CPT Codes

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

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