CPT 64483 & 64484: Transforaminal Epidural Injection
CPT 64483 & 64484: Transforaminal Epidural Injection, Explained
CPT 64483 covers a transforaminal epidural steroid injection at a single lumbar or sacral level. 64484 is its add-on code, used for each additional level injected in the same session.
What are CPT 64483 and 64484?
64483 reports a transforaminal epidural injection of anesthetic and/or steroid at one lumbar or sacral spinal level, including imaging guidance. 64484 is reported in addition to 64483, once for each additional level injected during the same encounter, it’s never billed as a standalone procedure.
These codes are distinct from interlaminar epidural codes (62321, 62323), which use a different injection approach, don’t substitute one for the other based on convenience, the approach documented in the procedure note has to match the code billed.
When to use them
Use 64483 for the first lumbar or sacral level injected transforaminally in a session, and add 64484 once per additional level. Both require imaging guidance (fluoroscopy or CT) to be performed and documented, this isn’t optional for these codes.
Medicare generally limits these injections to 6 per year across a patient’s treatment course. Going past that limit without strong, clearly documented medical necessity is close to an automatic denial, this is one of the most common and most avoidable reasons pain management claims get rejected.
What your documentation needs to show
The procedure note needs to specify the exact spinal level(s) injected, the imaging guidance method used, and the medical necessity for the injection, typically the patient’s diagnosis, prior conservative treatment attempts, and the clinical rationale. If the procedure was bilateral at the same level, that needs to be clearly documented as well, since it affects how the claim should be coded.
Common reasons this code gets denied
Exceeding frequency limits. Going over the typical 6-per-year Medicare cap without documentation that clearly justifies the additional injections.
Missing or incorrect modifier 50. When the same level is injected bilaterally, modifier 50 needs to be appended correctly. Missing it, or applying it incorrectly, is a frequent and avoidable denial trigger.
Incomplete imaging documentation. Since imaging guidance is required for these codes, a note that doesn’t clearly document it can result in denial even when the procedure itself was performed correctly.
64484 billed without 64483. The add-on code can’t stand alone, if it’s billed without its primary code on the same claim, it will be rejected.
Related codes
Frequently asked questions
Can 64484 be billed by itself? +
No. 64484 is an add-on code and must be billed alongside 64483 on the same claim, it reports each additional level beyond the first.
How many epidural injections will Medicare cover per year? +
Medicare generally limits these to 6 per year. Exceeding that without clear documented medical necessity is a common and largely avoidable reason for denial.
Do these codes require imaging guidance? +
Yes. Imaging guidance (fluoroscopy or CT) is required and needs to be clearly documented in the procedure note to support the claim.
Seeing denials on injection claims?
We work specifically with pain management practices. A free audit looks at your actual claims and shows you exactly what’s behind your denial pattern, not a generic checklist.