Injection · Spine

Add-on for each additional cervical or thoracic level injected during a transforaminal epidural injection session, with imaging guidance included.

3 sources ↓

Medicare: $142.96
Work RVU: 1.17
Global, days
Region: Spine

Drawn from CMS

Documentation requirements

What must appear in the operative or office note to support the claim.

Source · Editorial brief grounded in 3 cited references ↓

Each additional level and side injected
Saved image at each level
Drug and volume at each level
Imaging or exam findings supporting multilevel involvement
Primary 64479 performed in the same session

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

50 Bilateral procedure RT Right side LT Left side 59 Distinct service XS Separate structure

What this code covers

Source · Editorial summary grounded in 3 cited references ↓

64480 adds each additional cervical or thoracic level to a transforaminal epidural injection reported with 64479. It has no global of its own and is never billed without 64479 on the same claim.

The Medicare ESI LCDs cap transforaminal injections at two levels per session, unilateral or bilateral. So a right-sided C5-C6 and C6-C7 injection is 64479 plus one unit of 64480. Many commercial payers follow the same limit or are stricter. Billing a third level almost always triggers a denial.

When the added level is bilateral, the add-on takes modifier 50 the same way the primary does. Do not use modifier 51, since add-ons are exempt from multiple procedure reductions. Imaging is included at each level. If the primary is denied for medical necessity, this code goes down with it, so fix the primary on appeal first. Each level injected should have its own image saved.

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 (1.17) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (4.28) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	1.17
Practice expense RVU	3
Malpractice RVU	0.11
Total RVU	4.28
Medicare national rate	$142.96
Global period	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	$142.96

Common denial reasons

The recurring reasons claims for CPT 64480 get rejected.

Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓

Billed without 64479
More than two transforaminal levels in one session
Bilateral add-on missing modifier 50
Modifier 51 appended
Primary 64479 denied
Additional level not supported by imaging or exam

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 3 cited references ↓

01What primary code goes with 64480?

64479, the single-level cervical or thoracic transforaminal injection.

02How many units of 64480 can be billed?

Under the Medicare ESI LCDs, transforaminal injections are capped at two levels per session, so one unit of 64480 at most. A bilateral second level takes modifier 50 rather than a second unit.

03Does 64480 take modifier 50?

Yes, when the additional level is injected bilaterally.