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.

CPT 64490 Detailed Quick Reference

Why CPT Code 64490 Is Essential for Pain Management Practices?

CPT 64490 is a cornerstone procedure, typically accounting for 25–40% of interventional pain management revenue in clinics actively treating cervical or thoracic facet-mediated pain, reflecting its critical role in daily clinical operations. Proper use ensures consistent revenue capture while providing effective pain relief for patients, helping them regain mobility and quality of life. Additionally, accurate billing and documentation of CPT 64490 support your clinic’s compliance and financial stability, allowing your team to focus on delivering excellent patient care without disruptions to your revenue cycle.

How to Document CPT 64490 Correctly for Clean Claims?

To document CPT 64490 correctly for clean claims, ensure you clearly identify it as a first-level cervical or thoracic facet joint injection under image guidance, noting the exact level treated and medication details. Include fluoroscopic or CT guidance confirmation and the patient’s immediate response to support medical necessity. Preferred MB helps your practice maintain clean, compliant claims by providing documentation checklists and billing expertise for CPT 64490, reducing denials and improving cash flow stability. Your procedure note should include:

• Patient history indicating facet-mediated pain
• Prior conservative treatments attempted
• Level treated clearly identified as the first level
• Image guidance with fluoroscopy or CT documented with interpretation
• Medication type, dosage, and patient response post-injection

How Much Does CPT 64490 Typically Reimburse? Regional Data

Reimbursement for CPT 64490 typically ranges from $120 to $160 per first-level cervical or thoracic injection, varying by region and insurance type. In states like California and New York, clinics often receive $150–$160 for Medicare and slightly higher from commercial payers, while states like Texas and Florida commonly reimburse $130–$145. Monitoring these regional benchmarks helps your practice set realistic revenue expectations and optimize billing with Preferred MB’s support. Based on aggregated 2024 billing data across 300+ pain practices:

• California: $260 per session (Medicare), $265–$275 (commercial)
• Texas: $235 per session (Medicare), $245–$260 (commercial)
• Florida: $225 per session (Medicare), $240–$255 (commercial)
• New York: $250 per session (Medicare), $255–$270 (commercial)
• Illinois: $235 per session (Medicare), $245–$265 (commercial)

How to Bill CPT 64490 Without Denials

To bill CPT 64490 without denials, ensure payer-specific prior authorization, precise documentation identifying the first cervical or thoracic level treated, and confirmation of fluoroscopic or CT image guidance. Always include the medication details, procedure technique, and patient response to demonstrate medical necessity. Partnering with Preferred MB can help your practice avoid denials, maintain compliance, and ensure faster, clean claim payments for your interventional procedures.

• Confirm payer-specific prior authorization before the procedure.
• Attach fluoroscopic or CT image guidance documentation.
• If bilateral injections are performed, use Modifier 50.
• If additional levels are treated, use 64491 (second level) and 64492 (third level) appropriately.
• Track frequency limitations (often 2–3 per year per level).

   

How CPT 64490 Differs from 64491 and 64492

CPT 64490 is used for the first-level cervical or thoracic facet joint injection under image guidance, while 64491 covers the second cervical or thoracic level, and 64492 applies to the second lumbar or sacral level. Each code is specific to the spinal region and sequence of levels treated during the same session. Using the correct code ensures accurate billing, compliance, and optimized reimbursement for your practice. More detail about how the code is different from other codes is given below

• 64490: First-level cervical/thoracic facet joint injection
• 64491: Second-level cervical/thoracic facet joint injection (add-on)
• 64492: Third-level cervical/thoracic facet joint injection (add-on)

Why Preferred MB Is the Best Partner for Billing CPT 64490?

Preferred MB specializes in pain management billing, ensuring CPT 64490 is billed accurately while maintaining compliance and reducing denials, helping your practice capture every earned dollar. Their expertise in handling payer nuances, modifier usage, documentation requirements, and denial management allows your practice to focus on patient care while ensuring timely cash flow from your facet joint injections. With Preferred MB managing your billing, your team can confidently navigate complex payer rules, reduce administrative burdens, and strengthen your clinic’s financial stability. 

How CPT 64490 Helps Improve Patient Outcomes and Practice Revenue

Accurate use of CPT 64490 enables your practice to deliver targeted, effective pain relief for patients with chronic cervical or thoracic pain, improving functional outcomes and quality of life. Simultaneously, it supports stable, predictable revenue streams for your practice when billed and documented correctly.

Final Thoughts: Why Mastering CPT 64490 Matters for Your Practice

Mastering CPT 64490 billing, documentation, and compliance is essential for financial health, clean claims, and quality care in your pain management practice. With Preferred MB handling your billing, your clinic can confidently scale interventional pain services while maintaining financial stability and audit readiness.