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 2017 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, genicular nerve blocks, and lateral branch blocks for the SI joints)
  • 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 (WITH fluoroscopic imaging)
    • Interlaminar – cervical or thoracic62321
    • Interlaminar – lumbar or sacral (caudal)62323
    • Remember: Fluoro can NOT be billed separately for these.
  • 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

Acupuncture

  • with electrical stimulation: 97813
  • without electric stimulation: 97810

Modalities

  • Diathermy (Microwave): 97024
  • Heating pads / cold packs: 97010
  • Self-care / home management training: 97535
  • Therapeutic ultrasound: 97035
  • Traction: 97012
  • Transcutaneous Electrical Nerve Stimulation (TENS): G0283

Osteopathic Manipulative Treatment

  • OMT 1-2 body regions: 98925
  • OMT 3-4 body regions: 98926
  • OMT 5-6 body regions: 98927
  • OMT 7-8 body regions: 98928
  • OMT 9-10 body regions: 98929
    (note from a reader: use 98928 or less if OMT done in conjunction with an injection and 98927 or less of OMT done in conjunction with epidural)

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

162 COMMENTS

  1. 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. 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. 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. 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

      • 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 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.

    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. 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. 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.

    • 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

  15. 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.

    • Sounds like you’re talking about medial branch blocks for the C-spine. C2/3, C3/4, C4/5, C5/6.

      I’d leave out the 64450. You’re probably trying that for the third occipital nerve which innervates the C2/3 facet joint. So along with the C3 medial branch nerve, it constitutes the 64490 charge.

  16. Is fluoroscopy included in nerve block injections? Or shoul I be using 77002? What about with stellate ganglion blokcs 64510 does it include fluoro? If it doesn’t would the fluoro code be 77002 or 77003?

  17. This is one of the best lists out there, and was wondering if this is going to be updated with the 2015 revised codes. Please and thank you !!

  18. I’m a certified coder of 20+ yrs but new to pain mgmt.
    I’ve been trying to look for some good coding courses that would help me with this challenging field.
    Any suggestions would be greatly appreciated!!
    Thank you.

    This article is one of the best things I’ve come across. Thank you so much. 🙂

  19. At the top of your web page it says, “These have all been updated for the most recent 2013 changes.” Well, it’s the end of 2014 & almost 2015, my question here is, How often does this get updated & where do you get your sources from? Just wondering, kind of like to know. I noticed nobody has ever or that I have seen asked that question. If you don’t mind letting us know please.

  20. 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.

  21. 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.

  22. 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.

  23. Hello: Need help in cpt code 27096, performed bilateral, UMWA paid in 2012, now they are asking for refund, unless I show the proof that 27096, 50 is approved by Medicare. How do I show the proof? I cold not find any CMS policy to prove this. Thank you

  24. Sacroiliac denervation. Right L4 medial branches L5 DPR & Right S1, S2, S3 lateral branches Radiofrequency lesioning. Only L5-1 and S1-4 were done as patient could not tolerate the procedure. How would you bill this to include all modifiers? Thank You.

  25. How would you code for Medial Nerve Branch Radiofrequency procedure using a Halyard (formerly Kimberly-Clark) Cooled Radiofrequency Pain Management RF generator?
    64635 or unlisted?

  26. 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.

  27. 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?

  28. 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. IS THERE A CPT CODE THAT I CAN ADD FOR MY DOCTOR WHO TREATS PAIN, WHEN HE GIVES OUT TWO OR THREE SCRIPTS.FOR EXAMPLE IF THE WRITES NORCOR AND THEN WRITES XANAX IS THERE A CPT CODE TO CHARGE FOR TWO SCRIPTS?

  30. 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.

  31. I am just wondering what code is used for injection of steroid/anesthetic in the joint between L5 transverse process and ilium or sacrum.

    Thanks.

  32. 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

  33. 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?

  34. Dr. Faubel,

    In your experience, is it appropriate for the physician or the facility to charge for moderate sedation services provided during interventional pain procedures? We are in a battle of the wills with our pain physician over this issue. He feels it is appropriate to use the 99144 code (which we understand that Medicare will not reimburse), while the facility would code using 99149. We do not want to double-bill the patient/payor. I’ve sounded other pain practices in my region, but all use anesthesia services rather than nurse-provided sedation. Thanks in advance.

    • Sorry, I don’t have a good answer for you. I don’t use conscious sedation except for spinal cord stimulator trials and kyphoplasties, and for these, an anesthesia group comes in to provide the sedation and bill separately.

  35. My CRPS/pain management neurology office started to no longer perform bilateral nerve blocks on the same day. I assume this is so they can bill separately and receive more money from Medicare. This practice seems unethical for multiple reasons, including requiring a patient to undergo sedation twice instead of once, which creates additional risk, as well as prolonging patients ‘ pain because they have to wait a week or more as these procedures are only done 1 day a week and appointments are limited, often increasing wait times therefore prolonging patient pain and suffering. Thank you for your time and knowledge in responding to a patient rather than a
    billing staff. I appreciate your timely answer as I receive regular, multiple sites blocks so this affects me imminently and greatly.

  36. My physician performed a Lg joint injection (20610/J0702), on this same day the patient was also seen for an EMG study (95912/95886) here in the office. We have billed the injection w/ a -59 and it was paid but the insurance has denied the EMG as “included in the Lg joint injection” and said cannot be billed/paid separately. What, if anything can I do to get this “unbundled” from the injection? Thank you in advance for your help!

  37. For the Genicular nerve block: 64450, would the units be the number of places the physician injects? or is it always X3 units? We are doing our first one and I wanted to make sure that we are billing it appropriately.

    • The units are billed per separate nerve injected. The standard is to block 3 separate nerves. The superior medial genicular nerve, superior lateral genicular nerve, and inferior medial genicular nerve. It’s NOT different parts of a single nerve, these are three separate nerves.

  38. When billing from an in-office based setting, can the supplies for the procedures, such as the needles and drugs for the conscious sedation be billed or are they bundled into the procedure codes?

  39. 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…

  40. 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.

  41. 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.

  42. 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”

  43. Hi,
    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. Is there an RF procedure of the sacrococcygeal joint. Performed a ganglion impar injection and interarticular SC injection with good relief. Pt with hx of RF procedure to the sacrococcygeal joint. Can’t find any information about this procedure or how it would be billed. Any information would be appreciated

  46. As of January 1st, 2017, the CPT codes have changed for ESIs

    New Codes:

    62320 – Injection(s), of diagnostic or therapeutic substance(s) (e.g., anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, including needle or catheter placement, interlaminar epidural or subarachnoid, cervical or thoracic, WITHOUT IMAGING GUIDANCE (previous code – 62310)

    62321 – WITH IMAGING GUIDANCE (i.e., fluoroscopy or CT)

    62322 – Injection(s), of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, including needle or catheter placement, interlaminar epidural or subarachnoid, lumbar or sacral (caudal), WITHOUT IMAGING GUIDANCE (previous code 62311)

    62323 – WITH IMAGING GUIDANCE (i.e., fluoroscopy or CT)

    62324 – Injection, including indwelling catheter placement, continuous infusion or intermittent bolus, of diagnostic or therapeutic substance(s) (e.g., anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, interlaminar epidural or subarachnoid, cervical or thoracic, WITHOUT IMAGING GUIDANCE (previous code 62318)

    62325 – WITH IMAGING GUIDANCE (i.e., fluoroscopy or CT)

    62326 – Injection, including indwelling catheter placement, continuous infusion or intermittent bolus, of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, interlaminar epidural or subarachnoid, lumbar or sacral (caudal), WITHOUT IMAGING GUIDANCE (previous code 62319)

    62327 – WITH IMAGING GUIDANCE (i.e., fluoroscopy or CT)

    Deleted Codes:

    62310 – Injection, single, of diagnostic or therapeutic substance(s) (including anesthetic, antispasmodic, opioid, steroid, other solution) not including neurolytic substances, including needle or catheter placement, includes contrast for localization when performed, epidural or subarachnoid; cervical or thoracic

    62311 – lumbar, sacral (caudal)

    62318 – Injection, including indwelling catheter placement, continuous infusion or intermittent bolus, of diagnostic or therapeutic substance(s) (including anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, includes contrast for localization when performed, epidural or subarachnoid, cervical or thoracic

    62319 – lumbar, sacral (caudal)

  47. Is there a CPT code to bill for reviewing Opioid risk screening tools/questionnaires like the COMM or the SOAPR-R, ORT, etc.?
    I have a rep that is selling a screening questionnaire stating they can get our practice 40 extra dollars per questionnaire. We are actually in the process of implementing this practice wide but we didn’t think we were going to get paid for it. Is this possible? If so, do you happen to know what the codes are and the process of billing to review the questionnaire?

  48. How do you code for migraine/cluster headache?
    Do you use 64400 and 64505 with 50 modifier?
    How do you appeal for denial?

  49. We have a pain clinic physician who is wanting to report the new CPT 64486 TAPS by single injection for chronic pain management of the transverse abdominus. Since 64486 seems to be indicated for post op pain management I believe that CPT 64450 injection other peripheral nerve would be a better choice.

  50. Thanks for the above information, it is fantastic! I am a physiatry resident and future pain management doc and find this extremely helpful.

    Can I suggest adding a two more categories of codes?

    First, Office Modalities:
    Acupuncture
    -with electrical stimulation: 97813
    -without electric stimulation: 97810
    Diathermy (Microwave): 97024
    Heating pads / cold packs: 97010
    Self-care / home management training: 97535
    Theurapeutic ultrasound: 97035
    Traction: 97012
    Transcutaneous Electrical Nerve Stimulation (TENS): G0283

    Second, for us D.O.’s, we do OMT = Osteopathic Manipulative Treatment:
    OMT 1-2 body regions: 98925
    OMT 3-4 body regions: 98926
    OMT 5-6 body regions: 98927
    OMT 7-8 body regions: 98928
    OMT 9-10 body regions: 98929
    (note: use 98928 or less if OMT done in conjunction with an injection and 98927 or less of OMT done in conjunction with epidural)

  51. Hi,
    My provider does Trigger point injections and uses the following verbiage…

    “then gave the patient trigger point injections in cervical paraspinous and trapezius region. I used dry needling technique with 25-gauge, 1.5-inch needle, and 1 mL of injectate was given at each level. Total injectate was 40 mg of preservative-free Kenalog, 4.5 mL of 0.25% Marcaine, and 4.5 mL of 2% lidocaine. Band-Aids were placed over all injectate sites. Patient was hemodynamically and neurologically intact upon discharge. Follow up in two months”

    When she refers to the dry needling technique does this change it from a 20552-20553 to an unlisted code?
    Thank you for your help!

  52. I have been diagnosed with occipital neuraglia ICD9 (723.8) & ICD10 (M53.82)
    I have received the nerve block injection: CPTcode 64405,77002,J1040,J34901PF1
    These injection give immediate relief therefore this is the correct diagnosis (after years of being treated for migraines)
    The insurance companies deem these CPT codes “medically unnecessary” so they do not pay for the injection…Any advice on how to get nerve blocks for the lesser and greater occipital nerve covered….thanks

  53. As of 01/01/2017, the ESI CPT codes have been updated as follows:
    62320 – Interlaminar epidural or subarachnoid, cervical or thoracic, without imaging guidance
    62321 – with imaging guidance (i.e. fluoroscopy or CT)
    62322 – Interlaminar epidural or subarachnoid, lumbar or sacral (caudal), without imaging guidance
    62323 – with imaging guidance (i.e. fluoroscopy or CT)

    If indwelling catheter placement is included in procedure, CPT codes are 62324-62327 for cervical and lumbar, with and without imaging guidance.
    *N0te: Do not report 62320-62327 with 77003, 77012, or 76942

  54. Cervical Epidurals have a new code as of 2017- 62321 with fluro
    Lumbar interlaminar/caudal – 62323 with fluro
    Your website should be updated

  55. Hi I’m new to pain management. I’m confused, are facet injections the same thing as medial branch blocks? I thought lumbar MBB codes were 64493, 64494, 64495, but I’m also seeing them listed as facet injection codes. My doc wants his pt pain free before she gets off the table. His plan is as follows: right L4/5 facet; then a right L4/5 mbb if that doesn’t work; and if neither of those work, then a LESI L4/5. I know the LESI code is 62323. Thanks for your help!

    • The codes for medial branch blocks and facet steroid injections is the same. The difference is that you need to block two medial branch nerves in order to kill the pain from one facet joint. So for the right L4/5 facet joint, he/she would have to block the L3 and L4 medial branch nerves on the right side. But regardless, this is billed as ONE facet joint, so just the 64493. You really can’t bill for two facet joints if the doctor does a medial branch block AND intraarticular facet joint steroid injection. It’s still just the 64493.

    • I’m not sure anyone would do a suprascapular nerve thermal RFA. Pulsed RFA is common for this nerve, but a thermal ablation would kill off the nerve supply to the supraspinatus and infraspinatus muscles causing wasting away. Pulsed RF is for pain management of should pain, but isn’t reimbursed by insurances. BUT, if the doctor is doing a true thermal suprascapular nerve RFA, the correct code would likely be 64640 (other peripheral nerve ablation).

  56. The CPT Codes for the interlaminar epidural steroid injection has changed in 2017. I think you should update it.
    CPT Code for interlaminar- cervical or thoracic: 62321
    CPT code for interlaminar- lumbar or sacral: 62323

    • Most people do the third occipital nerve RF in addition to the C3 facet joint medial branch RF and therefore bill for denervation of one cervical facet joint. 64633 would be the correct code. Otherwise, if you just do the TON, you could bill for a peripheral nerve RF 64640.

  57. Your 2015 coding sheet has been such a great resource for my staff…. would love to see a new updated PDF version with the 2017 coding changes.

  58. Different coding opinions from pro coders/hospital coders: Anterior scalene anesthetic injections . .most are for neurogenic thoracic outlet syndrome: . . .patient was placed in a supine position on the CAT scan table. After placement of an overlying skin marking device, limited axial images were obtained to select a trajectory into the anterior scalene muscle. Local anesthesia was achieved with bupivacaine. A 25-gauge needle was then placed into the skin and repeat imaging was obtained. There was significant patient movement between initial imaging and marking and a second location was marked and anesthetized. A 25-gauge needle was advanced with intermittent serial axial imaging into the anterior scalene muscle. Position was verified. 0.1 mL of diluted Omnipaque 180 (1:20 with normal saline) was injected via micro-tubing connected to the needle. Repeat imaging demonstrated good position of the contrast material. The intramuscular anesthetic was then slowly injected via micro-tubing connected to the needle. Repeat imaging demonstrated continued spread with good distribution of the contrast material.
    Intramuscular Anesthetic: 2 mL of 0.5% bupivacaine
    IMPRESSION. Left Anterior Scalene Anesthetic Injection

    Is this 64415 or 20552 –
     

  59. I have some serious confusion surrounding genicular nerve blocks, genicular RFA, and the use of flouroscopic guidance for the medial superior genicular nerve, lateral superior genicular nerve, and the medial inferior genicular nerve. We used to bill these codes with 3 units and then with CPT 77002 for flouroscopic guidance. Now, Medicare isn’t paying for the flouro when billed with 64450 or 64640. They used to pay it with a 59 modifier. My questions lies in what everyone else is seeing…..According to NCCI Edits that were published this year you can now only bill 1UOS for 64450:

    8. CPT codes 64400-64530 describe injection of anesthetic agent for diagnostic or therapeutic purposes, the codes being distinguished from one another by the named nerve and whether a single or continuous infusion by catheter is utilized. All injections into the nerve including branches described (named) by the code descriptor at a single patient encounter constitute a single unit of service(UOS). For example:
    (1) If a physician injects an anesthetic agent into multiple areas around the sciatic nerve at a single patient encounter, only one UOS of CPT code 64445 (injection, anesthetic agent; sciatic nerve, single) may be reported.
    (2) If a physician injects the superior medial and lateral branches and inferior medial branches of the left genicular nerve, only one UOS of CPT code 64450 (Injection, anesthetic agent; other peripheral nerve or branch) may be reported regardless of the number of injections needed to block this nerve and its branches.

  60. I am having difficulty in getting an actuate CPT code for a sacrococcygeal joint injection. My provider coded 20605, but the Dx code M53.3 will not support that code and he doesn’t agree with coding 62323, yes, the coccyx is a joint, however , in coding, I believe it is part of the spine, what is your recommendation?

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