Procedure billing guide

Facet Joint Injection and Medial Branch Block Billing

Facet joint injections and medial branch blocks are billed with CPT 64490 to 64495: 64490 to 64492 for cervical and thoracic levels and 64493 to 64495 for lumbar and sacral levels, with add-on codes for the second and third levels. Imaging guidance is included. Medicare requires two diagnostic medial branch blocks with significant relief before it covers radiofrequency ablation.

Updated October 12, 2026

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CPT codes

What are the CPT codes for facet joint injections?

Code	Description
64490	Facet joint injection or medial branch block, cervical or thoracic, single level
+64491	Cervical or thoracic, second level
+64492	Cervical or thoracic, third and any additional level
64493	Facet joint injection or medial branch block, lumbar or sacral, single level
+64494	Lumbar or sacral, second level
+64495	Lumbar or sacral, third and any additional level

Codes shown for reference. Always confirm against the current year’s CPT code set and your payer’s policy.

Billing rules

How do you bill facet joint injections and medial branch blocks?

What does Medicare require for facet joint injections?

Medicare's facet joint interventions LCD requires moderate to severe axial pain for at least three months that has not responded to conservative care. It also limits the number of levels per session and how often injections can be repeated, so the notes need to show the pain, how long it has lasted and the conservative care tried.

Before RFA, Medicare requires two medial branch blocks, each giving at least 80 percent relief. Tracking and documenting those results is part of billing the diagnostic blocks correctly.

Do facet joint injections need prior authorization?

Often, yes. Since July 2023, traditional Medicare has required prior authorization for facet joint interventions performed in hospital outpatient departments. Commercial and Medicare Advantage plans also commonly require it, so we confirm authorization status before every scheduled facet injection or medial branch block.

How do you code facet joint injections correctly?

Facet codes are counted per level, not per joint or per nerve, so blocking two medial branch nerves for one joint is one level. Bilateral procedures take modifier 50 or RT and LT on both the primary and add-on codes, imaging is never billed separately, and every diagnostic block needs a recorded relief percentage.

Codes are per level, not per joint or per nerve: two medial branch nerves blocked for one joint is one level
Bilateral procedures use modifier 50 (or RT and LT) on the primary and add-on codes
Do not bill imaging separately; it is included in 64490 to 64495
Document the pain relief percentage after every diagnostic block

Common denials

Why are facet joint injection claims denied?

These are the denial reasons we see most often. We check for each one before a claim goes out, instead of finding out from a denial.

Denials we prevent

Pain duration or conservative care not documented
More levels billed than the LCD allows in one session
Diagnostic block relief not recorded, which later blocks RFA approval
Hospital outpatient procedure done without the Medicare prior authorization

FAQ

Facet Joint Injections questions

How many levels can be billed for a facet injection?

The codes cover a first level, a second level and a third or additional level. Medicare's facet LCD limits how many levels can be treated in one session, and commercial payers often set their own limits.

Is a medial branch block billed with the same codes as a facet injection?

Yes. CPT 64490 to 64495 cover both intra-articular facet injections and medial branch blocks.

What does Medicare require before facet RFA?

Medicare requires two diagnostic medial branch blocks, each providing at least 80 percent relief of the expected duration for the anesthetic used, before it covers facet radiofrequency ablation.

Sources

Coverage rules change; always check the current version of each policy and your payer’s own rules.

Keep reading

Related services and procedures

Radiofrequency Ablation (Rhizotomy)

Facet, genicular and SI joint RFA coding, diagnostic block rules and repeat limits.

Epidural Steroid Injections

Interlaminar and transforaminal ESI coding, LCD rules and prior authorization.

Prior Authorization

Approvals for injections, RFA, SCS and kyphoplasty, matched to each payer's criteria.

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