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).
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
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.