What is CPT Code 64479?

This code is for a specific shot in the upper spine. It’s called a transforaminal epidural injection. Done in the neck or mid-back. Always with imaging, like fluoroscopy or CT, so the doctor sees where the needle goes.

The idea is simple. Medicine — usually a steroid or anesthetic — is placed near a nerve root to calm pain. This code only counts for the first level treated. If the doctor works on another level in the same session, there’s a separate add-on code for that.

Key Components of CPT 64479

• To bill 64479 the right way you need to know the basics.
• It’s only for the cervical or thoracic spine.
• The injection is a transforaminal epidural.
• It must be done with imaging — fluoroscopy or CT.
• The code covers one level only.

If the doctor does more than one level in the same session, you don’t repeat 64479. You use 64480 as the add-on code for each extra level.

Indications and Medical Necessity

Insurance won’t pay for 64479 unless there’s a real reason. Has to be medically needed.

Typical cases:

• Cervical radiculopathy
• Thoracic radiculopathy
• Herniated disc
• Spinal stenosis
• Nerve pain in the neck, shoulder, and upper back

Insurers don’t just take the diagnosis at face value. They want the story. How long has the pain been there? What treatments were tried already? Why this shot might help. If those details aren’t written down, the claim usually gets denied.

CPT 64479 Billing Guidelines

• When billing 64479, there are a few rules that matter most.
• Use 64479 for the first cervical or thoracic level treated.
• If more than one level is injected, bill 64480 as the add-on for each extra level.
• Imaging has to be part of the procedure. Claims without fluoroscopy or CT won’t get paid, so documentation of imaging is required.
• For bilateral procedures, payers don’t all follow the same rule. Some want a modifier -50. Others want you to bill RT and LT separately. Always check the payer’s instructions first.
• Bill per level, not per shot. More than one injection at the same level on the same day still counts as a single unit.

Modifiers with 64479

Correct use of modifiers ensures clean claims and faster payments. Here are the most relevant ones for 64479:

• -50 (Bilateral procedure): Use when injections are performed on both sides of the spine.
• -26 (Professional component): Applies if only the physician’s interpretation and report of the imaging are billed.
• -TC (Technical component): Use if only the technical portion, such as use of the facility and equipment, is billed.
• -59 (Distinct procedural service): May be necessary if 64479 is reported along with another injection code to indicate the services are separate and distinct.

Always confirm modifier requirements with the payer, since Medicare and commercial insurers may have different rules.

Documentation Requirements

Insurance won’t pay unless the notes are solid. At a minimum, you need:

• The diagnosis and symptoms.
• A line that shows medical necessity.
• The exact spinal level treated.
• Proof of imaging (fluoro or CT).
• Which side — right, left, or both.
• A full procedure or operative note.

Good documentation does three things. It keeps you safe in case of an audit. It keeps the claim compliant. And it cuts down the chances of denial.

Common Coding Errors and Denials

Even good coders trip up on 64479. The denials usually come from the same mistakes:

• No imaging note. Fluoro or CT has to be documented, or the claim won’t pass.
• Mixing it up with lumbar codes. 64483 is for lumbar or sacral, not cervical or thoracic.
• Modifiers are used wrong. -50, RT, LT — if they’re missing or applied wrong, payment gets cut.
• Billing more than one unit for the same level. Auditors flag that right away.
• Weak medical necessity. If the chart doesn’t show why the shot was needed, payers don’t reimburse.

Reimbursement and Fee Schedule for CPT 64479

What gets paid for 64479 depends on who the payer is and where the shot is done. Medicare has a national average rate, but private insurers may pay more or sometimes less. The setting matters too — office, hospital, or surgery center each has different schedules.

On the Medicare side, reimbursement is usually a few hundred dollars. Commercial plans often pay higher. Payment usually covers both the doctor’s work and the facility or equipment costs.

Bundling rules apply here as well. Imaging is already included in the code, so you don’t bill it separately. Sedation, if it’s used, can usually be reported on its own.

CPT 64479 vs. Related Codes

64479 often gets mixed up with other injection codes, so it helps to know the differences.

• 64479 vs 64480: 64479 is only for the first cervical or thoracic level. 64480 is the add-on for each extra level in the same session.
• 64479 vs 64483: 64479 covers cervical or thoracic. 64483 is for lumbar or sacral injections.
• 64479 vs 62321 or 64490: These are different procedures altogether — epidural or facet joint injections — and should only be used when that’s what was actually done.

Mixing up the codes doesn’t just slow down payment. It can also draw unwanted attention from auditors.

Final Thoughts

64479 looks simple on paper, but billing it right takes care. Imaging has to be in the note every time. Modifiers need to match the procedure. Medical necessity must be spelled out, not assumed.

Knowing how 64479 differs from the related codes and sticking to each payer’s rules cuts down denials and keeps payment moving. Good documentation and accurate coding don’t just protect revenue — they also keep providers safe if an audit comes up.

FAQs

Q: What is CPT 64479 used for?
Ans: It is used to report cervical or thoracic transforaminal epidural steroid injections with imaging guidance.

Q: Does CPT 64479 require imaging?
Ans: Yes. Either fluoroscopy or CT guidance must be documented, or the claim will be denied.

Q: Can CPT 64479 be billed with 64480?
Ans: Yes. 64479 covers the first level, while 64480 is billed for each additional level during the same session.

Q: How do you bill bilateral injections?
Ans: This depends on the payer. Some require modifier -50, while others want separate claims with RT and LT.

Q: How much does Medicare reimburse for 64479?
Ans: Reimbursement varies but is generally a few hundred dollars. Commercial payer rates can be higher.