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


  • 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


  • -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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  1. Kathryn Willard

    This is one of the best lists for these type of procedures I have been able to find. We are new to coding the Epidural Steroid Injections and we are trying to make sure we are charging all of the correct codes. Still a little iffy on the Fluoro-also, when to charge supply codes and when not to charge them separately.

  2. I disagree with you on the example given for NCV code.
    Example: Bilateral sensory and motor median and ulnar NCS is performed. This is four separate tests, so the proper code now is 95908.
    Since the studies were performed bilaterally, the correct should be 95910. Because bilateral testing is often necessary and therefore the nerves are counted separately. Since four tests are performed individually on each extremity, they should be added together to get the right code.

  3. Tonya Bedell

    Good afternoon,

    I have a pain doc that performed a common peroneal nerve block and need to know which would be the best code to bill. My research has brought me to 64450 but it does not look correct to me. Any help would be great!

  4. 2013 CPT coding

    Hi, recently my billing manager stopped billing 77002, 77003, 76000, 96360 for an epidural procedure. She said everything is all ‘bundled’ now as of new change in 2013 CPT coding. Is that true? I’m taking a hit in my RVU production. I need to clarify this.

    Also what code may I use for moderate sedation?

  5. Thank you Paul!

    Paul we have a mutual friend I believe, Azlan? Anyway, I am starting my pain practice and was trying to develop my own superbill. This is invaluable!! Thank you sooooo much!

  6. Need the CPT code for a saphenous nerve block. Some say use the 64447 as it is a branch of the femoral nerve other say use the 64450.
    Your opinion?
    Thank you

  7. What is the proper way of billing the levels? example
    Medial Branch block left c5, c6, c7, c8
    previously I would add all the levels in the computer and now the new biller wants the number of levels instead.

    thank you

    • That’s a simple 4-level MBB.

      64492 x 2 units

      • Thank you. I’d figured that, but they want me to list all the cpt codes like this.
        64490 left c5
        64491 left c6
        64492 left c7
        64492 left c8
        Can I even do it like this??
        This is how they want it listed in the system.

        • Sonia, I’m not sure how they are listed in a particular system, but from a physician procedure coding stand point, those are correct. Keep in mind that 64490 can be billed for any cervical facet injection or medial branch block level; so listing it as “64490 left c5” seems silly. Good luck.

          • I just wanted to point out about the codes referenced above…64492 cannot be billed more than once per day, per notation immediately beneath the code in the CPT book. This is also true for 64495 for the L/S levels. From my understanding, the RVU’s for these 2 codes were calculated to be slightly more than 64491/64494 to allow for the fact that they might cover more than 1 level, but in the cases studied before these coding changes were made, most MBB’s were performed at only 3 levels.

          • Meagan, I have a “note” under the facet injection/block codes that I think explains what you say above. Let me know if it is not already clearly stated and I’ll think about changing the wording.

  8. I work in a pain management office. for a medial branch block via RFA @ S1,S2,S3 I use codes 64635 and 64636×2. I was told to use 64640 instead?? Is this correct??
    Also when coding injections for an in-office procedure dont forget to code for the drug and contrast.

    • I have never performed sacral (SI joint) radiofrequency ablation of the lateral branch nerves. I do know that you can not use the 64635 and 64636 codes though. I’m not sure if 64640 is correct, but I do know many insurance companies will consider RFA of the SI joint experimental. Good luck. If you figure it out, please come back and update us.

      And yes, always remember the Q- & J-codes for contrast/steroids (I have those listed above under all the injections, and before the EMG/NCS)

  9. What about manual therapy codes following transdermal compound use.
    Mobilizations, soft tissue manual releases, accupuncture.

  10. Hi, I was wondering what the correct ICD 9 code would be for a sacrococcygeal joint radiofrequency would be. Any help would be appreciated.


    • I know some that are performing RFA at the L5 dorsal primary ramus, and then the lateral branches of S1, S2, S3.

      L5 is being billed as 64635
      S1, S2, and S3 are billed as 64640 (for each one).

      I haven’t done this yet, so I don’t know about denials, but the physician that told me said she hasn’t had any problems with it.

  11. Hey Everyone!
    So I am having this issue with a new(er) Neuropathy treatment using the 64450. I bill as follows:
    64450 LT 1 unit
    64450 59-51 4 units
    64450 RT 1 Unit
    64450 59-51 4 units
    Medicare is not paying a whole lot and when I spoke to them on the phone they recommended:
    64450 50 1 unit
    64450 50-59 4 units
    Still trying to figure out how to get the maximum amount I can get when I was billing originally for 10 units (5 each side) HELP!!!

  12. When coding Lumbar Radio frequency 64635,64636 on the add on coded 64636 do you use a modifier. I been getting Medicare denials for wrong modifier

  13. Help!!!!
    I’m new at pain management and I am trying to bill 3 level lumbar neuroplasty and I can’t the find the billing codes Can anyone help me. Thank you very much

    • Unfortunately, I’m not sure what you mean by “neuroplasty”. Do you mean “Epidural Adhesiolysis”? 62264 and 62263 are the codes for epidural adhesiolysis, but I don’t perform these so I really can’t help other than that. Good luck.

  14. What is the correct cpt code for ganglion impar nerve block for coccydynia? Much confusion about correct coding.

  15. Dr did a fluor guided contrast bilateral c2-3 and c3-4 facet injections and 3rd occipital nerve block. i have 64490(50),64491(50). how would I code for occipital nerve block?

    • We use the code 64450 (other peripheral nerve) for third occipital nerve (TON) blocks. More importantly than the actual joint, for medial branch blocks, you need to look at the actual medial branch nerves (facet nerves) that were blocks. For instance, did the physician block the TON, C3 and C4 nerves bilaterally; that’s what I’m getting from the question. In that case, you’re absolutely right about the 64490-50 and 64491-50. Sometimes insurances will deny the 64450 code, but I would give it a shot as it is anatomically needed in ordered to block the entire C2/3 facet joint.

  16. I just took over the billing and have a ton of rejects regarding the G0434 code for Medicare, any suggestions?

    • Sorry Olivia. Unfortunately I can’t help you there; we don’t do any in-office drug screens. We send everything out to be run.


      To bill medicare on the G0434 you have to have a QW modifier. You need to add to your claim the billing provider, supervising provider, ordering provider, referring provider and of course your facility name and CLIA waiver number. I had so much trouble getting medicare to pay on this code. Once you add all this information

  17. Vlada Frankenberger MD

    Can you please help me with the correct code for ganglion Impar Block
    under fluoro. Thanks in advance.

  18. how to bill code 64640 for S1, S2, S3 rfa?

  19. What is the correct cpt code and icd 9 code for piriformis injection and piriformis syndrome?

  20. Italo Alberti

    Hello. My name is Italo and I´m from Guatemala, Central America.
    We do not usually use CPT coding in Guatemala, but I am opening a Pain Management clinic and would like to use CPT coding in order to calculate an objective pricing on our services. Does anyone know where can I find a CPT coding guide for Pain Management that includes value units??
    Thank you so much for your help!!

    Kind regards.

  21. I’m getting denials from Medicare for code 64520, how should I be billing this? I’ve tried billing with -50 or with 2 units and its still getting denied. Please help.

    • I am getting denials from Medicare for this procedure as well and cannot figure out why. Modifier 50 is not applicable because the physician did just a unilateral procedure. I am going to file with a 59 modifier to see what happens.

  22. We will be doing medial branch blocks 64493 at the office with the C-arm and wanted to know how to bill the facility fees and the professional fees and the tray of instruments. We have never done this at the office before it’s going to be our first time and I do not know how to properly bill it. Thank you in advance for all of your help.

    • Sonata, there won’t be any facility fees when done in the clinic setting. Facility fees are for ASC or hospital procedures only. Instead, there is a single global fee that includes the instrument/supplies. The C-arm codes are also bundled with the facet medial branch blocks too. I have an article on my site that explains the coding/billing for MBBs and RFAs.

  23. Debi Madden

    We are getting payor path rejections beginning in 2015 when my pain management physician does a MBB followed by an RFA on one side, then goes back on a later date and does MBB followed by RFA on the contralateral side. The initial side is being paid with no problems; when I file for the contralateral side, I am getting rejections stating that the patient is in a global period for that service or test???? So if I file my initial MBB coding with RT or LT modifiers as appropriate, then the follow-up RFA with that RT/LT modifier, when I bill for contralateral side and use the other side modifiers, do we think that might solve this issue?? I am so confused! Again, this just started in 2015.

  24. Ray Parker

    Hi, I am working in a group for Anesthesiology – Pain Medicine, I observed that Medicare is not paying 77003 and 77002 separately, these services they always bundled with other services. My question is that is there any way to get payment for these services separately?

    Your prompt response will be appreciated.

  25. When Billing out a 64517 Humana is asking for an Anesthesia Code. Should this be billed along with 64505?

  26. Wendi Oliver

    Hello! I am having problems with some carriers refusing to pay for the U/S guidance for the piriformis injection. We use 20552 for injection and 76942 for u/s guidance. Even when appealed with office notes I am getting rejections. Any suggestions?

  27. Brittany

    Can you please help with what is the correct cpt code to bill chronic pain programs?

  28. Michelle

    HI Dr,
    Could you please help me why my billing INJ. code got denied as Quantative,Unit,Measure required even I had information at location box 19 (1500 CMS form). Please advice what I need to do to get pay on drug injection code
    J1030,j3490,j3420,j1020,j1885,j1040 etc…Thank You

  29. I am wondering what are the payable DX for CPT J0702 for Medicare billing?



  31. Crystal M

    I work for a large Orthopedic Group and one of the Dr’s I bill for provides Genicular Blocks to the knee. He uses CPT 64445, 64447, 64450 & 77002 when he does these procedures. Are you familiar with this “newer type” of procedure and if so do you have any insight to help me maximize his reimbursements? I’ve checked CMS website but they do not yet recognize “Genicular” nerves. Thank you in advance.

    • Everyone I know uses either 64447 (femoral nerve block) or 64450 (other peripheral nerve). The RFA of these genicular nerve branches would be 64640 for the first one, and 64640-59 for the second one.

      I haven’t started doing these yet, so I can’t comment with personal experience.

  32. Impar block ganglion ulnar nerve. Is there an billable code for workers’ comp?

  33. HI. I am performing lumbar medial branch blocks from L2-S1, 5 levels and billing for 4 levels. My billing department is telling me that I can only bill for 3. In the past I was adding 2 units to the 64495. In the 2015 CPT code book it states that 64495 can only be used once per day. Can you explain this please?

    medial branch block lumbar or sacral (1st level): 64493
    medial branch block (MBB) – lumbar or sacral (2nd level): 64494
    medial branch block (MBB) – lumbar or sacral (3rd level): 64495

  34. 1. When billing SCS trial with two leads, do you suggest 63650 for the first lead and 63650-59 for the second lead or do you use modifier 50 for bilateral?

    2. When billing piriformis and hip bursa injections performed under fluoro on the same day
    a. 20610 and 20552-59 and 77002
    b. 20552 and 20610-59 and 77002
    c. something else?

  35. The vertebroplasty and kyphoplasty codes need updating:

  36. Billing Trigger points and g.trochanter injection together? Will I be able to bill these procedures together? I also used fluro for needle guidance secondary to body habitus for the g.trochanter injection…

    I had talked to someone who felt I should do them on separate days… seems silly to me but reimbursement may not feel the same way…

  37. Anne Bunch, CPC, COC

    The medial branch joint stops at L5. S1-S4 are not part of the medial branch. To block these nerves code 64450(other peripheral nerve) is used. Same with RFA’s, except the S1-S4 is coded per nerve with 64640 with mod 59.

  38. Can we bill 77002 with 64450 g-block?

  39. Not sure if this blog is still active. I am trying to get reimbursed for disposable supply items used during esi and blocks. How is everyone doing it these days.


    I am billing for 3 ml of omnipaque Q9966 how many units do I bill?

  41. Jasmine Hiraldo

    on CPT code 20553, it is for 3 or more muscles, can this be billed as bilateral if it is for 3 muscles on left and 3 muscles on the right? Or do i just bill the 1 unit as the description says “3 or more muscles”

  42. Julie Thompson

    Since the description of 64421 is Intercostal nerves, multiple, regional block, can you multiple units be billed?

  43. Norrizan Yusof

    Radiofrequency denervation of cervical medial branches under fluoroscopic guidance – your website suggests 64633-64634.
    However, the CPT book state that for radiofrequency, it is 64999.

  44. Here’s s0me updated information for your site.

    This is from CPT Nov. 2015

    Surgery: Nervous System
    Question: When a physician injects the superior medial and lateral branches and inferior medial branches of the left genicular nerve, is code 64450 reported three times or just once for the left genicular nerve?

    Answer:It is appropriate to report code 64450, Injection, anesthetic agent; other peripheral nerve or branch, for the genicular nerve block of three branches of this nerve around the knee joint; however, code 64450 is reported just once during a session when performing the injection(s). Although one, two, or more injections may be required during the session, the code is reported only once, irrespective of the number of injections needed to block this nerve and its branches.

    This is from CPT June 2012
    Surgery: Nervous System

    Question:May code 64640 be reported for each individual peripheral neurolytic nerve destruction procedure performed at the L5, S1, S2, and S3 nerves?

    Answer: Yes. When performing individually separate nerve destruction, each peripheral nerve root neurolytic block is reported as destruction of a peripheral nerve, using code 64640, Destruction by neurolytic agent; other peripheral nerve or branch. In this instance, for peripheral nerve root neurolytic blocks (destruction) of L5, S1, S2, and S3, code 64640 should be reported four times. The coder should append modifier 59, Distinct Procedural Service, to the second and subsequent listings of code 64640 to separately identify these procedures.

    • Great information. I would argue that the first question/answer regarding the genicular nerve blocks is incorrectly worded. The physician isn’t injecting/blocking three branches of the genicular nerve, they are blocking three separate and distinct nerves. The superior lateral genicular nerve, the superior medial genicular nerve, and the inferior medial genicular nerve.

  45. The above is information is from CPT Assistant June 2012 and November 2015.

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