) as the diagnostic codes

Vertebroplasty / Kyphoplasty

  • Vertebroplasty
    • Vertebroplasty – Cervicothoracic (1st level):  22510
    • Vertebroplasty – Lumbosacral (1st level):  22511
    • Vertebroplasty – Each additional level of the above:  +22512
    • Note:  Same charge whether you perform unilateral or bilateral injection of cement (PMMA).  Modifier 50 can NOT be used.
    • Note:  The global charge for the procedure includes all imaging guidance and any bone biopsy performed.
  • Kyphoplasty
    • Kyphoplasty – Thoracic (1st level):  22513
    • Kyphoplasty – Lumbar (1st level):  22514
    • Kyphoplasty – Thoracic or Lumbar (each additional level):  +22515
    • Note:  Same charge whether you perform unilateral or bilateral injection of cement (PMMA).  Modifier 50 can NOT be used.
  • Note:  10-day global period

Neurostimulation (Spinal Cord Stimulator / Dorsal Column Stimulator)

  • Trial Procedure
    • Percutaneous implant of electrode array:  63650 (includes 10-day global) – bill two units if you implant two trial leads
  • Implantation of Spinal Cord Stimulator Percutaneous Leads and Generator
    • Percutaneous implant of electrode array:  63650 (includes 10-day global)
    • Insertion or replacement of pulse generator:  63685 (includes 10-day global)
  • Implantation of Spinal Cord Stimulator PADDLE Leads and Generator
    • Laminectomy for implant of neurostimulator electrode, paddle:  63655 (includes 90-day global)
    • Insertion or replacement of pulse generator:  63685 (includes 10-day global)
  • Removal of Leads/Generator (Explant)
    • Removal of spinal neurostimulator percutaneous array(s):  63661 (includes 10-day global)
    • Removal of spinal neurostimulator paddle electrode:  63662 (includes 90-day global)
    • Removal of pulse generator:  63688 (includes 10-day global)
  • Important:  Also bill for the implanted neurostimulator electrodes (each lead):  L8680

Discogram / Discography

  • Discogram / Discography – Cervical/Thoracic (each disc):  62291
  • Supervision & interpretation of fluoroscopy – Cervical/Thoracic (each disc):  72285
  • Discogram / Discography – Lumbar (each disc):  62290
  • Supervision & interpretation of fluoroscopy – Lumbar (each disc):  72295
  • Remember:  Fluoroscopy is bundled here and can NOT be billed separately for these.

Botulinum Toxin Injections

  • Botulinum toxin type A – Botox, Dysport (per unit):  J0585
  • Botulinum toxin type B – Myobloc (per 100 units):  J0587
  • Needle electromyography in conjunction with chemodenervation:  95874
  • Chemodenervation of muscles in the neck (spasmodic torticollis):  64616
  • Chemodenervation of muscles of the trunk and/or extremity (cerebral palsy, dystonia, multiple sclerosis):  64614
  • Chemodenervation of muscles innervated by facial, trigeminal, cervical spinal and accessory nerves, bilateral (chronic migraine):  64615

Other

  • Carpal tunnel injection:  20526
  • Epidural blood patch:  62273
  • Moderate sedation (first 30 minutes):  99144 (requires presence of another trained person to monitor the patient’s consciousness and vitals)
  • Moderate sedation (each additional 15 minutes):  99145
  • Fluoroscopic  needle guidance (spinal):  77003
  • Fluoroscopic  needle guidance (non-spinal):  77002
  • CT needle guidance:  77012

Modifiers

  • -50:  Bilateral
  • -52:  Incomplete procedure (reduced service) [Stopping a part of a procedure because of reasons other than the patient’s well-being]
  • -53:  Incomplete procedure (physician elected to terminate a surgical or diagnostic procedure due to the patient’s well-being) – reduced service.  I’ve used for a patient that had a severe vasovagal response to a radiofrequency procedure and I elected to abort the procedure and reschedule later.
  • -59:  Indicates that a procedure or service is separate and independent from other services performed the same day
  • -26:  Professional component only

Injectables (J-codes)

  • Omnipaque 300 (per ml):  Q9967
  • Omnipaque 240 (per ml):  Q9966
  • Dexamethasone sodium phosphate (per mg):  J1100
  • Celestone (per 3 mg):  J0702
  • Celestone (per 4 mg):  J0704
  • Depo-Medrol (40mg):  J1030
  • Depo-Medrol (80mg):  J1040
  • Kenalog/Triamcinolone (per 10 mg):  J3301
  • Toradol/Ketorolac (per 15mg):  J1885 (don’t forget the 96372 code if injected intramuscular)
  • Methocarbamol – Robaxin (up to 10 ml):  J2800 (don’t forget the 96372 code if injected intramuscular)
  • Synvisc 3 dose (per 2 ml syringe):  J7325
  • Synvisc One (per 6 ml syringe):  J7325S
  • Versed (per mg):  J2250
  • Fentanyl (0.1 mg):  J3010
  • Diphenhydramine – Benadryl (injection up to 50-mg):  J1200
  • Botulinum toxin type A – Botox, Dysport (per unit):  J0585
  • Botulinum toxin type B – Myobloc (per 100 units):  J0587

Electromyography (EMG) & Nerve Conduction Studies (NCS)

  • Sensory NCS (each nerve):  95904
  • Motor NCS w/o F-wave (each):  95900
  • Motor NCS with F-wave (each):  95903
  • H-reflex (gastrocnemius/soleus):  95934
  • H-reflex (other than gastroc/soleus):  95936
  • Blink reflex (orbicularis oculi):  95933 (only once per study)
  • EMG guidance during botulinum toxin injections:  95874
    • Add modifier -26 if you don’t own the EMG machine you’re using
  • EMG w/NCS, each extremity, “limited” (4 or fewer muscles):  95885
  • EMG w/NCS, each extremity, “complete” (5+ muscles, innervated by 3+ nerves or 4+ spinal levels):  95886
  • EMG w/o NCS on same day:  one extremity = 95860, two extremities = 95861, three = 95863, four = 95864
  • Cranial nerves
    • EMG (unilateral):  95867
    • EMG (bilateral ):  95868
  • Note:  EMG needles can not be billed separately, as they are included in the EMG codes
  • Muscle testing before the study
    • Extremity w/o hand (must include a report of this):  95831
    • Hand:  95832
  • 2013 CPT Coding Changes for Nerve Conduction Studies – Effective January 1, 2013
    • Each conduction study is counted as one for sensory, motor with or without F-wave, or H-reflex.  Orthodromic and antidromic tests on the same nerve count only once.
    • Example:  Bilateral sensory and motor median and ulnar NCS is performed.  This is eight (8) separate tests, so the proper code now is 95910.  Adding a radial sensory on one side would then make it a 95911.
    • 1-2 NCS = 95907
    • 3-4 NCS = 95908
    • 5-6 NCS = 95909
    • 7-8 NCS = 95910
    • 9-10 NCS = 95911
    • 11-12 NCS = 95912
    • 13+ NCS = 95913

Evaluation and Management (E&M) codes

  • New patients
    • Straightforward – 10 minutes:  99201
    • Straightforward – 20 minutes:  99202
    • Low complexity – 30 minutes:  99203
    • Moderate complexity – 45 minutes:  99204
    • High complexity – 60 minutes:  99205
  • Established patients
    • Brief – 5 minutes:  99211
    • Straightforward – 10 minutes:  99212
    • Low complexity – 15 minutes:  99213
    • Moderate complexity – 25 minutes:  99214
    • High complexity – 40 minutes:  99215
  • Independent medical examination (IME):  99456

 

5 COMMENTS

  1. 2015 codes for TAP blocks, includes imaging guidance when performed

    64486 Transversus Abdominus plane (TAP) block unilateral, by injection
    64487 Transversus Abdominus plane (TAP) block unilateral, by continuous infusion
    64488 Transversus Abdominus plane (TAP) block bilateral, by injection
    64489 Transversus Abdominus plane (TAP) block bilateral, by continuous infusion

  2. Thank you so much for this information. This website has been a great resource for me. I did have a question though. Your “Reminder” paragraph at the top states you can not bill for fluoro with Interlaminar ESI, but in the ESI section it lists the fluoro CPT (77003). Can 77003 be used with 62310?

  3. how can i get the information or the updates that you post on the website?? or can i make an account on your website so any information or any new update i,ll receive on my email instead of visiting the website every time.

    • Asim, thanks for bringing this to my attention. My previous website version had this feature. I just added it back. On the bottom right of the homepage you can sign up to receive an email (I hope) when I update things.

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