CPT 64484Surgery

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CPT code 64484 is used when a physician performs a transforaminal epidural injection in the lower back (lumbar or sacral spine), delivering anesthetic and/or steroid medication through the opening where nerve roots exit the spinal column. This is an add-on code used for each additional level beyond the first level treated.

Showing rates for

National Average

Base Medicare rate

$106.10

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

PE RVU (NF)

2.2

MP RVU

0.08

Total RVU

3.28

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

NCCI bundling edits

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Billing tips

Always verify that a primary code (64479 for cervical/thoracic or 64483 for lumbar/sacral first level) is billed on the same claim before reporting 64484
Impact: Prevents automatic denial of the add-on code, ensuring $48.84-$106.10 payment per level is not lost
Document each distinct spinal level treated with specific anatomical notation (e.g., L4-L5, L5-S1) and separate fluoroscopic imaging confirmation for each level
Impact: Reduces audit risk and supports billing multiple units of 64484; missing level-specific documentation can result in downcoding to single-level payment, losing $48.84-$106.10 per additional level
Bill in the non-facility setting (office with fluoroscopy equipment) when possible to capture the $106.10 rate versus $48.84 facility rate
Impact: Increases reimbursement by $57.26 per additional level (117% increase); requires appropriate equipment and overhead investment
Report fluoroscopic guidance separately using 77003 for each additional level when performed and documented, as it is not bundled with 64484
Impact: Captures additional reimbursement of approximately $20-40 per level depending on payer and setting
Use accurate unit reporting: one unit of 64484 per additional level beyond the first; do not bill 64484 for the first level (use 64483 for lumbar/sacral first level instead)
Impact: Billing 64484 for the first level results in automatic denial; proper coding ensures correct $48.84-$106.10 payment per appropriate level
Verify payer-specific limitations on the number of levels covered per session; many payers limit to 3-4 total levels including the primary code

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Frequently asked questions

What is CPT code 64484 used for?

CPT code 64484 is an add-on code used to report each additional level of transforaminal epidural injection with anesthetic and/or steroid in the lumbar or sacral spine, beyond the first level. It must be billed with primary code 64483 (first level lumbar/sacral) and represents each subsequent level treated during the same session.

How much does Medicare pay for CPT 64484 in 2025?

Medicare pays $106.10 for CPT 64484 in the non-facility (office) setting and $48.84 in the facility setting (ASC or hospital outpatient) based on the 2025 national average rates. Actual payment may vary by geographic location due to locality adjustments.

Can CPT 64484 be billed alone or does it require another code?

CPT 64484 cannot be billed alone; it is an add-on code that must be reported with a primary transforaminal epidural injection code. For lumbar/sacral injections, it must be billed with 64483 (first level). For cervical/thoracic injections, it would be billed with 64479.

How many units of 64484 can be billed per session?

The number of units of 64484 that can be billed depends on how many additional levels beyond the first were injected. For example, if three levels total are injected, you would bill 64483 (first level) plus two units of 64484 (second and third levels). Most payers limit total levels to 3-4 per session, though policies vary.

What documentation is required to bill CPT 64484?

Documentation must include specific anatomical identification of each level treated, fluoroscopic or CT imaging confirmation of needle placement at each distinct level, medication details for each injection, medical necessity for treating multiple levels supported by imaging findings, and correlation to clinical symptoms. Each additional level must be separately documented.

What is the difference between CPT 64483 and 64484?

CPT 64483 is the primary code for the first level of lumbar or sacral transforaminal epidural injection, while 64484 is the add-on code for each additional level beyond the first. 64483 can be billed alone for single-level injections, but 64484 must always be accompanied by 64483 when billing lumbar/sacral multilevel procedures.

Can bilateral transforaminal epidural injections at the same level be billed with 64484?

No, bilateral injections at the same anatomical level are typically reported by billing the appropriate primary or add-on code twice with RT and LT modifiers to indicate right and left sides. Each side at each level is billed separately. For example, bilateral L5-S1 injections would include two units of the appropriate code (64483 for first occurrence, potentially 64484 for additional) with laterality modifiers.