CPT 62323Surgery

Njx interlaminar lmbr/sac

CPT 62323 represents an epidural steroid injection performed in the lower back (lumbar) or sacral region, where medication is injected into the space around the spinal cord to reduce pain and inflammation. This is commonly performed for patients with sciatica, herniated discs, or spinal stenosis.

Showing rates for

National Average

Base Medicare rate

$246.80

This calculator gives a typical-case estimate using standard Medicare modifier rules. Actual payment depends on payer policies, documentation, code-specific CMS status indicators, and locality. Verify before billing.

RVU breakdown

Work RVU

1.8

PE RVU (NF)

5.66

MP RVU

0.17

Total RVU

7.63

Conversion factor: 32.3465 · Source: CMS MPFS RVU25A · Confidence: High

NCCI bundling edits

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Billing tips

Bill in a non-facility setting when possible to capture the higher reimbursement rate
Impact: Increases reimbursement from $96.07 to $246.80 - a difference of $150.73 per procedure (157% increase)
Do NOT report 62323 with imaging guidance codes (77003, 77012) as this code specifically excludes imaging; use 62321 instead if fluoroscopy is used
Impact: Prevents automatic denials and potential fraud flags; incorrect pairing triggers NCCI edits
Document medical necessity clearly including failed conservative treatment (typically 4-6 weeks of PT, NSAIDs, or other non-invasive therapies)
Impact: Reduces denial rate by approximately 40-60%; most denials stem from lack of medical necessity documentation
Adhere to frequency limitations: Medicare typically covers 3-4 epidural injections per year per region; document rationale if exceeding
Impact: Prevents denials on subsequent injections; frequency violation denials often affect $250+ in claims
Report only one unit of 62323 regardless of volume or number of injections at the same interlaminar level during one session
Impact: Prevents downcoding and recoupment; multiple unit billing can trigger $96-247 in takebacks per extra unit
Verify that the procedure note specifies 'interlaminar' approach and 'lumbar or sacral' region; vague documentation leads to denials
Impact: Proper documentation prevents an estimated 25-35% of initial denials

Common denials

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Frequently asked questions

What is the difference between CPT 62323 and 62321?

CPT 62323 is for lumbar/sacral interlaminar epidural injection WITHOUT imaging guidance, while 62321 includes fluoroscopic guidance. If fluoroscopy or CT is used during the procedure, you must report 62321 instead. The reimbursement for 62321 is higher due to the imaging component, so proper code selection is critical for accurate payment.

How much does Medicare pay for CPT 62323 in 2025?

Medicare pays $246.80 for CPT 62323 in non-facility settings (physician office) and $96.07 in facility settings (hospital outpatient or ASC) based on the 2025 national average rates. Actual reimbursement varies by geographic locality based on the GPCI adjustments for your specific region.

How many times can CPT 62323 be billed per year?

Medicare typically allows 3-4 epidural steroid injections per spinal region per year. Exceeding this frequency requires strong medical necessity documentation explaining why additional injections are warranted. Commercial payers may have different policies, ranging from 2-6 injections annually, so verify individual payer policies.

Can I bill an E/M visit with CPT 62323 on the same day?

Yes, but only if the E/M service is significant, separately identifiable, and clearly documented beyond the standard pre-procedure evaluation. Use modifier 25 on the E/M code. The documentation must show that the E/M addressed problems beyond the decision to perform the injection. This combination is heavily audited, so ensure your documentation clearly supports both services.

What diagnosis codes support medical necessity for CPT 62323?

Common supporting diagnoses include M51.16 (lumbar disc disorder with radiculopathy), M48.06 (lumbar spinal stenosis with neurogenic claudication), M54.16 (lumbar radiculopathy), M54.5 (low back pain with appropriate qualifiers), and G89.29 (chronic pain). The diagnosis must support the need for epidural intervention and demonstrate that conservative treatment was insufficient.

What are the work RVUs for CPT code 62323?

CPT 62323 has 1.8 work RVUs, 5.66 practice expense RVUs (non-facility), 1.0 practice expense RVUs (facility), and 0.17 malpractice RVUs, for a total of 7.63 non-facility RVUs. When multiplied by the 2025 conversion factor of 32.3465, this yields the Medicare rates of $246.80 (non-facility) and $96.07 (facility).

Do I need to document informed consent for CPT 62323?

Yes, informed consent is required and should be documented in the medical record prior to the procedure. The consent should include discussion of risks (infection, bleeding, nerve damage, dural puncture), benefits, alternatives, and the patient's understanding and agreement. Many auditors specifically look for consent documentation, and its absence can support a denial even if the procedure itself was medically necessary.