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CPT Codes
2012-10-13 20:10:20 Christopher Faubel, M.D.
Disclaimer: The information here is NOT meant to replace the sound
advice of a billing and coding expert.
Below is a list of the most common CPT codes (procedure codes) used in a PM&R and interventional pain management
clinic. Electrodiagnostic (EMG/NCS) codes are also included. These have all been updated for the most recent 2017
changes. Feel free to make coding tips in the comments below.
Remember: Use the -50 modifier when performing BILATERAL procedures below. Note: Fluoro needle guidance is built in to SI
joint (27096), transforaminal and interlaminar ESIs, medial branch blocks, radiofrequency ablation (RFA) and facet injections;
therefore, you can NOT bill for fluoro separately for these procedures. But you CAN bill separate fluoro guidance codes (77002 for
non-spinal) for peripheral joints/ligaments/bursa (hips, shoulders, iliolumbar ligament, troch bursa, etc.)
Joints and Bursa – Injection or Aspiration
Major joint/bursa: 20610 (knee, hip, shoulder, trochanteric bursa, subacromial bursa, pes anserine bursa)
Intermediate joint/bursa: 20605 (temporomandibular, acromioclavicular, wrist, elbow, ankle, olecranon bursa)
Minor joint/bursa: 20600 (fingers [PIP, DIP], toes)
Sacroiliac joint (SIJ) with fluoroscopy: 27096
Sacroiliac joint (SIJ) without fluoroscopy: 20552 (billed as a trigger point injection)
Fluoroscopic needle guidance (non-spinal): 77002
Shoulder arthrogram injection: 23350 (+77002)
Hip arthrogram injection: 27093 (+77002)
Genicular nerve blocks: 64450 x3 units
Genicular nerve RFA: 64640, 64640-59, 64640-59
Tendons, Ligaments, and Muscle Injections
Tendon sheath or Ligament: 20550 (iliolumbar ligament, trigger finger, De Quervain’s tenosynovitis, plantar fascia)
Tendon origin/insertion: 20551
Trigger point injection (1 or 2 muscles): 20552
Trigger point injection (3 or more muscles): 20553
Sacroiliac joint (SIJ) without fluoroscopy: 20552 (billed as a trigger point injection)
Intramuscular injections: 96372
Fluoroscopic needle guidance (non-spinal): 77002
Nerve Blocks
Greater occipital nerve block: 64405
Lesser occipital nerve block: 64450
Other peripheral nerve: 64450 (I use this for superior cluneal nerve blocks, genicular nerve blocks, and lateral branch blocks
for the SI joints)
Suprascapular nerve: 64418
Intercostal nerve (single): 64420
Intercostal nerve (multiple): 64421
Ilioinguinal and Iliohypogastric nerve: 64425
Trigeminal nerve (any branch): 64400
Sphenopalatine ganglion: 64505
Stellate ganglion (cervical sympathetic): 64510
Superior hypogastric plexus: 64517
Thoracic or lumbar paravertebral sympathetic or ganglion impar block: 64520
Celiac plexus: 64530
Plantar common digital nerve (Morton’s neuroma): 64455
Unlisted procedure: 64999
Epidural Steroid Injections (ESI)
Interlaminar (WITH fluoroscopic imaging)
Interlaminar – cervical or thoracic: 62321
Interlaminar – lumbar or sacral (caudal): 62323
Remember: Fluoro can NOT be billed separately for these.
Transforaminal
Transforaminal – cervical or thoracic (first level): 64479
Transforaminal – cervical or thoracic (each additional level): 64480
Transforaminal – lumbar or sacral (first level): 64483
Transforaminal – lumbar or sacral (each additional level): 64484
Remember: Fluoro can NOT be billed separately for these.
Ex: A bilateral L5 TF ESI would be billed as 64483 -50.
Facet Joint Procedures
Intraarticular Joint or Medial Branch Block
Intraarticular joint or medial branch block (MBB) – cervical or thoracic (1st level): 64490
Intraarticular joint or medial branch block (MBB) – cervical or thoracic (2nd level): 64491
Intraarticular joint or medial branch block (MBB) – cervical or thoracic (3rd level): 64492
Intraarticular joint or medial branch block (MBB) – lumbar or sacral (1st level): 64493
Intraarticular joint or medial branch block (MBB) – lumbar or sacral (2nd level): 64494
Intraarticular joint or medial branch block (MBB) – lumbar or sacral (3rd level): 64495
Note: You can bill for bilateral facets or MBB at the same levels (with the -50 modifier), but you will NOT typically get
reimbursed for over 3 facet joints or medial branches on the same side.
Note: For medial branch blocks, the proper billing is to bill for each complete facet joint blocks (see example below)
Ex: Bilateral L3, L4, L5 MBBs would be billed as 64493 -50, 64494 -50.
Note: The third occipital nerve (TON) partially innervates the C2/3 facet joint, so along with a C3 MBB, this would be
billed as one full joint (64490)
Ex: Right TON, C3, C4, C5 blocks = Three full facet joints (C2/3, C3/4, C4/5) = 64490, 64491, 64492
Remember: Fluoro can NOT be billed separately for these.
Radiofrequency Ablation (RFA) / “Destruction” of Facet Joint
Radiofrequency ablation (RFA) – cervical or thoracic (1st joint): 64633
Radiofrequency ablation (RFA) – cervical or thoracic (each additional joint): 64634
Radiofrequency ablation (RFA) – lumbar or sacral (1st joint): 64635
Radiofrequency ablation (RFA) – lumbar or sacral (each additional joint): 64636
Remember: Fluoro can NOT be billed separately for these.
Sacroiliac Joint
Sacroiliac joint (SIJ) without fluoroscopy: 20552 (billed as a trigger point injection)
Sacroiliac joint (SIJ) with fluoroscopy: 27096
Sacral lateral branch blocks: 64450 (remember to bill 77003 with these, but not with the 64493 code)
Radiofrequency Ablation (RFA) of the Sacroiliac Joint
RF of L5 dorsal primary ramus: 64635
RF of S1 lateral branches: 64640
RF of S2 lateral branches: 64640
RF of S3 lateral branches: 64640
Fluoroscopic needle guidance (Spinal): 77003 (for the S1-S3 nerve lateral branches, not the L5)
Note: Use 724.6 (Disorder of the sacrum) and 721.3 (lumbar spondylosis) as the diagnostic codes
Vertebroplasty / Kyphoplasty
Vertebroplasty
Vertebroplasty – Cervicothoracic (1st level): 22510
Vertebroplasty – Lumbosacral (1st level): 22511
Vertebroplasty – Each additional level of the above: +22512
Note: Same charge whether you perform unilateral or bilateral injection of cement (PMMA). Modifier 50 can NOT be
used.
Note: The global charge for the procedure includes all imaging guidance and any bone biopsy performed.
Kyphoplasty
Kyphoplasty – Thoracic (1st level): 22513
Kyphoplasty – Lumbar (1st level): 22514
Kyphoplasty – Thoracic or Lumbar (each additional level): +22515
Note: Same charge whether you perform unilateral or bilateral injection of cement (PMMA). Modifier 50 can NOT be
used.
Note: 10-day global period
Neurostimulation (Spinal Cord Stimulator / Dorsal Column Stimulator)
Trial Procedure
Percutaneous implant of electrode array: 63650 (includes 10-day global) – bill two units if you implant two trial leads
Implantation of Spinal Cord Stimulator Percutaneous Leads and Generator
Percutaneous implant of electrode array: 63650 (includes 10-day global)
Insertion or replacement of pulse generator: 63685 (includes 10-day global)
Implantation of Spinal Cord Stimulator PADDLE Leads and Generator
Laminectomy for implant of neurostimulator electrode, paddle: 63655 (includes 90-day global)
Insertion or replacement of pulse generator: 63685 (includes 10-day global)
Removal of Leads/Generator (Explant)
Removal of spinal neurostimulator percutaneous array(s): 63661 (includes 10-day global)
Removal of spinal neurostimulator paddle electrode: 63662 (includes 90-day global)
Removal of pulse generator: 63688 (includes 10-day global)
Important: Also bill for the implanted neurostimulator electrodes (each lead): L8680
Discogram / Discography
Discogram / Discography – Cervical/Thoracic (each disc): 62291
Supervision & interpretation of fluoroscopy – Cervical/Thoracic (each disc): 72285
Discogram / Discography – Lumbar (each disc): 62290
Supervision & interpretation of fluoroscopy – Lumbar (each disc): 72295
Remember: Fluoroscopy is bundled here and can NOT be billed separately for these.
Botulinum Toxin Injections
Botulinum toxin type A – Botox, Dysport (per unit): J0585
Botulinum toxin type B – Myobloc (per 100 units): J0587
Needle electromyography in conjunction with chemodenervation: 95874
Chemodenervation of muscles in the neck (spasmodic torticollis): 64616
Chemodenervation of muscles of the trunk and/or extremity (cerebral palsy, dystonia, multiple sclerosis): 64614
Chemodenervation of muscles innervated by facial, trigeminal, cervical spinal and accessory nerves, bilateral (chronic
migraine): 64615
Other
Carpal tunnel injection: 20526
Epidural blood patch: 62273
Moderate sedation (first 30 minutes): 99144 (requires presence of another trained person to monitor the patient’s
consciousness and vitals)
Moderate sedation (each additional 15 minutes): 99145
Fluoroscopic needle guidance (spinal): 77003
Fluoroscopic needle guidance (non-spinal): 77002
CT needle guidance: 77012
Acupuncture
with electrical stimulation: 97813
without electric stimulation: 97810
Modalities
Diathermy (Microwave): 97024
Heating pads / cold packs: 97010
Self-care / home management training: 97535
Therapeutic ultrasound: 97035
Traction: 97012
Transcutaneous Electrical Nerve Stimulation (TENS): G0283
Osteopathic Manipulative Treatment
OMT 1-2 body regions: 98925
OMT 3-4 body regions: 98926
OMT 5-6 body regions: 98927
OMT 7-8 body regions: 98928
OMT 9-10 body regions: 98929
(note from a reader: use 98928 or less if OMT done in conjunction with an injection and 98927 or less of OMT done in
conjunction with epidural)
Modifiers
-50: Bilateral
-52: Incomplete procedure (reduced service) [Stopping a part of a procedure because of reasons other than the patient’s well-
being]
-53: Incomplete procedure (physician elected to terminate a surgical or diagnostic procedure due to the patient’s well-being) –
reduced service. I’ve used for a patient that had a severe vasovagal response to a radiofrequency procedure and I elected to
abort the procedure and reschedule later.
-59: Indicates that a procedure or service is separate and independent from other services performed the same day
-26: Professional component only
Injectables (J-codes)
Omnipaque 300 (per ml): Q9967
Omnipaque 240 (per ml): Q9966
Dexamethasone sodium phosphate (per mg): J1100
Celestone (per 3 mg): J0702
Celestone (per 4 mg): J0704
Depo-Medrol (40mg): J1030
Depo-Medrol (80mg): J1040
Kenalog/Triamcinolone (per 10 mg): J3301
Toradol/Ketorolac (per 15mg): J1885 (don’t forget the 96372 code if injected intramuscular)
Methocarbamol – Robaxin (up to 10 ml): J2800 (don’t forget the 96372 code if injected intramuscular)
Synvisc 3 dose (per 2 ml syringe): J7325
Synvisc One (per 6 ml syringe): J7325S
Versed (per mg): J2250
Fentanyl (0.1 mg): J3010
Diphenhydramine – Benadryl (injection up to 50-mg): J1200
Botulinum toxin type A – Botox, Dysport (per unit): J0585
Botulinum toxin type B – Myobloc (per 100 units): J0587
Electromyography (EMG) & Nerve Conduction Studies (NCS)
Sensory NCS (each nerve): 95904
Motor NCS w/o F-wave (each): 95900
Motor NCS with F-wave (each): 95903
H-reflex (gastrocnemius/soleus): 95934
H-reflex (other than gastroc/soleus): 95936
Blink reflex (orbicularis oculi): 95933 (only once per study)
EMG guidance during botulinum toxin injections: 95874
Add modifier -26 if you don’t own the EMG machine you’re using
EMG w/NCS, each extremity, “limited” (4 or fewer muscles): 95885
EMG w/NCS, each extremity, “complete” (5+ muscles, innervated by 3+ nerves or 4+ spinal levels): 95886
EMG w/o NCS on same day: one extremity = 95860, two extremities = 95861, three = 95863, four = 95864
Cranial nerves
EMG (unilateral): 95867
EMG (bilateral ): 95868
Note: EMG needles can not be billed separately, as they are included in the EMG codes
Muscle testing before the study
Extremity w/o hand (must include a report of this): 95831
Hand: 95832
2013 CPT Coding Changes for Nerve Conduction Studies – Effective January 1, 2013
Each conduction study is counted as one for sensory, motor with or without F-wave, or H-reflex. Orthodromic and
antidromic tests on the same nerve count only once.
Example: Bilateral sensory and motor median and ulnar NCS is performed. This is eight (8) separate tests, so the
proper code now is 95910. Adding a radial sensory on one side would then make it a 95911.
1-2 NCS = 95907
3-4 NCS = 95908
5-6 NCS = 95909
7-8 NCS = 95910
9-10 NCS = 95911
11-12 NCS = 95912
13+ NCS = 95913
Evaluation and Management (E&M) codes
New patients
Straightforward – 10 minutes: 99201
Straightforward – 20 minutes: 99202
Low complexity – 30 minutes: 99203
Moderate complexity – 45 minutes: 99204
High complexity – 60 minutes: 99205
Established patients
Brief – 5 minutes: 99211
Straightforward – 10 minutes: 99212
Low complexity – 15 minutes: 99213
Moderate complexity – 25 minutes: 99214
High complexity – 40 minutes: 99215
Independent medical examination (IME): 99456
