62320
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Medicare Pricing
Work RVU
1.76
Facility
$87.84
Non-Facility
$163.66
Documentation Required
- All documentation must be maintained in the patient's medical record, be legible, include complete patient identification and dates of service, and include the legible signature of the responsible physician or non-physician practitioner.
- The submitted medical record must support the selected ICD-10-CM code(s) and the submitted CPT/HCPCS code must accurately describe the service performed.
- Procedural reports for selective nerve root blocks (SNRBs) and TFESIs must document indications, medical necessity, and the baseline pain score.
- For SNRBs specifically, the procedural report must include baseline pain score, percent pain relief achieved immediately after injection, and retained films (minimum two views) documenting final needle position and contrast flow.
Key Coverage Criteria
- Epidural steroid injections (ESIs) are covered when performed as epidural injections in defined anatomic spinal regions: cervical/thoracic or lumbar/sacral using the listed epidural CPT codes.
- Epidural injections (CPT 62322-62327) used for cerebrospinal fluid flow imaging (cisternography, CPT 78630) are allowed and diagnosis code restrictions do not apply when billed on the same claim.
- Epidural injections (CPT 62321, 62323, 64479, 64480, 64483, 64484) used for postoperative pain management are allowed and diagnosis code restrictions do not apply.
- Epidural injection CPT 62323 is allowed when performed as an implantable infusion pump trial and diagnosis code restrictions do not apply.
- A transforaminal epidural steroid injection (TFESI) performed at the T12-L1 level should be reported with CPT 64479.
- Diagnostic selective nerve root block (DSNRB) is coded identically to an epidural injection and is allowable when properly identified with the -KX modifier.
20 Active Policies
L39054 — Epidural Steroid Injections for Pain Management
J05
A58777 — Billing and Coding: Epidural Steroid Injections for Pain Management
J05
L39036 — Epidural Steroid Injections for Pain Management
J06
A58745 — Billing and Coding: Epidural Steroid Injections for Pain Management
J06
Related Codes
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