64480
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Medicare Pricing
Work RVU
1.17
Facility
$53.11
Non-Facility
$142.96
Documentation Required
- All documentation must be maintained in the patient's medical record, be legible, include patient identifiers and dates of service, and be made available to the contractor upon request.
- The medical record must include the legible signature of the physician or non-physician practitioner responsible for the care and the submitted records must support the selected ICD-10-CM and CPT/HCPCS codes.
- Procedural reports for SNRBs and TFESIs must document indications, medical necessity, and baseline pain score; SNRBs must also document percent pain relief achieved immediately after the injection.
- Fluoroscopic/contrast films documenting final needle position and contrast flow (minimum two views) should be retained and made available upon request.
Key Coverage Criteria
- Epidural steroid injections (ESIs) for pain management are covered when reasonable and necessary per Local Coverage Determination L33906.
- Epidural injection CPT codes 62321, 62323, 64479, 64480, 64483 or 64484 used for postoperative acute post-thoracotomy pain (G89.12) or other acute postprocedural pain (G89.18) are exempt from the LCD diagnosis-code restrictions.
- Epidural injection CPT 62323 used as part of an implantable infusion pump trial for severe spasticity is adjudicated under NCD 280.14 and is exempt from the diagnosis-code restrictions in this article.
- Epidural injection CPT 62323 used for cerebrospinal fluid flow imaging (cisternography CPT 78630) is exempt from the diagnosis-code restrictions and should be billed on the same claim.
- Diagnostic selective nerve root blocks (DSNRBs) are coded identically to epidural injections and when performed on a transforaminal level (TFESI CPT 64479, 64480, 64483, 64484) the -KX modifier must be appended to distinguish DSNRB from therapeutic epidural injection.
- Epidural steroid injections (epidural injections only) are covered for pain management when reasonable and necessary per LCD L36920.
20 Active Policies
A58777 — Billing and Coding: Epidural Steroid Injections for Pain Management
J05
L39054 — 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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