Lumbar Puncture CPT Code (2022) – Description, Guidelines, Reimbursement, Modifiers & Examples

Lumbar puncture CPT code(s) 62270 and 62328 bill for service when the Physician performs a diagnostic lumbar puncture of the spine. The Physician places a needle into the backbone of the lower back to remove a sample of spinal fluid for testing (biopsy). This procedure is often called a spinal puncture.

Lumbar Puncture CPT Code Description

The Physician sets the anatomical landmarks for a diagnostic Lumbar Puncture CPT code 62270, a spinal tap. If the procedure performs under fluoroscopic or CT guidance, reports with CPT 62328. 

A spinal taps aids in identifying severe infections, which are as follows:

Multiple sclerosis

Nervous system disorders 

Meningitis 

Neoplasm of the brain or spinal cord 

Guillain-Barre syndrome

The Physician places the Patient in a spinal tap position, either lying on one side or upright. The Physician places a needle into the anatomical site.

He retrieves cerebrospinal fluid (CSF) for diagnostic testing. The spinal tap site sterilizes first and may administer local anesthesia.

The needle removes from the spinal tap, and a small sterile dressing applies to the wound after completing the procedure. 

Lumbar Puncture CPT code 62270 bills for service when the Physician performs a diagnostic lumbar puncture of the spine.

Lumbar Puncture CPT code 62328 bills for service when the Physician performs a diagnostic lumbar puncture of the spine under fluoroscopic or CT guidance.

Lumbar Puncture CPT Code Reimbursement 

A maximum of two units can bill on the same service date of Lumbar Puncture CPT code 62270 and 62328. In contrast, the Three unit allows when documentation supports the medical necessity of the service.

The cost and RUVS of CPT 62270 are $65.75 and 1.8996 when performed in the facility. In contrast, the reimbursement and RUVS of CPT 62270 are $145.04 and 4.19121 when performed in the non-facility.

Lumbar Puncture CPT Code Modifiers

The following are the list modifiers when Lumbar Puncture CPT code(s) 62270 and 62328 are billed:

• 22, 23, 47, 51, 52, 53, 58, 59, 63, 76, 77, 78, 79, 99, AI, AQ, AR, CC, CR, ET, EY, GA, GC, GK, GR, GU, GY, GZ, KX, PT, Q5, Q6, QJ, SG, XR, XP, XU, XS. 

Modifier 76 is applicable with Lumbar Puncture CPT code 62270 and 62328 when a similar service performs by the Same Physician on the same service date.

Modifier 76 is applicable with CPT 62270 and 62328 when a similar service performs by a different Physician on the same service date.

Modifier 59 is applicable with CPT 62270 and 62328 when Distinct service performs by the Physician and bundled with another procedure on the same date.  

Modifier X {E, P, S, U} is applicable instead of Modifier 59 with CPT 62270 and 62328 when service bills to medicare insurance. It divides the modifier into four parts for further specification of the procedure.

Modifier 53 will be reported with Lumbar Puncture CPT code 62270 and 62328 if unsuccessful Holter monitors occur due to unavoidable circumstances like allergic reactions to the substance.

 Modifier 22 applies to CPT 62270 and 62328 when services perform longer than usual and take extra resources during the procedure.

Modifier 23 is applicable with Lumbar Puncture CPT code 62270 and 62328 when general or local anesthesia administers by the Physician and routinely does not require during the procedure.

Modifier 52 applies when the Physician does not complete the lumbar puncture procedure and service terminates due to unavoidable circumstances.

If physicians believe that Medicare will deny such service, reporting with a GA modifier is appropriate. The beneficiary must sign an Advance Beneficiary Notification (ABN), and Lumbar Puncture CPT code 62270 and 62328 must apply the GA modifier to that service.

Lumbar Puncture CPT Code Billing Guidelines

Documentation should support the medical necessity of service. It reflects that counseling service is medically necessary and appropriate. 

The following are ICD 10 Payable Dx codes:

A52.19, A52.2, A52.3, B00.82, B01.12, B02.24, B45.1, C41.2, C70.1, C71.5, C71.8, C71.9, C72.0, C72.1, C72.9, C79.31, C79.32, D32.0, D32.1, D32.9, D33.0, D33.1, D33.2, D33.4, D33.7, D33.9, D42.0, D42.1, D42.9, D43.0, D43.1, D43.2, D43.4, D57.03, D57.213 and E74.810

E74.818, E74.819, E74.89, G00.0, G00.1, G00.2, G00.3, G00.8, G00.9, G01, G02, G03.0, G03.1, G03.8, G03.9, G04.00, G04.01, G04.02, G04.2, G04.30, G04.31, G04.3, G04.39, G04.81, G04.82, G04.89, G04.90, G04.91, G05.3, G05.4, G06.1, G35, G61.0, G61.81, G61.89, G61.9

G91.2, G93.2, G93.7, G95.0, G95.11, G95.89, G95.9, G96.12, I60.00, I60.01, I60.02, I60.10, I60.11, I60.12, I60.2, I60.30, I60.31, I60.32, I60.4, I60.50, I60.51, I60.52, I60.6, I60.7, I60.8, I60.9, P00.82

CPT 62270 does not include the Radiological guidance code (77003, 77012). If guidance utilizes by the Physician, reports with CPT code 62328.

CPT 62270 or 62328 bills with ultrasound or MRI guidance. Check payer guidelines if the modifier is relevant with guidance CPT codes 76942 or 77021. This guidance is appropriate to report separately.

The contrast medium includes CPT codes 62270 and 62328 and does not report separately.

CPT 62328 includes CT and Fluoroscopic guidance and does not appropriate to report separately. 

Lumbar Puncture CPT Code Examples

The following are the examples when Lumbar Puncture CPT code 62270 or 62328:

Example 1

A 28-year-old male presents with headaches and nausea for four days to the office. The Patient did not take any medication for pain. He was able to eat normally and had a healthy lifestyle. The Patient also had a high fever last night. 

The Patient denies any recent travel, Dizziness, abdominal pain, vomiting, extremity swelling, headache, numbness, chest pain, shortness of breath, and urinary problem.

Diagnostic studies were unremarkable. The physical exam shows an abnormal finding nervous system. The Physician asks him about his personal life and retrieves his past and social family history.

The Physician ordered a series of diagnostics tests such as CT and MRI of the head. The Physician consulted with a neurologist and suggested doing a spinal tap to confirm the differential diagnosis of meningitis. 

The Physician prescribes medicines and schedules follow-up visits. The Physician scheduled a diagnostic lumbar puncture to identify if the Patient has meningitis or not. The spinal tap confirmed the diagnosis of meningitis. 

Example 2 

A 33-year-old male presents to the office with seizures and insomnia for four days. The Patient did not take any medication for seizures. He was able to eat normally and had a healthy lifestyle. The Patient also had a high fever for three days. 

The Patient denies any recent travel, Dizziness, abdominal pain, vomiting, extremity swelling, headache, numbness, chest pain, shortness of breath, and urinary problem.

Diagnostic studies were unremarkable. The physical exam shows an abnormal finding nervous system. The Physician asks him about his personal life and retrieves his past and social family history.

The Physician ordered a series of diagnostics tests such as CT and MRI of the head. The Physician consulted with a neurologist and suggested doing a spinal tap to confirm the differential diagnosis of meningitis. 

The Physician prescribes medicines and schedules follow-up visits. The Physician scheduled a diagnostic lumbar puncture to identify if the Patient has meningitis or not. The spinal tap confirmed the diagnosis of meningitis.

Example 3

A 67-year-old male presents to the office with visual problems, tingling, and numbness in the hands. The Patient did not take any medication for pain. He was able to eat normally and had a healthy lifestyle. The Patient also had a high fever last night. 

The Patient denies any recent travel, Dizziness, abdominal pain, vomiting, extremity swelling, headache, numbness, chest pain, shortness of breath, and urinary problem.

Diagnostic studies were unremarkable. The physical exam shows an abnormal finding nervous system. The Physician asks him about his personal life and retrieves his past and social family history.

The Physician ordered a series of diagnostics tests such as CT and MRI of the head. The Physician consulted with the neurologist and suggested doing a spinal tap to confirm the differential diagnosis of meningitis. 

The Physician prescribes medicines and schedules follow-up visits. The Physician scheduled a diagnostic lumbar puncture to identify if the Patient has meningitis or not. The spinal tap confirmed the diagnosis of meningitis.

Example 4

A 70-year-old male presents to the office with urinary problems, sexual dysfunction, and balance problems. The Patient did take medication but gave relief for a few hours. 

The Patient denies any recent travel, Dizziness, abdominal pain, vomiting, extremity swelling, headache, numbness, chest pain, shortness of breath, and urinary problem. He was able to eat every day and had a healthy lifestyle. The Patient also had a high fever last night.

 Diagnostic studies were unremarkable. The physical exam shows an abnormal finding nervous system. The Physician asks him about his personal life and retrieves his past and social family history. The Physician ordered a series of diagnostics tests such as CT and MRI of the head. 

The Physician consulted with a neurologist and suggested doing a spinal tap to confirm the differential diagnosis of meningitis. 

The Physician prescribes medicines and schedules follow-up visits. The Physician scheduled a diagnostic lumbar puncture to identify if the Patient has meningitis or not. The spinal tap confirmed the diagnosis of meningitis.

Example 5

A 55-year-old male presents to the ED with no feet movement for four days. The Patient was playing football last night, and no issue that time. He woke up today with no sign on his feet and doesn’t have any feeling in his feet. Paralysis is leading to his waste. 

The Patient denies any recent travel, Dizziness, abdominal pain, vomiting, extremity swelling, headache, numbness, chest pain, shortness of breath, and urinary problem.

Diagnostic studies were unremarkable. The physical exam shows an abnormal finding nervous system. The Physician asks him about his personal life and retrieves his past and social family history.

 The Physician ordered a series of diagnostics tests such as CT and MRI of the head. The Physician consulted with the neurologist and suggested doing a spinal tap to confirm the differential diagnosis of meningitis. 

The Physician prescribes medicines and schedules follow-up visits. The Physician scheduled a diagnostic lumbar puncture to identify if the Patient has meningitis or not. The spinal tap confirmed the diagnosis of meningitis.