separately in addition to the code for primary procedure, which is an
add-on code for an injection at a level subsequent to the first level per-
formed).
• 0230T. Single level lumbar or sacral injections.
• 0231T. Each additional level lumbar or sacral injection (list sepa-
rately in addition to the code for primary procedure, which is an add-
on code for an injection at a level subsequent to the first level per-
formed).
Facet joint nerve injections
Facet injections, also referred to as medial branch blocks, involve the
physician placing the spinal needle at the medial branch nerve of the
facet joint (the cervical or thoracic areas), which is smaller than the
lumbar area, making the cervical and thoracic procedure a higher risk
than those performed in the lumbar area. Codes 64490-64495 are uni-
lateral procedure codes; if the procedure is performed bilaterally, you
need to bill in a bilateral manner by appending either the -RT/-LT or
the -50 modifier (usually not for use on Medicare claims).
The codes for these procedures have a different code for each level
billed. The last code allowable for each spinal area (for example, cer-
vical or lumbar) is for the 3rd level and the code states that it "cannot
be billed more than once per day," which in CPT rules means you can
only bill a maximum of 3 levels. So, if the physician performs facet
injections at a 4th level or beyond, there is no code for those levels
and they are not billable. While the direction in the CPT book is to use
the -50 modifier if these procedures are performed bilaterally,
Coding & Billing
CB
3 8 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • N O V E M B E R 2 0 1 6
Imaging is not separately billable on
most pain procedures, so don't unbundle it.
