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CPT Code 64490 | Paravertebral Facet Joint Injection With Image Guidance

CPT 64490 involves injecting a diagnostic or therapeutic agent into the cervical or thoracic region’s paravertebral facet joint using image guidance and ensuring hemostasis at the injection site.

What Is CPT Code 64490

CPT code 64490 is a procedure in which a diagnostic or therapeutic agent is injected into the paravertebral facet (zygapophyseal) joint of the cervical or thoracic region using image guidance (fluoroscopy or CT).

Before the procedure, the patient is prepared and anesthetized. The provider then inserts a needle through the skin and guides it to the correct joint location using fluoroscopy or CT imaging.

Once in place, the provider injects the agent (such as a steroid or anesthetic mixture) and removes the needle, ensuring the injection site is free of bleeding.


The CPT book describes CPT code 64490 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.”


The provider preps and anesthetizes the patient for a facet joint injection in this service. The provider then inserts the needle through the skin and advances it to the proper joint position using fluoroscopy or CT imaging guidance.

He then injects the therapeutic or diagnostic agent, like a steroid or anesthetic mixture. He then removes the needle and ensures that the site obtains hemostasis.

How To Use CPT 64490

Do not separately code for multiple injections at the same spinal level.

Report CPT code 64490 once for the first level, for example, C3 to C4; report add–on code CPT 64491 once for the second level, for example, C4 to C5; and report add–on code CPT 64492 once for any additional levels.


CPT Professional 2022

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