62322
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Medicare Pricing
Work RVU
1.51
Facility
$74.15
Non-Facility
$145.63
Documentation Required
- All documentation must be maintained in the patient's medical record, be legible, include patient identification and dates of service, and be made available to the contractor upon request.
- Every record page must include the legible signature of the physician or non-physician practitioner responsible for the care and be signed and dated.
- The submitted medical record must support the selected ICD-10-CM diagnosis code(s) and the submitted CPT/HCPCS code must accurately describe the service performed.
- For selective nerve root blocks (SNRBs) and transforaminal epidural steroid injections (TFESIs) the procedural report must document indications, medical necessity, and the baseline pain score; for SNRBs also document percent pain relief immediately after injection.
Key Coverage Criteria
- Epidural steroid injections (epidural injections) are covered when reasonable and necessary per the associated Local Coverage Determination (LCD).
- Epidural injections (CPT 62322-62327) used for cerebrospinal fluid flow imaging/cisternography (CPT 78630) are allowed and the LCD diagnosis code restrictions do not apply; bill both services on the same claim.
- Epidural injections (CPT 62321, 62323, 64479, 64480, 64483, 64484) used for postoperative pain management are allowed and the LCD diagnosis code restrictions do not apply.
- Epidural injection CPT 62323 used for an implantable infusion pump trial is allowed and the LCD diagnosis code restrictions do not apply.
- A diagnostic selective nerve root block (DSNRB) is coded identically to an epidural injection but should have the -KX modifier appended to distinguish it for billing purposes.
- Epidural steroid injections (epidural injections) are covered for pain management when reasonable and necessary per LCD L39054.
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
Have a follow-up question?
Ask Verity about documentation requirements, denial risks, or coverage in your state.