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 2013 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 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, and 77003 for spinal) for interlaminar ESI and 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

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 third occipital nerve blocks [TON block] and superior cluneal 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:  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 sacral62311
    • 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 or site):  64490
    • Intraarticular joint or medial branch block (MBB) – cervical or thoracic (2nd level or site):  64491
    • Intraarticular joint or medial branch block (MBB) – cervical or thoracic (3rd level or site):  64492
    • Intraarticular joint or medial branch block (MBB) – lumbar or sacral (1st level or site):  64493
    • Intraarticular joint or medial branch block (MBB) – lumbar or sacral (2nd level or site):  64494
    • Intraarticular joint or medial branch block (MBB) – lumbar or sacral (3rd level or site):  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.
    • Ex:  Bilateral L3, L4, L5 MBBs would be billed as 64493 -50, 64494 -50, and 64495 -50.
    • Note:  Many use 64450 (other peripheral nerve) for third occipital nerve (TON) blocks.
    • 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 – Thoracic (1st level):  22520
    • Vertebroplasty – Thoracic (each additional level):  22522
    • Vertebroplasty – Lumbar (1st level):  22521
    • Vertebroplasty – Lumbar (each additional level):  22522
    • Note:  Same charge whether you perform unilateral or bilateral injection of cement (PMMA).
  • Kyphoplasty
    • Kyphoplasty – Thoracic (1st level):  22523
    • Kyphoplasty – Thoracic (each additional level):  22525
    • Kyphoplasty – Lumbar (1st level):  22524
    • Kyphoplasty – Lumbar (each additional level):  22525
  • Fluoroscopic guidance (radiologic supervision & interpretation) for vertebroplasty or kyphoplasty:  72291
  • Under CT guidance:  72292
  • 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) [I have used this for hip or epidural injections that the patient didn't tolerate and so it wasn't completed]
  • -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

 

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40 Comments

  1. Kathryn Willard says:

    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. Nidhi M says:

    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 says:

    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!
    Thanks,

  4. 2013 CPT coding says:

    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! says:

    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. JSMITH says:

    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. Sonia says:

    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.

      64490
      64491
      64492 x 2 units

      • Sonia says:

        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

        • 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.

          • Meagan S says:

            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. Annie says:

    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. tp says:

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

  10. Lori says:

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

    Thanks!

    • 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. Matthew says:

    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. Liz says:

    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. elizabeth says:

    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. Daniel K says:

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

  15. LISA says:

    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. olivia says:

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

  17. Vlada Frankenberger MD says:

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

  18. ANNIE says:

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

  19. Gail says:

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

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