(2023) CPT Code 64483 | Description, Guidelines, Modifiers, Reimbursement & Examples
CPT code 64483 will be reported for service when the physician administers an anesthetic agent and/or a long-acting corticosteroid into the epidural space using a transforaminal approach.
Description Of The 64483 CPT Code
The patient under sedation and can awake during the procedure is placed in the prone position on the procedure table, and the administration site is sanitized with antiseptics (iodine or chlorhexidine).
A small gauge needle is introduced through the skin into the epidural space through the bony opening of the exiting nerve root. This service usually treats lumbar disk displacement, degeneration, protrusions, stenosis, and radiculopathy.
The radiologic or imaging guidance is included in the CPT code 64483 and would not be reported separately. It can be performed on multiple levels on the same date of service.
The first level will be reported by CPT code 64483, and each subsequent level will be reported by CPT 64484. There are separate CPT codes, 64479 and 64480, for cervical or thoracic regions, including the T12-L1 level.
The first level will be reported with CPT code 64479, and each additional level will be billed with CPT 64480.
CPT code 64483 will be reported for service when the physician injects an anesthetic agent(s), steroid, and/or injection(s) transforaminal epidural with imaging guidance (CT or Fluoroscopy) to the Lumbar or sacral region on a single level.
64484 CPT code will be reported for service when the physician injects an anesthetic agent(s), steroid, and/or injection(s) transforaminal epidural with imaging guidance (CT or Fluoroscopy) to the Lumbar or sacral region on each additional level.
Does CPT Code 64483 Need A Modifier?
Yes, CPT code 64483 can be billed with a modifier. The following is the list of modifiers.
Modifier 50 will apply to CPT 64483 when injection or any anesthetic substance is administrated bilaterally.
For instance, the patient was seen for an epidural injection due to lower back pain in the L2 vertebrae on both the left and right sides. Then it would be reported like 64483-50, M54.50.
Modifier 23 is applicable with the 64483 CPT code if general or local anesthesia is given to patients who are usually not required for the procedure.
Modifier 76 will be attached to CPT code 64483 if the service is repeated by the same physician on the same date of service, while modifier 77 will be if the procedure has been done on the same date of service by a different physician, respectively.
Modifier 78 will be appended with CPT code 64483 if the procedure is repeated with the exact condition of the global period. In contrast, modifier 79 is applicable when the procedure is reported for an unrelated condition.
Modifier 59 applies with the 64483 CPT code if any other procedure is done in combination with these services that are generally not billed together on the same service date.
For example, modifier 59 will be appropriate, or service is performed on the distinct region on the same day, e.g., the physician has administrated injection on lumbar region L3 vertebrae and thoracic region T3 vertebrae.
Modifier 53 will be reported with CPT code 64483 if injection administration of an anesthetic agent to the lumbar or sacral region is unsuccessful due to unavoidable circumstances like allergic reactions to the substance.
Reimbursement
A maximum of 1 and 4 units of 64483 CPT code and 64484 can be billed on the same service date, respectively, while 2 and 3 units can be billed when documentation supports the medical necessity of CPT code 64483.
When performed in the facility, the cost and RUVS of CPT 64483 will be $121 and 3.50978. At the same time, non-facility will be $291.43 and 8.42128, respectively.
Each additional level injection administrated to the Lumbar or sacral region will be reported with CPT code 64484. When performed in the facility, the cost and RUVS of CPT 64484 will be $55.56 and 1.60545, respectively.
At the same time, non-facility will be $131.19 and 3.79095, respectively.
CPT codes 64483 and 64484 will be billed on the same day of the surgical procedure when the physician performs pain management only or if operative anesthesia is general anesthesia, epidural injection, or subarachnoid injection and the adequacy of the intraoperative anesthesia is not dependent on the peripheral nerve block.
In addition, CPT codes 64483 and 64484 are not separately payable when performed in combination with the surgical procedure as a primary anesthetic agent or as an addition to the primary anesthetic technique.
Billing Guidelines
Documentation should support the medical necessity of service. For example, it should reflect that an anesthetic agent or substance is injected and administrated to the nerve. The most used ICD codes are M54.50, M54.51, M54.59, M54.16, M47.816, M43.06, M48.061, M48.062, M54, etc.
CPT 64483 includes imaging guidance such as CT or Fluoroscopy, contrast injections, and Single or multiple injections on the same site.
If CPT code 64483 is performed with the Destruction of genicular nerve branches (CPT 64624), CPT 64483 will not be reported separately. Instead, only CPT code 64624 will be reported due to higher pay.
If CPT 64483 is performed with Injection genicular nerve branches (CPT 64454), CPT 64483 will be reported separately with appropriate modifiers according to NCCI.
CPT 64484 will be billed with the 64483 CPT code and cannot be reported separately.
These CPT codes are typically performed unilaterally, but if performed bilateral, it is appropriate to report with modifier 50 or billed as twice with LT and RT modifier according to a third party or payer guidelines.
For example, CPT 64484 will be reported twice if the procedure is performed bilaterally. As per CPT guidelines, modifier 50 is not required for Add-on code 64484, but Medicare still needs modifier 50 with CPT 64484.
If Epidural or subarachnoid injection is administrated in combination with CPT code 64484, then it is appropriate to report separately with CPT codes 62320-62327
If Nerve destruction CPT codes 62280-62282, 64600-64681, 64624, 64625, 64633, 64634, 64635, and 64636 are not allowed to be billed together on the same date of service with CPT 66483 according to NCCI.
If any Evaluation and management (E/M) service is performed in conjunction with CPT code 64483, modifier 24 will be reported with E/M service for an unrelated condition.
For example, suppose the E/M visit is for post-operative care of the prior surgical procedure.
In that case, it is not appropriate to report the E/M code because it is included in the surgical procedure during the global period, if any.
CPT codes 64483 and 64484 include radiologic and imaging guidance and will not be reported separately.
Billing Examples
The following are examples of CPT code 64483 when performed by the physician:
Example 1
A 60-year-old female presented with low back pain for four days at the office. The pain gets worse with movement and when lying down. The patient took some medication for pain.
The patient denies other symptoms, such as headache, numbness, urinary problems, nausea, vomiting, and shortness of breath. A physical exam revealed swelling in the Lumbar region.
The physician ordered a CT Lumbar spine, revealing degeneration of the lumbar spine at L1 – L4, L5– S1, and disk budging at L5-L6 level. The patient also has spondylosis of the lumbar spine.
The physician has administrated steroid injection via transforaminal epidural space for pain management.
Example 2
A 16-year-old male presented to the emergency department after a motor vehicle accident today and had a severe headache, back pain, and chest pain.
The patient is unable to move and has severe low back pain. The patient denies urinary symptoms, extremity pain, and dizziness. A physical exam revealed neck and eye swelling.
The physician ordered a CT of the Lumbar, head, and chest. The patient had multiple fractures of L2-L3 and L5, and S1 levels. The physician ordered an anesthetic agent for pain management of the lumbar region.
Example 3
A 39-year-old male with tumors on the lumbar region presented to the emergency department with c/o constant low back pain that started four days ago. The patient was unable to walk for 1-week.
The patient consulted with his primary care physician, who suggested attending the emergency department.
Denies trauma, heavy palpitations, dizziness, cough, recent illness, fever, chills, back pain, abdominal pain, nausea, recent travel, known sick contacts, recent antibiotic use, near-syncope or syncope, changes in stool color, urinary complaints, or any other symptoms.
The patient took his routine medication. The physician ordered a CT scan of the lumbar region and laboratory studies to confirm whether the tumor was metastasized.
The physician decides to do a surgical procedure to excise the tumor. The procedure was performed successfully.
On the second day of surgery, the patient was back with severe pain and decided to administer an anesthetic agent at L4-45 in the epidural space.
Example 4
A 76-year-old male presents to the office for radiculopathy and stenosis of the lumbar region. A patient has had severe low back pain since last week.
The patient took some medication for pain, but it is getting worse daily.
Denies trauma, heavy palpitations, dizziness, cough, recent illness, fever, chills, back pain, abdominal pain, nausea, recent travel, known sick contacts, recent antibiotic use, near-syncope or syncope, changes in stool color, urinary complaints, or any other symptoms.
The lumbar region CT scans revealed spondylosis of the L2-L3 level, disc protrusion at the L4-L5 level, and degenerated changes at the L5-S1 region.
The patient requested the physician for pain management as he could not bear it. The physician ordered a steroid injection in the epidural space at the L4-L5 level, and he received relief from the pain. The physician prescribed pain medicines and scheduled an appointment for a follow-up visit.
