Overview
PM&R physicians commonly perform spinal interventions for pain management. Code selection hinges on three variables: approach (interlaminar vs. transforaminal vs. facet/MBB), region (cervical/thoracic vs. lumbar/sacral), and imaging guidance (required for most, but not all, code families).
Quick Decision Tree
- Medication into the epidural space, midline → Interlaminar ESI (62320–62323)
- Medication through the neural foramen, targeting a nerve root → Transforaminal ESI (64479–64484)
- Medication into/around the facet joint or its medial branch nerve → Facet joint injection / MBB (64490–64495)
- Thermal destruction of the medial branch nerve → RFA (64633–64636)
Interlaminar Epidural Steroid Injections (ESI)
Midline approach into the epidural space. Imaging guidance is billed separately as a distinct code pair — without vs. with fluoroscopy/CT.¹
| CPT | Description |
|---|---|
| 62320 | Interlaminar epidural/subarachnoid injection, cervical/thoracic; without imaging guidance |
| 62321 | Cervical/thoracic; with imaging guidance (fluoroscopy or CT) |
| 62322 | Interlaminar epidural/subarachnoid injection, lumbar/sacral (caudal); without imaging guidance |
| 62323 | Lumbar/sacral (caudal); with imaging guidance (fluoroscopy or CT) |
Bilateral Modifier Does NOT Apply
Transforaminal Epidural Injections
Needle placed through the neural foramen to target a specific nerve root — a distinct technique from interlaminar, and not interchangeable with it.³
| CPT | Description |
|---|---|
| 64479 | Transforaminal epidural, cervical/thoracic; single level |
| 64480 | Cervical/thoracic; each additional level (add-on) |
| 64483 | Transforaminal epidural, lumbar/sacral; single level |
| 64484 | Lumbar/sacral; each additional level (add-on) |
Bilateral IS Billable Here
Facet Joint Injections / Medial Branch Blocks (MBB)
Reported per level, per side, regardless of how many nerves or needle passes were required at that level.⁶
| CPT | Description |
|---|---|
| 64490 | Paravertebral facet (zygapophyseal) joint or nerve, cervical/thoracic; single level |
| 64491 | Cervical/thoracic; second level (add-on, bill with 64490) |
| 64492 | Cervical/thoracic; third and any additional level(s) (add-on, bill with 64490/64491) |
| 64493 | Paravertebral facet joint or nerve, lumbar/sacral; single level |
| 64494 | Lumbar/sacral; second level (add-on, bill with 64490 or 64493) |
| 64495 | Lumbar/sacral; third and any additional level(s) (add-on, bill with 64493/64494) |
Bilateral at One Level
Radiofrequency Ablation (RFA) — Thermal Facet Denervation
Reported per joint, not per nerve — even though 2 (cervical/thoracic) or 2–3 (lumbar) medial branch nerves typically innervate each joint.⁸
| CPT | Description |
|---|---|
| 64633 | Destruction by neurolytic agent, paravertebral facet joint nerve(s), cervical/thoracic; single facet joint |
| 64634 | Cervical/thoracic; each additional facet joint (add-on, bill with 64633) |
| 64635 | Lumbar/sacral; single facet joint |
| 64636 | Lumbar/sacral; each additional facet joint (add-on, bill with 64635) |
Non-Thermal Modalities Excluded
Documentation Requirements
Imaging Guidance
Fluoroscopy or CT is required for facet, RFA, and (per LCD) most interlaminar/transforaminal codes. Document:
- Approach (interlaminar / transforaminal / facet-MBB) and exact level(s)
- Imaging modality and contrast confirmation, if used
- Images saved to permanent record
- Laterality (unilateral/bilateral) and needle placement verification
Coding Tips
Level Counting
- Cervical: C1–C7 · Thoracic: T1–T12 · Lumbar: L1–L5 · Sacral: S1–S5
- T12-L1 counts as cervical/thoracic for anatomic-region purposes across all four families above.
Add-On Codes
- Cannot be billed alone — must accompany the correct primary code (see table pairings)
- No modifier --51 on add-on codes
- Multiple spinal regions same day may require modifier -59 or -XS
Session Limits (verify against Noridian JE/JF LCD — figures below reflect commonly cited MAC policy and may not match your jurisdiction)
- Interlaminar/transforaminal ESI: commonly capped at 4 sessions per spinal region per rolling 12 months across 62320–62323 and 64479–64484 combined¹⁰
- Facet/RFA diagnostic blocks: -KX modifier typically required to distinguish diagnostic vs. therapeutic use
Drug Billing
Steroids are billed separately with HCPCS J-codes:
- J3301: Triamcinolone acetonide (10mg)
- J1030: Methylprednisolone acetate (40mg)
- Use -JW modifier for wasted amount
1. AAPC Knowledge Center, "Capture Elements of Spinal Injections and Fluoroscopy" 2. Transcure, "Epidural Steroid Injection: CPT 62321 Billing Guide" (2026) 3. Pabau, "CPT Code 62321: Cervical/Thoracic Epidural Injection with Imaging" (2026) 4. CMS MCD Article A56681, "Epidural Steroid Injections for Pain Management" 5. OneOSeven RCM, "CPT Code 64483: 2026 Billing, Modifiers, and LCD Guide" 6. HIA, "CPT Coding for Paravertebral Facet Joint Injections – the Impact of Laterality" 7. BCBS TX, CPCP036 Paravertebral Facet Injection Procedure Billing 8. CMS MCD Article A57787 / A56670, "Facet Joint Interventions for Pain Management" 9. Stryker, "Radiofrequency Ablation" Reimbursement Guide (2024) 10. CMS MCD Article A58777, "Epidural Steroid Injections for Pain Management"