Transforaminal epidural injection of anesthetic, steroid, or both at one cervical or thoracic level, with fluoroscopic or CT guidance included.
- Medicare
- $285.24
- Work RVU
- 2.23
- Global, days
- 0
- Region
- Spine
Documentation requirements
What must appear in the operative or office note to support the claim.
Source · Editorial brief grounded in 3 cited references ↓
- Level and side injected
- Imaging modality with saved image showing contrast flow
- Drug, dose, and volume, including steroid type
- Radicular symptoms of at least four weeks and failed conservative care
- Pre-procedure pain and function scores
- Relief and duration from prior injection for repeats
Applicable modifiers
Modifiers commonly billed with this code.
Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual
What this code covers
Source · Editorial summary grounded in 3 cited references ↓
64479 is a single-level cervical or thoracic transforaminal epidural injection under fluoroscopy or CT. The needle goes into the foramen to deliver drug near the exiting nerve root. Each additional level reports add-on 64480. Imaging is included, so 77003 and 77012 are not billed.
Cervical transforaminal injections carry real risk, and payers know it. Medicare ESI LCDs set the same baseline as lumbar: radicular symptoms for at least four weeks, failed conservative care, pain and function scores, and up to four sessions per region in a rolling 12 months. The LCDs also cap transforaminal injections at two levels per session, unilateral or bilateral. Many commercial plans require prior authorization, and some put tighter limits on cervical transforaminal injections than on lumbar.
Bilateral at the same level uses modifier 50. Repeat injections need documented relief from the prior one. Global period is 0 days. A same-day E/M needs modifier 25 and a separate reason, such as a new shoulder complaint.
RVU & reimbursement
Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.
Source · CMS Physician Fee Schedule, RVU26A · January 2026
Work RVU vs. total RVU
The work RVU (2.23) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (8.54) adds practice overhead and malpractice, and is what drives the Medicare payment below.
| Work RVU | 2.23 |
| Practice expense RVU | 6.11 |
| Malpractice RVU | 0.2 |
| Total RVU | 8.54 |
| Medicare national rate | $285.24 |
| Global period | 0 days |
Payment by site of service
Medicare pays different rates by setting. HOPD typically pays substantially more than ASC for the same procedure.
Source · CMS OPPS Addendum B·ASC HCPCS payment rates·2026
| Setting | Medicare rate (national) |
|---|---|
Office (PFS non-facility) Procedure performed in physician's office | $285.24 |
HOPD (APC 5443) Hospital outpatient department | $903.63 |
ASC (PI A2) Ambulatory surgical center (freestanding) | $485.51 |
Common denial reasons
The recurring reasons claims for CPT 64479 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- More than two transforaminal levels per session
- More than four sessions per region in 12 months
- No prior authorization on file
- Imaging billed separately
- Bilateral injection without modifier 50
- Axial neck pain without radiculopathy
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 3 cited references ↓
01How many levels can be billed for a transforaminal ESI?
02How do you bill a bilateral cervical transforaminal injection?
03Is fluoroscopy included in 64479?
04What add-on code goes with 64479?
Sources & references
Editorial content was developed using the following public sources.
Mira Scribe
Mira Scribe's notes record dermatomal symptoms, exam findings, and relief from prior injections, so a repeat cervical or thoracic ESI has the history the LCD calls for.
See how Mira captures CPT 64479 documentation