Add-on for a second lumbar or sacral facet joint or medial branch level injected during the same session, with imaging guidance included.
- Medicare
- $95.86
- Work RVU
- 0.98
- Global, days
- 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 ↓
- Both levels named by joint
- Side of each level
- Intent of the block
- Imaging guidance with saved images
- Pain scores before and after
- Medication and volume at each level
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 ↓
64494 adds the second lumbar or sacral facet level to 64493. It is reported once per session, carries a ZZZ global, and is not paid on its own.
The classic use is a two-level diagnostic medial branch block at L4-5 and L5-S1 before lumbar RFA. If both levels are done bilaterally, 64493 and 64494 each get modifier 50. Coders sometimes bill 64494 with two units for a bilateral second level, and that triggers a units denial.
Medicare facet LCDs cap levels per session, so for most Medicare lumbar sessions 64494 is the last line that pays. Keep the levels in the note consistent with the levels on the RFA order. If the blocks were at L4-5 and L5-S1, the RFA should be at the same joints, or the RFA claim will be questioned.
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 (0.98) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (2.87) adds practice overhead and malpractice, and is what drives the Medicare payment below.
| Work RVU | 0.98 |
| Practice expense RVU | 1.81 |
| Malpractice RVU | 0.08 |
| Total RVU | 2.87 |
| Medicare national rate | $95.86 |
| Global period | 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 | $95.86 |
Common denial reasons
The recurring reasons claims for CPT 64494 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Missing 64493 on the same claim
- Two units billed for bilateral
- Region frequency limit exceeded
- Levels inconsistent with prior diagnostic blocks
- Conservative care not documented
- Imaging guidance billed separately
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 3 cited references ↓
01Is 64494 billed per side or per level?
02Can a lumbar facet injection and a transforaminal epidural be billed on the same day?
03What is the primary code for 64494?
Sources & references
Editorial content was developed using the following public sources.
Mira Scribe
Mira Scribe notes keep the injected levels and response consistent from block to RFA, which is where lumbar facet claims usually get tripped up.
See how Mira captures CPT 64494 documentation