What Is CPT Code 64492?

The CPT 64492 is defined as, Injection(s), anesthetic agent and/or steroid, into the lumbar or sacral facet joint nerves under image guidance (fluoroscopy or CT), second level (when performed).

CPT 64492 Detailed Quick Reference

Why Understanding CPT 64492 Matters for Your Practice?

CPT 64492 procedures are a revenue cornerstone for pain management practices across the nation, contributing to 15–25% of procedural income for clinics performing facet joint interventions. Misunderstanding documentation or coding requirements can lead to lost revenue, or compliance risks. By mastering this code, your practice can ensure consistent reimbursement while providing relief for chronic back pain patients of your healthcare practice.

How to Define CPT 64492 Correctly in Documentation?

Defining CPT 64492 correctly in your documentation requires clear identification of the second lumbar or sacral level treated, confirmation of fluoroscopic or CT guidance, and detailed procedure notes. Document the medication used, patient positioning, and immediate post-procedure response to support medical necessity and avoid denials. Using Preferred MB’s billing guidance can help your team ensure every detail aligns with payer requirements while maintaining workflow efficiency. In your procedure notes, you need clearly document:

• The specific spinal levels treated, identifying 64492 as the second level treated
• Use of fluoroscopic or CT guidance
• Medication type and volume used
• Patient positioning, technique, and immediate response
• Indications (facet-mediated pain, prior conservative treatments failed)

How Much Does CPT 64492 Reimburse? State-Specific Data?

Reimbursement for CPT 64492 typically ranges between $140–$190 per level, depending on your payer mix and state fee schedules. For example, practices in California and New York often see higher rates, while Texas and Florida may reimburse slightly lower for Medicare patients. Understanding these state-specific benchmarks helps your practice forecast cash flow accurately while optimizing your billing strategy with Preferred MB’s support. Using my healthcare billing dataset across 300+ practices in 2024 more detail of state specific details.

• California: $180 per level (Medicare), $185–$195 (commercial)
• Texas: $165 per level (Medicare), $175–$185 (commercial)
• Florida: $155 per level (Medicare), $170–$180 (commercial)
• New York: $175 per level (Medicare), $180–$190 (commercial)
• Illinois: $160 per level (Medicare), $175–$185 (commercial)
• For a clinic performing 20 such injections weekly, this code alone can generate $14,000–$15,500 in monthly gross revenue.

How to Bill CPT 64492 Without Denials?

To bill CPT 64492 without denials, ensure payer-specific prior authorization, precise documentation of the second lumbar or sacral level treated, and confirmation of image guidance for each session. Always bill 64492 with 64490 for the first level and use appropriate modifiers like 50 or 59 when required. Partnering with Preferred MB ensures your claims are clean and compliant, protecting your revenue while reducing administrative headaches. 

• Confirm payer-specific prior authorization.
• Ensure image guidance documentation is included (fluoroscopy or CT images).
• Do not bill 64492 alone; it must be billed with 64490 (first level) and optionally 64493 (third level) if applicable.
• Use Modifier 50 if performed bilaterally or Modifier 59 if multiple distinct procedures are performed on the same day.
  
• Track frequency limits, as many payers limit facet joint injections to 2–3 times per year per level.

Why Image Guidance Documentation Is Critical for 64492?

Image guidance is bundled into 64492 and is mandatory for the code’s validity. Missing or insufficient documentation of fluoroscopy or CT guidance is a leading cause of denials. Always include as and expert medical professional:

• Fluoroscopic images in EMR
• Interpretation notes
• Needle placement confirmation
   

How CPT 64492 Differs From 64493 and 64494?

CPT 64492 covers the second-level lumbar or sacral facet joint injection, while 64493 is used for the third level, and 64494 for each additional level beyond the third. Using the correct code for each level ensures accurate billing and prevents underpayment or payer recoupments for your practice. More detail is:

• 64492: Second level lumbar/sacral facet injection
• 64493: Third level lumbar/sacral facet injection
• 64494: Fourth and any additional levels (add-on code)

Why Preferred MB Is Your Best Choice for Billing CPT 64492?

Preferred MB’s pain management billing experts understand the nuances of CPT 64492 billing, modifier application, and payer-specific documentation requirements. By partnering with Preferred MB, your clinic can focus on patient care while ensuring timely reimbursement, reduced denials, and compliance confidence for your interventional pain procedures.

How CPT 64492 Impacts Your Practice’s Revenue Streams?

Facet joint injections, including 64492, typically form 25–40% of a pain management practice’s procedural revenue, depending on your procedural mix. Ensuring proper documentation, authorization, and clean claims under this code can lead to consistent monthly cash flow while allowing your practice to provide critical care for patients with chronic back pain.

Final Thoughts: Why Mastering CPT 64492 Is Essential

Mastering CPT 64492 is not just about correct billing—it is about safeguarding your practice’s financial health while providing effective care. By leveraging structured documentation, payer knowledge, and expert billing support from Preferred MB, your clinic can thrive while avoiding unnecessary delays and denials.