Reimbursement
$88.51
Threshold
N/A
2026 Status
Active
What is CPT Code 64490?
CPT 64490 is defined as: Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), cervical or thoracic; single level. This procedure is used to manage neck or upper back pain originating from the facet joints.
This code is primarily used for Specialist services. It falls under the category of Interventional Pain Management and is valid for the 2026 calendar year according to the CMS Physician Fee Schedule.
2026 RVU Components
Relative Value Units (Non-Facility)
Work RVU
1.4
Physician Effort
PE (Non-Fac)
1.1
Practice Expense
Malpractice
Risk Factor
Total RVU
2.65
Note: [(Work RVU * Work GPCI) + (PE RVU * PE GPCI) + (MP RVU * MP GPCI)] * Conversion Factor
2026 CMS Policy Intelligence
site of service differential
Aggressive redistribution: Office rate increases by 11% while facility rate decreases by 7%, creating a ~$111 spread per level.
migration incentive
Huge economic pressure to move procedures from institutional settings (HOPD/ASC) to office-based suites.
imaging standard
Guidance is assumed part of the work and PE for 64490; ultrasound alternatives require Category III codes (0213T/0214T).
Administrative Framework
Global Period
000
Place of Service
NCCI Exclusions
Key Modifiers
Operational Requirements
minimum time
Procedure-based
staff type
Physician (Anesthesiology, PM&R, etc.)
frequency
NCCI strictly limits facet injections to 3 levels per session.
add on codes
64491 (Second level), 64492 (Third level)
imaging bundling
Fluoroscopy or CT guidance is bundled into 64490. Separate billing of guidance codes (77003/77012) is prohibited.
Compliance Checklist
Audit Defense
No specific audit defense elements defined.
Common Clinical Scenarios
CMS Eligibility: Cervical or thoracic facet joint pain.. Chronic pain refractory to conservative management.
Target Specialties & Utilization
Typical Clinical Indications (ICD-10)
Billing Differentiation
VS 64493
64493 is for the Lumbar/Sacral region; 64490 is Cervical/Thoracic.
VS MBB
Medial Branch Blocks (MBB) use the same codes as facet joint injections in this category.
Frequently Asked Questions
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