Injection of anesthetic or steroid into a lumbar or sacral facet joint, or at the medial branch nerves supplying it, at one level with imaging guidance.
- Medicare
- $190.39
- Work RVU
- 1.48
- Global, days
- 0
- Region
- Spine
Documentation requirements
What must appear in the operative or office note to support the claim.
Source · Editorial brief grounded in 3 cited references ↓
- Level, side, and target (joint or medial branch)
- Diagnostic versus therapeutic intent
- Pain duration of three months or more and conservative care tried
- Exam findings pointing to facet pain, with no radicular findings that explain it
- Imaging guidance with saved image
- Pre and post procedure pain scores for diagnostic blocks
Applicable modifiers
Modifiers commonly billed with this code.
Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual
What this code covers
Source · Editorial summary grounded in 3 cited references ↓
64493 is the primary code for the first lumbar or sacral facet level, whether the injection goes into the joint or onto the medial branches. Fluoroscopic or CT guidance is included. L4-5 and L5-S1 are the usual targets.
Ortho spine practices order these to sort out axial low back pain before a decision on radiofrequency ablation or fusion. A patient with pain on extension and rotation, normal neuro exam, and facet arthropathy on MRI is the typical case. Bilateral at one level is a single line with modifier 50. Second and third levels go to 64494 and 64495.
Medicare facet LCDs drive most denials: pain for at least three months, failed conservative treatment, no radiculopathy explaining the pain, and limits on how many sessions a region can get per year. Diagnostic blocks need recorded pain scores so that the follow-up RFA can meet the relief threshold. Do not bill a same-day lumbar epidural in the same region without a payer-accepted reason.
RVU & reimbursement
Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.
Source · CMS Physician Fee Schedule, RVU26A · January 2026
Work RVU vs. total RVU
The work RVU (1.48) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (5.7) adds practice overhead and malpractice, and is what drives the Medicare payment below.
| Work RVU | 1.48 |
| Practice expense RVU | 4.08 |
| Malpractice RVU | 0.14 |
| Total RVU | 5.7 |
| Medicare national rate | $190.39 |
| Global period | 0 days |
Payment by site of service
Medicare pays different rates by setting. HOPD typically pays substantially more than ASC for the same procedure.
Source · CMS OPPS Addendum B·ASC HCPCS payment rates·2026
| Setting | Medicare rate (national) |
|---|---|
Office (PFS non-facility) Procedure performed in physician's office | $190.39 |
HOPD (APC 5443) Hospital outpatient department | $903.63 |
ASC (PI G2) Ambulatory surgical center (freestanding) | $485.51 |
Common denial reasons
The recurring reasons claims for CPT 64493 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Session frequency limit for the lumbar region exceeded
- Conservative care not documented
- Fluoroscopy billed separately
- Radiculopathy diagnosis paired with a facet injection
- Same-day epidural in the same region without support
- Bilateral reported as two units
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 3 cited references ↓
01What is the difference between 64493 and 64483?
02How do you bill bilateral L4-5 facet injections?
03Is imaging guidance billable with 64493?
04How often can lumbar facet injections be repeated for Medicare?
Sources & references
Editorial content was developed using the following public sources.
Mira Scribe
Mira Scribe notes capture the axial pain pattern, the failed conservative treatment, and the block response, so the lumbar facet claim and any later RFA hold up under review.
See how Mira captures CPT 64493 documentation