Key takeaways
- 62321 (cervical or thoracic) and 62323 (lumbar or sacral) are single-level interlaminar epidural codes that include imaging guidance. Transforaminal injections use 64479 and 64483 for the first level and add-on codes 64480 and 64484 for each additional level.
- One Medicare policy limits transforaminal injections to two levels per session, one spinal region per session, and four sessions per region in a rolling 12 months.
- Unilateral is one unit. Bilateral outside an ASC takes modifier 50. In an ASC you report two lines with RT and LT instead.
- Keep the final-needle-position images with at least two views, and a baseline pain score, in the record.
The epidural injection codes
Epidural steroid injections are billed by approach and spinal region. The interlaminar codes cover the epidural space reached between the vertebrae. The transforaminal codes cover the nerve root canal.
| Approach | Region | Code | Levels |
|---|---|---|---|
| Interlaminar | Cervical or thoracic | 62321 | One level per session |
| Interlaminar | Lumbar or sacral | 62323 | One level per session |
| Transforaminal | Cervical or thoracic | 64479, add-on 64480 | First level, each additional level |
| Transforaminal | Lumbar or sacral | 64483, add-on 64484 | First level, each additional level |
These codes include imaging guidance, so fluoroscopy or CT for the same injection is not billed on top.
Session and frequency limits
Under the Medicare policy in the CMS Coverage Database, transforaminal codes are limited to two levels per session, whether two unilateral or two bilateral. Only one spinal region can be treated per session. No more than four sessions per anatomic region are covered in a rolling 12-month period.
The practical rule is to check the count before you schedule the injection, not after the claim is denied. Track sessions by region and date, and ask the patient about injections done elsewhere.
Bilateral injections and modifiers
- Unilateral: one line and one unit.
- Bilateral outside an ASC: one line with modifier 50.
- Bilateral in an ASC: no modifier 50. Report two lines, one unit each, with RT and LT.
- Modifier KX is used for a diagnostic selective nerve root block, to separate it from a therapeutic epidural. Misuse can bring a focused review.
What the record needs
- The indication, the medical necessity and a baseline pain score.
- For a diagnostic nerve root block, the percent pain relief right after the injection.
- Saved images of the final needle position and contrast flow, with at least two views, available on request.
- A signed, legible report that supports the diagnosis code and the procedure code you billed.
Do not include a biological or other substance that is not FDA approved for epidural use. The policy says the whole claim may be denied.
Common epidural injection billing mistakes
- Billing imaging guidance separately on a code that already includes it.
- Using modifier 50 in an ASC, or leaving off RT and LT.
- Billing more than two transforaminal levels in a session.
- Exceeding four sessions per region in 12 months with no check.
- Missing images or a baseline pain score in the record.
- Assuming one MAC policy applies everywhere. Check your own MAC and each commercial payer.
Sources
Codes, levels, session and frequency limits, modifiers, imaging and documentation: CMS Medicare Coverage Database, billing and coding article A56681 (LCD L36920). Medicare contractors publish their own versions, so confirm yours.
Epidural steroid injection billing FAQ
What CPT codes are used for epidural steroid injections?
62321 for cervical or thoracic and 62323 for lumbar or sacral interlaminar injections, and 64479 and 64483 for the first level of a transforaminal injection with add-on codes 64480 and 64484 for each additional level.
Is imaging guidance billed separately for an epidural injection?
No for these codes. 62321, 62323 and the transforaminal codes include imaging guidance, so fluoroscopy or CT for the same injection is not billed separately.
How many epidural injections will Medicare cover?
Under the policy in the CMS Coverage Database, no more than four sessions per anatomic region in a rolling 12 months, one spinal region per session, and two transforaminal levels per session. Check your own MAC.
How do you bill a bilateral epidural injection?
Outside an ASC, one line with modifier 50. In an ASC, two lines with one unit each and modifiers RT and LT.
What records support an epidural injection claim?
The indication, medical necessity, a baseline pain score, a signed report and saved images of the final needle position and contrast flow with at least two views.