CPT code and description
64479 - Injection, anesthetic agent and/or steroid, transforaminal epidural; Cervical or Thoracic, single level
64480 - Cervical or Thoracic, each additional level
64483 - Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with imaging guidance (fluoroscopy or CT); lumbar or sacral, single level - average fee amount - $220 - $230
64484 – Lumbar or Sacral, each additional level
Whether a transforaminal epidural injection is performed unilaterally or bilaterally at one vertebral level, use CPT code 64479 or 64483 for the first level injected. If a second level is injected unilaterally or bilaterally, use CPT code 64480 or 64484.
Explanation of Revision: Annual 2011 HCPCS Update. Revised descriptors for CPT codes 64479, 64480, 64483 and 64484 in LCD. The effective date of this revision is based on date of service.
Coverage Indications, Limitations, and/or Medical Necessity
Epidural injections are used for the treatment of multiple different conditions in chronic and acute pain. Epidural injections may be used for therapeutic and/or diagnostic purposes. There are multiple approaches to epidural injections including caudal, translaminar, and transforaminal. These different approaches are used for different but specific indications. (In general it is felt that the closer the injection can be placed to the pathology the more likely to achieve a beneficial response). Correct placement is best confirmed by using fluoroscopic guidance and injection of contrast.
Epidural injections and/or infusions will be considered medically reasonable and necessary for the following conditions:
1. Management of pain caused by intervertebral disc disease with or without myelopathy.
2. Management of pain caused by spinal stenosis.
3. Management of intractable radicular pain due to postlaminectomy syndrome/failed back syndrome.
4. Management of intractable pain due to complex regional pain syndrome.
5. Management of intractable pain due to post herpetic neuralgia and acute herpes zoster.
6. Management of intractable pain due to traumatic neuropathy of the spinal nerve roots.
7. Management of intractable and severe pain secondary to neuropathy from other causes (e.g., diabetic or metabolic).
8. Management of severe, intractable pain in patients with advanced stages of cancer with estimated life expectancy of 4 months or less.
9. Management of pain caused by radiculitis (inflammation of the nerve roots).
Low back pain may also be produced by “Myofascial Pain Syndrome” in which case there is not nerve root pathology and epidural injections are not reasonable and necessary. If there is a doubt in the differential diagnosis, the diagnosis of radiculopathy can be confirmed by an EMG/nerve conduction/small fiber testing or appropriate radiological study. Degenerative Disk Disease without root compression has been shown to be a significant cause of low back and/or radicular pain; some patients will respond to Epidural Steroid Injection in this situation.
Epidural injections, with the exception of interlaminar injections, should be performed under fluoroscopic or CT-guided imaging. Therefore, injections for chronic pain performed without imaging guidance are considered not medically reasonable or necessary.
CPT/HCPCS Codes
For Single Injection Group 1 Codes
62310Inject spine cerv/thoracic
62311Inject spine lumbar/sacral
For Transforaminal Epidural Injections Group 2 Codes
64479Inj foramen epidural c/t
64480Inj foramen epidural add-on
64483Inj foramen epidural l/s
64484Inj foramen epidural add-on
64479 - Injection, anesthetic agent and/or steroid, transforaminal epidural; Cervical or Thoracic, single level
64480 - Cervical or Thoracic, each additional level
64483 - Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with imaging guidance (fluoroscopy or CT); lumbar or sacral, single level - average fee amount - $220 - $230
64484 – Lumbar or Sacral, each additional level
Whether a transforaminal epidural injection is performed unilaterally or bilaterally at one vertebral level, use CPT code 64479 or 64483 for the first level injected. If a second level is injected unilaterally or bilaterally, use CPT code 64480 or 64484.
Explanation of Revision: Annual 2011 HCPCS Update. Revised descriptors for CPT codes 64479, 64480, 64483 and 64484 in LCD. The effective date of this revision is based on date of service.
Coverage Indications, Limitations, and/or Medical Necessity
Epidural injections are used for the treatment of multiple different conditions in chronic and acute pain. Epidural injections may be used for therapeutic and/or diagnostic purposes. There are multiple approaches to epidural injections including caudal, translaminar, and transforaminal. These different approaches are used for different but specific indications. (In general it is felt that the closer the injection can be placed to the pathology the more likely to achieve a beneficial response). Correct placement is best confirmed by using fluoroscopic guidance and injection of contrast.
Epidural injections and/or infusions will be considered medically reasonable and necessary for the following conditions:
1. Management of pain caused by intervertebral disc disease with or without myelopathy.
2. Management of pain caused by spinal stenosis.
3. Management of intractable radicular pain due to postlaminectomy syndrome/failed back syndrome.
4. Management of intractable pain due to complex regional pain syndrome.
5. Management of intractable pain due to post herpetic neuralgia and acute herpes zoster.
6. Management of intractable pain due to traumatic neuropathy of the spinal nerve roots.
7. Management of intractable and severe pain secondary to neuropathy from other causes (e.g., diabetic or metabolic).
8. Management of severe, intractable pain in patients with advanced stages of cancer with estimated life expectancy of 4 months or less.
9. Management of pain caused by radiculitis (inflammation of the nerve roots).
Low back pain may also be produced by “Myofascial Pain Syndrome” in which case there is not nerve root pathology and epidural injections are not reasonable and necessary. If there is a doubt in the differential diagnosis, the diagnosis of radiculopathy can be confirmed by an EMG/nerve conduction/small fiber testing or appropriate radiological study. Degenerative Disk Disease without root compression has been shown to be a significant cause of low back and/or radicular pain; some patients will respond to Epidural Steroid Injection in this situation.
Epidural injections, with the exception of interlaminar injections, should be performed under fluoroscopic or CT-guided imaging. Therefore, injections for chronic pain performed without imaging guidance are considered not medically reasonable or necessary.
CPT/HCPCS Codes
For Single Injection Group 1 Codes
62310Inject spine cerv/thoracic
62311Inject spine lumbar/sacral
For Transforaminal Epidural Injections Group 2 Codes
64479Inj foramen epidural c/t
64480Inj foramen epidural add-on
64483Inj foramen epidural l/s
64484Inj foramen epidural add-on
Introduction/Injection of Anesthetic Agent (Nerve Bock), Diagnostic or Therapeutic
Fluoroscopic and computed tomographic (CT) guidance will be bundled into the 2011 editorially revised transforaminal epidural anesthetic and/or steroid injection codes 64479, 64480, 64483, 64484, as either fluoroscopic or CT guidance is required to perform these injections.
Note that ultrasound guidance is not included in the descriptor for codes 64479-64484; therefore, if ultrasound-guidance is used in place of fluoroscopic or CT guidance, one of the newly created Category III bundled ultrasound-guided transforaminal epidural injection procedure codes, 0228T- 0231T, should be reported as of January 1, 2011. Similar to the fluoroscopy and CT-guided paravertebral facet joint injection codes created in 2010, these codes are reported per level. If multiple injections are performed at a single level on the same side, the code should only be reported once.
Transforaminal Epidural Injection of Anesthetic Agent and/or Steroid (includes fluoroscopy or CT imaging guidance)*
Fluoroscopic or CT Guidance Ultrasound Guidance
Lumbar or Sacral 64483 0230T
Bundling Issues with ESI Procedures
The 64479 code is Unbundled in the CCI Edits from code 62310 (Regular ESI procedure) in the Mutually Exclusive Table of the CCI Unbundling Material. Code 64483 is Unbundled from code 62311 (Regular ESI procedure) in the Mutually Exclusive Table of the CCI Unbundling Material. Therefore, for Medicare and other payors who observe the CCI edits, these codes are not billable together when they are performed at the SAME spinal area. If the physician does an ESI (62311) at level L5 and a Transforaminal ESI (64483) at area L4-5, the procedures are Unbundled and not both billable – only code 62311 would be billable in that case. However, if the physician does an ESI (62311) at level L5 and a Transforaminal ESI (64483) at area L3-4, then it is allowable to put a -59 Modifier on the 64483 code and bill it as the 2nd code following the 62311 ESI code on the claim form.