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64493 CPT Code: Lumbar Facet Joint Injection Rules

Last Updated: February 14, 2026

CPT 64493 represents an injection into a lumbar or sacral facet joint (or facet joint nerve). This code has seen significant Medicare scrutiny and requires exact adherence to Local Coverage Determinations (LCDs).

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2026 Medicare National Fee (64493): Non-Facility (Office): $248.27 · Facility (Hospital): $94.73
✓ 26 Medicare-Approved ICD-10 Diagnoses on file for 64493:

Imaging is Mandatory

The AMA defines 64493 as explicitly requiring imaging guidance (fluoroscopy or CT). If the physician performs a facet joint injection without imaging, or uses ultrasound guidance, you CANNOT bill 64493. You must use the unlisted code 64999 or 0216T for ultrasound.

Billing Multiple Levels

64493 covers the first level injected. If additional levels are injected, use add-on codes:

  • 64494: Second level
  • 64495: Third and any additional levels (max 1 unit)

NCCI Edits

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Not sure if these codes bundle? Check the latest Medicare NCCI database updates before you bill.

Medicare strictly limits facet joint interventions to a specific number of sessions per year (often 3 or 4). Check your LCD to avoid frequency denials.

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