What Is CPT Code 64491?

CPT 64491 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; second level (list separately in addition to code for primary procedure).

CPT 64491 Detailed Reference

Why CPT Code 64491 Is Critical for Your Practice’s Financial Health?

CPT 64491 procedures can account for 20–35% of procedural revenue in high-volume pain management practices treating facet-mediated pain. Correct billing and documentation of this code are essential to ensure consistent reimbursement and cash flow stability while avoiding costly audits.

How to Define CPT 64491 Correctly in Your Documentation?

Defining CPT 64491 correctly in your documentation requires clearly noting it as the injection of an anesthetic and/or steroid into the second cervical or thoracic facet joint nerve under image guidance. Include the exact level treated, type and volume of medication, fluoroscopic or CT guidance used, and patient tolerance during the procedure. This level of detail ensures payer compliance and supports clean claim submission with Preferred MB’s billing expertise. Your procedural note should clearly state:

• The specific cervical or thoracic level treated as the second level
• Fluoroscopic or CT guidance was used and documented
• Type and volume of anesthetic/steroid injected
• Indication for the procedure (facetogenic pain)
• Immediate patient response

How Much Does CPT 64491 Typically Reimburse? State-Based Data?

Reimbursement for CPT 64491 varies by state and payer, typically ranging from $60 to $100 per second-level cervical/thoracic injection. For example, Florida Medicaid reimburses around $63.72 non-facility / $37.31 facility, while Maryland’s scheduled rates list $95.09 non-facility / $60.83 facility. More detail according to state is given below:

• Based on 2024 aggregated practice billing data:
• California: $210 per session (Medicare), $215–$230 (commercial)
• Texas: $190 per session (Medicare), $200–$215 (commercial)
• Florida: $185 per session (Medicare), $195–$210 (commercial)
• New York: $205 per session (Medicare), $210–$225 (commercial)
• Illinois: $195 per session (Medicare), $200–$220 (commercial)

How to Bill CPT 64491 Correctly Without Denials?

To bill CPT 64491 correctly without denials, ensure payer-specific prior authorization is obtained and that documentation clearly identifies it as a second-level cervical or thoracic facet injection under image guidance. Include the precise spinal level, medication details, and image confirmation to support medical necessity. Leveraging Preferred MB’s billing services can help your practice submit clean, compliant claims while reducing costly delays and rework. 

• Ensure 64490 (first level) is billed in the same session, as 64491 is an add-on code.
• Confirm prior authorization with payers before scheduling.
• Use Modifier 50 if bilateral injections are performed or Modifier 59 for distinct procedural services.
• Include fluoroscopic or CT images and interpretation notes in the patient’s record.
• Track payer frequency limits, typically restricting facet injections to 2–3 times per year per level.

   

How CPT 64491 Differs from 64490 and 64492?

CPT 64491 is used for second-level cervical or thoracic facet joint injections under image guidance, while 64490 applies to the first cervical or thoracic level, and 64492 is used for the second lumbar or sacral level. Each code reflects a different spinal region and sequence, making accurate level documentation essential. Using the correct code ensures proper reimbursement and prevents denials for your practice. More detail how the code is different from others is given below:

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

Why Preferred MB Is the Best Choice for Billing CPT 64491?

Preferred MB specializes in pain management billing, ensuring accurate and compliant billing for CPT 64491 while reducing denials, improving AR recovery, and maintaining audit readiness for your practice. Our medical billing team proactively handles prior authorizations, modifier applications, and payer-specific documentation requirements to protect your revenue. With Preferred MB managing your healthcare practice billing, you can focus on providing effective interventional pain care, enhancing patient outcomes, and maintaining stable, predictable cash flow from your procedures without administrative stress. 

How CPT 64491 Impacts Patient Care and Revenue?

By mastering CPT 64491, your practice can confidently treat patients suffering from chronic neck and upper back pain with image-guided precision, leading to higher patient satisfaction and improved functional outcomes. Simultaneously, correct billing and documentation under this code help your practice maintain financial health while adhering to compliance standards and payer-specific policies. This not only strengthens your clinic’s revenue cycle but also builds trust with your patients, knowing they are receiving accurate, effective care while your practice remains financially stable.

Final Thoughts: Why Mastering CPT Code 64491 Is Essential for Pain Practices?

Mastering the billing, documentation, and payer-specific requirements of CPT 64491 is critical for capturing earned revenue, avoiding audits, and maintaining compliance while delivering effective interventional pain care. Partnering with Preferred MB helps your clinic eliminate errors in coding, reduce claim rejections, and secure timely payments while focusing on patient outcomes.