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)
- 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])
- 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 thoracic: 62310
- Interlaminar – lumbar or sacral: 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 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.
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: 77291
- Under CT guidance: 72292
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.
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
Injectables (J-codes)
- Omnipaque 300 (per ml): Q9967
- 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
- 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
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 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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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.
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.
You are absolutely correct. Thanks for pointing out my miscalculation. It is indeed 8 nerves, so 95910 is correct. I have made the correction above.
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,
That is the one I would use as well.
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?
You can still use 77003 for interlaminar ESI, but not for transforaminal ESI. 77002 can still be billed for non-spinal fluoro use, such as for hips, knees, shoulders, trochanteric bursa, etc.
I have never used 76000 or 96360.
Moderate sedation CPT codes are listed above in the post, but I have never used them b/c I use local instead.
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!
Chris, I just got off the phone with my friend Paul. Please forgive the mistake….omg!
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
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
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.
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)