October 19, 2017

Question:
I heard that regardless of the number of facet injection performed on a single side, only three levels may be reported. Is this a payor rule?

Answer:
CPT guidelines state that the facet injection add-on code, for example, code +64495 for the third level, lumbar or sacral, includes the third and any additional level(s). Therefore, if a fourth level is injected, that level may not be separately reported.  This is a CPT guideline followed by payors.

*This response is based on the best information available as of 10/19/17.