Paravertebral Joint/Nerve Blocks - Diagnostic and Therapeutic

by  Find-A-Code
January 29th, 2018

According to Medicare article A50443, a facet joint level refers to the zygapophyseal joint or the two medial branch nerves innervating that zygapophyseal joint. 

Use CPT codes 64491 and 64492 in conjunction with 64490. Do not report CPT code 64492 more than once per day. Use CPT codes 64494 and 64495 in conjunction with 64493. Do not report CPT code 64495 more than once per day. For injection of the T12-L1 joint, or nerves innervating that joint, use 64493. 

The CPT codes 64490 and 64493 have a bilateral surgery indicator of "1." Thus, they are considered "unilateral" procedures and the 150% payment adjustment for the bilateral procedures applies.

• When injecting a facet joint/nerve bilaterally, file with modifier –50.
• When injecting a facet joint/nerve unilaterally, file the appropriate anatomic modifier –LT or –RT.
• Only one (1) unit of service (equals one bilateral injection or one unilateral injection) should be submitted for a unilateral or bilateral paravertebral facet joint/nerve injection.

Whether a paravertebral facet joint/nerve block is performed unilaterally or bilaterally at one vertebral level, use CPT code 64490 or 64493 for the first level injected. If a second, third or any additional level is injected unilaterally or bilaterally, use CPT codes 64491, 64492, 64494 or 64495.

• Facet joint levels refer to the joints that are blocked and not the number of medial nerve branches that innervate them. The CPT codes 64490 and 64493 are intended to be used to report all of the nerves that innervate the first paravertebral facet joint level injected and not each nerve. CPT codes 64491, 64492, 64494 or 64495 are intended to report each additional paravertebral facet joint level and not each additional nerve.

References:

• A50443