Add-on for a third or later cervical or thoracic facet joint or medial branch level injected in one session, with imaging guidance included.
- Medicare
- $102.21
- Work RVU
- 1.13
- 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 ↓
- All three levels and sides named
- Clinical reason for the third level
- Imaging guidance and saved images
- Diagnostic or therapeutic intent
- Signed ABN for Medicare patients when billing beyond LCD limits
- Medication and volumes
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 ↓
64492 is the third-level add-on for cervical or thoracic facet injections. It requires both 64490 and 64491 on the same claim and is reported only once per day, no matter how many additional levels were done.
Medicare is where this code runs into trouble. The facet joint LCDs cap how many levels one session can include, and a third cervical or thoracic level often falls outside that cap. If the physician still wants to do three levels on a Medicare patient, the practice should collect an ABN before the procedure and append GA.
Commercial payers vary. Some allow three levels with documentation that the pain generator cannot be narrowed further. Others follow Medicare. Imaging guidance stays bundled. Write the note so each level is named and has its own clinical reason, because an auditor will ask why the third level was needed.
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 (1.13) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (3.06) adds practice overhead and malpractice, and is what drives the Medicare payment below.
| Work RVU | 1.13 |
| Practice expense RVU | 1.84 |
| Malpractice RVU | 0.09 |
| Total RVU | 3.06 |
| Medicare national rate | $102.21 |
| 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 | $102.21 |
Common denial reasons
The recurring reasons claims for CPT 64492 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Medicare LCD level limit exceeded
- Billed more than once per day
- Missing 64490 or 64491 on the same claim
- No ABN on file for a non-covered Medicare service
- Insufficient documentation for the added level
- Frequency limit for the region exceeded
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 3 cited references ↓
01Does Medicare pay for 64492?
02How many units of 64492 can be billed?
03What codes must be billed with 64492?
Sources & references
Editorial content was developed using the following public sources.
Mira Scribe
Mira Scribe records the reason each level was chosen, which gives the practice something to point to when a payer questions the third level.
See how Mira captures CPT 64492 documentation