Does 64484 require prior authorization?

No, 64484 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 64484?

Medicare facility rate: $43.76. Non-facility rate: $117.57. Work RVU: 0.98.

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

0.98

Facility

$43.76

Non-Facility

$117.57

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.

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.

A58777 — Billing and Coding: Epidural Steroid Injections for Pain Management

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L39054 — Epidural Steroid Injections for Pain Management

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A58745 — Billing and Coding: Epidural Steroid Injections for Pain Management

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L39036 — Epidural Steroid Injections for Pain Management

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Ask Verity about documentation requirements, denial risks, or coverage in your state.