Add-on code for each additional lumbar or sacral level of a transforaminal epidural steroid injection, with fluoroscopic or CT guidance included in the payment.
- Medicare
- $117.57
- Work RVU
- 0.98
- Global, days
- 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 ↓
- Each level injected, named by foramen (for example right L5-S1)
- Side of each injection and whether bilateral
- Imaging modality used and a saved image showing needle position and contrast spread
- Radicular symptoms and exam findings supporting the level choice
- Prior conservative treatment and its duration
- Drug, dose, and volume injected at each level
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 ↓
64484 is the add-on for a second or later lumbar or sacral transforaminal epidural injection done in the same session as 64483. It never stands alone. If the claim shows 64484 without 64483 on the same date of service, expect a denial.
In an ortho spine practice this usually comes up with multilevel foraminal stenosis or radiculopathy that tracks to two adjacent roots, for example L4 and L5 on the right. Each additional level gets one unit of 64484. Bilateral injections at the same level are reported with modifier 50 (or RT/LT, depending on the payer's preference), not as an extra level.
Imaging guidance is bundled. Do not add 77003 or 77012. Medicare contractors apply the epidural steroid injection LCD, which limits the number of levels per session and the number of sessions per year, and expects documented radicular findings and a trial of conservative care before the first injection. Many commercial payers require prior authorization for the whole series, not just the first shot.
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 (0.98) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (3.52) adds practice overhead and malpractice, and is what drives the Medicare payment below.
| Work RVU | 0.98 |
| Practice expense RVU | 2.46 |
| Malpractice RVU | 0.08 |
| Total RVU | 3.52 |
| Medicare national rate | $117.57 |
| 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 | $117.57 |
Common denial reasons
The recurring reasons claims for CPT 64484 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Billed without primary code 64483 on the same claim
- Levels exceed the payer or LCD limit per session
- Separate fluoroscopy code billed and denied as bundled
- Bilateral service billed as two levels instead of with modifier 50
- No prior authorization on file for the additional level
- Diagnosis shows axial back pain only, without radiculopathy
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 3 cited references ↓
01Can 64484 be billed without 64483?
02How do you bill a bilateral lumbar transforaminal epidural at one level?
03Is fluoroscopy billed separately with 64484?
04How many levels of transforaminal ESI does Medicare allow?
Sources & references
Editorial content was developed using the following public sources.
Mira Scribe
Mira Scribe notes record each foraminal level, the side, the radicular exam, and the prior conservative care, so the additional-level charge has its support in the same note as the primary injection.
See how Mira captures CPT 64484 documentation