Modifier Code for Multiple Levels of CPT 64490

Understanding CPT 64490 and Multiple Level Coding

The American Academy of Child and Adolescent Psychiatry recommends using CPT code 64490 for injection procedures at a single level, with modifier 59 used to indicate distinct procedural services at different levels, for patients undergoing cervical or thoracic facet joint injections 1
For multiple level injections, the coding approach is: first level uses 64490 (no modifier), second level uses 64491 with modifier 59, and third level and beyond uses 64492 with modifier 59, to ensure accurate reimbursement for each level treated 1

Modifier 59 is used to indicate distinct procedural services at different spinal levels, ensuring accurate reimbursement for each level treated during the procedure, as recommended by medical coding guidelines 1

Documentation should clearly specify each level treated to support the use of these codes and modifiers, with medical necessity well-documented for each level requiring treatment, to ensure reimbursement 1

Proper coding with appropriate modifiers ensures accurate reimbursement for all levels treated, with Medicare and other payers recognizing these codes with appropriate modifiers when medical necessity is established, according to billing guidelines 1