Transforaminal epidural injection of anesthetic, steroid, or both at one lumbar or sacral level, with fluoroscopic or CT guidance included.
- Medicare
- $264.87
- Work RVU
- 1.85
- 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
- Saved image showing needle position and contrast flow
- Drug, dose, and volume
- Radicular symptoms for at least four weeks and failed conservative care
- Pre-procedure pain and function scores
- Percent 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 ↓
64483 is a single-level lumbar or sacral transforaminal epidural injection under fluoroscopy or CT. It is one of the most common procedures referred out of an ortho spine clinic, usually for an L5 or S1 radiculopathy from a disc herniation or foraminal stenosis. Each additional level reports add-on 64484. Imaging is included, so 77003 and 77012 are not billed.
Medicare ESI LCDs drive most of the denial risk. They expect radicular pain for at least four weeks, failed conservative care such as PT and medications, documented pain and function scores, and no more than four sessions per region in a rolling 12 months. Transforaminal injections are capped at two levels per session, unilateral or bilateral. A repeat injection needs documented relief from the last one.
A bilateral injection at the same level is 64483 with modifier 50. Global period is 0 days. A same-day visit can be billed with modifier 25 only for a separate problem.
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 (1.85) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (7.93) adds practice overhead and malpractice, and is what drives the Medicare payment below.
| Work RVU | 1.85 |
| Practice expense RVU | 5.91 |
| Malpractice RVU | 0.17 |
| Total RVU | 7.93 |
| Medicare national rate | $264.87 |
| 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 | $264.87 |
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 64483 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- More than four lumbar ESI sessions in 12 months
- More than two transforaminal levels in one session
- Axial low back pain without radiculopathy on the claim
- Fluoroscopy billed separately
- Bilateral injection missing modifier 50
- No documented relief from the prior injection
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 3 cited references ↓
01How do you bill a bilateral L5-S1 transforaminal injection?
02What add-on code goes with 64483?
03Is fluoroscopy billed separately with 64483?
Sources & references
Editorial content was developed using the following public sources.
Mira Scribe
Mira Scribe's notes capture the dermatomal pain pattern, PT history, and percent relief from earlier injections, the details payers check before paying a repeat lumbar ESI.
See how Mira captures CPT 64483 documentation