CPT code 64493: Lumbar or sacral facet joint injection

CPT code 64493 is used to report the first level of a lumbar or sacral facet joint injection, while CPT code 64494 is used to report the second level injected during the same session. If more than two levels are treated, CPT 64495 is used for the third and any additional levels.

When performing a bilateral facet joint injection at the same spinal level, you should report CPT 64493 with modifier 50 (bilateral procedure) or submit the code on two lines with RT and LT modifiers, depending on the payer’s preference. Be sure to document the medical necessity for treating both sides and check with your Medicare Administrative Contractor for specific billing requirements.

CPT code 64999 is an unlisted procedure code for the nervous system, used when no specific CPT code applies. Medicare may cover 64999 when supported by thorough documentation, a clear description of the procedure performed, and an appropriate comparison to an existing payable code—but prior authorization or further review is often required.