Billing and Coding: Facet Joint Interventions for Pain Management
A58350
This billing and coding policy governs CPT/HCPCS reporting for cervical/thoracic and lumbar/sacral facet joint interventions, specifying region- and level-based codes (e.g., 64490–64495 for paravertebral blocks and 64633–64636 for neurolytic/thermal denervation), image-guidance requirements (fluoroscopy or CT), and modifiers (e.g., -50 for bilateral, KX for diagnostic injections). It limits frequencies (maximum 1–2 levels per session per region; 64492/64495 once per day), disallows ultrasound guidance and routine moderate/deep sedation for injections, requires specific documentation (valid ICD-10, referring NPI when required, signed records, justification for therapeutic injections or sedation), and excludes non-covered uses such as CPT 64999 for non-thermal denervation and off-label biologic injections.
"Facet joint interventions (diagnostic paravertebral nerve block, therapeutic intra-articular facet injection, medial branch block, or medial branch radiofrequency ablation) are applicable for cervi..."