Disclaimer:  The information here is NOT meant to replace the sound advice of a billing and coding expert.

Below is a list of the most common CPT codes (procedure codes) used in a PM&R and interventional pain management clinic.  Electrodiagnostic (EMG/NCS) codes are also included.  These have all been updated for the most recent 2017 changes. Feel free to make coding tips in the comments below.

Remember:   Use the -50 modifier when performing BILATERAL procedures below. Note:   Fluoro needle guidance is built in to SI joint (27096), transforaminal and interlaminar ESIs, medial branch blocks, radiofrequency ablation (RFA) and facet injections; therefore, you can NOT bill for fluoro separately for these procedures.  But you CAN bill separate fluoro guidance codes (77002 for non-spinal) for peripheral joints/ligaments/bursa (hips, shoulders, iliolumbar ligament, troch bursa, etc.)

Joints and Bursa – Injection or Aspiration

  • Major joint/bursa: 20610 (knee, hip, shoulder, trochanteric bursa, subacromial bursa, pes anserine bursa)
  • Intermediate joint/bursa: 20605 (temporomandibular, acromioclavicular, wrist, elbow, ankle, olecranon bursa)
  • Minor joint/bursa: 20600 (fingers [PIP, DIP], toes)
  • Sacroiliac joint (SIJ) with fluoroscopy: 27096
  • Sacroiliac joint (SIJ) without fluoroscopy: 20552 (billed as a trigger point injection)
  • Fluoroscopic  needle guidance (non-spinal): 77002
  • Shoulder arthrogram injection: 23350 (+77002)
  • Hip arthrogram injection: 27093 (+77002)
  • Genicular nerve blocks:64450 x3 units
  • Genicular nerve RFA:64640, 64640-59, 64640-59

Tendons, Ligaments, and Muscle Injections

  • Tendon sheath or Ligament: 20550 (iliolumbar ligament, trigger finger, De Quervain's tenosynovitis, plantar fascia)
  • Tendon origin/insertion: 20551
  • Trigger point injection (1 or 2 muscles): 20552
  • Trigger point injection (3 or more muscles): 20553
  • Sacroiliac joint (SIJ) without fluoroscopy: 20552 (billed as a trigger point injection)
  • Intramuscular injections: 96372
  • Fluoroscopic  needle guidance (non-spinal): 77002

Nerve Blocks

  • Greater occipital nerve block: 64405
  • Lesser occipital nerve block: 64450
  • Other peripheral nerve: 64450 (I use this for superior cluneal nerve blocks, genicular nerve blocks, and lateral branch blocks for the SI joints)
  • Suprascapular nerve: 64418
  • Intercostal nerve (single): 64420
  • Intercostal nerve (multiple): 64421
  • Ilioinguinal and Iliohypogastric nerve: 64425
  • Trigeminal nerve (any branch): 64400
  • Sphenopalatine ganglion: 64505
  • Stellate ganglion (cervical sympathetic): 64510
  • Superior hypogastric plexus: 64517
  • Thoracic or lumbar paravertebral sympathetic or ganglion impar block: 64520
  • Celiac plexus: 64530
  • Plantar common digital nerve (Morton's neuroma): 64455
  • Unlisted procedure: 64999

Epidural Steroid Injections (ESI)

  • Interlaminar (WITH fluoroscopic imaging)
    • Interlaminar – cervical or thoracic: 62321
    • Interlaminar – lumbar or sacral (caudal): 62323
    • Remember: Fluoro can NOT be billed separately for these.
  • Transforaminal
    • Transforaminal – cervical or thoracic (first level): 64479
    • Transforaminal – cervical or thoracic (each additional level): 64480
    • Transforaminal – lumbar or sacral (first level): 64483
    • Transforaminal – lumbar or sacral (each additional level): 64484
    • Remember: Fluoro can NOT be billed separately for these.
    • Ex:   A bilateral L5 TF ESI would be billed as 64483 -50.

Facet Joint Procedures

  • Intraarticular Joint or Medial Branch Block
    • Intraarticular joint or medial branch block (MBB) – cervical or thoracic (1st level): 64490
    • Intraarticular joint or medial branch block (MBB) – cervical or thoracic (2nd level): 64491
    • Intraarticular joint or medial branch block (MBB) – cervical or thoracic (3rd level): 64492
    • Intraarticular joint or medial branch block (MBB) – lumbar or sacral (1st level): 64493
    • Intraarticular joint or medial branch block (MBB) – lumbar or sacral (2nd level): 64494
    • Intraarticular joint or medial branch block (MBB) – lumbar or sacral (3rd level): 64495
    • Note:   You can bill for bilateral facets or MBB at the same levels (with the -50 modifier), but you will NOT typically get reimbursed for over 3 facet joints or medial branches on the same side.
    • Note: For medial branch blocks, the proper billing is to bill for each complete facet joint blocks (see example below)
    • Ex:   Bilateral L3, L4, L5 MBBs would be billed as 64493 -50, 64494 -50.
    • Note:   The third occipital nerve (TON) partially innervates the C2/3 facet joint, so along with a C3 MBB, this would be billed as one full joint (64490)
    • Ex: Right TON, C3, C4, C5 blocks = Three full facet joints (C2/3, C3/4, C4/5) = 64490, 64491, 64492
    • Remember:   Fluoro can NOT be billed separately for these.
  • Radiofrequency Ablation (RFA) / "Destruction" of Facet Joint
    • Radiofrequency ablation (RFA) – cervical or thoracic (1st joint): 64633
    • Radiofrequency ablation (RFA) – cervical or thoracic (each additional joint): 64634
    • Radiofrequency ablation (RFA) – lumbar or sacral (1st joint): 64635
    • Radiofrequency ablation (RFA) – lumbar or sacral (each additional joint): 64636
    • Remember: Fluoro can NOT be billed separately for these.

Sacroiliac Joint

  • Sacroiliac joint (SIJ) without fluoroscopy: 20552 (billed as a trigger point injection)
  • Sacroiliac joint (SIJ) with fluoroscopy: 27096
  • Sacral lateral branch blocks: 64450(remember to bill 77003 with these, but not with the 64493 code)
  • Radiofrequency Ablation (RFA) of the Sacroiliac Joint
    • RF of L5 dorsal primary ramus: 64635
    • RF of S1 lateral branches: 64640
    • RF of S2 lateral branches: 64640
    • RF of S3 lateral branches: 64640
    • Fluoroscopic  needle guidance (Spinal): 77003 (for the S1-S3 nerve lateral branches, not the L5)
    • Note: Use 724.6 (Disorder of the sacrum) and 721.3 (lumbar spondylosis) as the diagnostic codes

Vertebroplasty / Kyphoplasty

  • Vertebroplasty
    • Vertebroplasty – Cervicothoracic (1st level) :22510
    • Vertebroplasty – Lumbosacral(1st level) :22511
    • Vertebroplasty – Each additional level of the above:+22512
    • Note: Same charge whether you perform unilateral or bilateral injection of cement (PMMA).  Modifier 50 can NOT be used.
    • Note: The global charge for the procedure includes all imaging guidance and any bone biopsy performed.
  • Kyphoplasty
    • Kyphoplasty – Thoracic (1st level):22513
    • Kyphoplasty – Lumbar (1st level): 22514
    • Kyphoplasty – Thoracic orLumbar (each additional level):+22515
    • Note: Same charge whether you perform unilateral or bilateral injection of cement (PMMA).  Modifier 50 can NOT be used.
  • Note: 10-day global period

Neurostimulation (Spinal Cord Stimulator / Dorsal Column Stimulator)

  • Trial Procedure
    • Percutaneous implant of electrode array: 63650 (includes 10-day global) – bill two units if you implant two trial leads
  • Implantation of Spinal Cord Stimulator Percutaneous Leads and Generator
    • Percutaneous implant of electrode array: 63650 (includes 10-day global)
    • Insertion or replacement of pulse generator: 63685 (includes 10-day global)
  • Implantation of Spinal Cord Stimulator PADDLE Leads and Generator
    • Laminectomy for implant of neurostimulator electrode, paddle: 63655 (includes 90-day global)
    • Insertion or replacement of pulse generator: 63685 (includes 10-day global)
  • Removal of Leads/Generator (Explant)
    • Removal of spinal neurostimulator percutaneous array(s): 63661 (includes 10-day global)
    • Removal of spinal neurostimulator paddle electrode: 63662 (includes 90-day global)
    • Removal of pulse generator: 63688 (includes 10-day global)
  • Important:   Also bill for the implanted neurostimulator electrodes (each lead): L8680

Discogram / Discography

  • Discogram / Discography – Cervical/Thoracic (each disc): 62291
  • Supervision & interpretation of fluoroscopy – Cervical/Thoracic (each disc): 72285
  • Discogram / Discography – Lumbar (each disc): 62290
  • Supervision & interpretation of fluoroscopy – Lumbar (each disc): 72295
  • Remember: Fluoroscopy is bundled here and can NOT be billed separately for these.

Botulinum Toxin Injections

  • Botulinum toxin type A – Botox, Dysport (per unit): J0585
  • Botulinum toxin type B – Myobloc (per 100 units): J0587
  • Needle electromyography in conjunction with chemodenervation: 95874
  • Chemodenervation of muscles in the neck (spasmodic torticollis): 64616
  • Chemodenervation of muscles of the trunk and/or extremity (cerebral palsy, dystonia, multiple sclerosis): 64614
  • Chemodenervation of muscles innervated by facial, trigeminal, cervical spinal and accessory nerves, bilateral (chronic migraine): 64615

Other

  • Carpal tunnel injection: 20526
  • Epidural blood patch: 62273
  • Moderate sedation (first 30 minutes): 99144 (requires presence of another trained person to monitor the patient's consciousness and vitals)
  • Moderate sedation (each additional 15 minutes): 99145
  • Fluoroscopic  needle guidance (spinal): 77003
  • Fluoroscopic  needle guidance (non-spinal): 77002
  • CT needle guidance: 77012

Acupuncture

  • with electrical stimulation: 97813
  • without electric stimulation: 97810

Modalities

  • Diathermy (Microwave): 97024
  • Heating pads / cold packs: 97010
  • Self-care / home management training: 97535
  • Therapeutic ultrasound: 97035
  • Traction: 97012
  • Transcutaneous Electrical Nerve Stimulation (TENS): G0283

Osteopathic Manipulative Treatment

  • OMT 1-2 body regions: 98925
  • OMT 3-4 body regions: 98926
  • OMT 5-6 body regions: 98927
  • OMT 7-8 body regions: 98928
  • OMT 9-10 body regions: 98929
    (note from a reader: use 98928 or less if OMT done in conjunction with an injection and 98927 or less of OMT done in conjunction with epidural)

Modifiers

  • -50:  Bilateral
  • -52:  Incomplete procedure (reduced service) [Stopping a part of a procedure because of reasons other than the patient's well-being]
  • -53:  Incomplete procedure (physician elected to terminate a surgical or diagnostic procedure due to the patient's well-being) – reduced service.  I've used for a patient that had a severe vasovagal response to a radiofrequency procedure and I elected to abort the procedure and reschedule later.
  • -59:  Indicates that a procedure or service is separate and independent from other services performed the same day
  • -26:  Professional component only

Injectables (J-codes)

  • Omnipaque 300 (per ml): Q9967
  • Omnipaque 240 (per ml):Q9966
  • Dexamethasone sodium phosphate (per mg): J1100
  • Celestone (per 3 mg): J0702
  • Celestone (per 4 mg): J0704
  • Depo-Medrol (40mg): J1030
  • Depo-Medrol (80mg): J1040
  • Kenalog/Triamcinolone (per 10 mg): J3301
  • Toradol/Ketorolac (per 15mg): J1885 (don't forget the 96372 code if injected intramuscular)
  • Methocarbamol – Robaxin (up to 10 ml): J2800  (don't forget the 96372 code if injected intramuscular)
  • Synvisc 3 dose (per 2 ml syringe): J7325
  • Synvisc One (per 6 ml syringe): J7325S
  • Versed (per mg): J2250
  • Fentanyl (0.1 mg): J3010
  • Diphenhydramine – Benadryl (injection up to 50-mg): J1200
  • Botulinum toxin type A – Botox, Dysport (per unit): J0585
  • Botulinum toxin type B – Myobloc (per 100 units): J0587

Electromyography (EMG) & Nerve Conduction Studies (NCS)

  • Sensory NCS (each nerve): 95904
  • Motor NCS w/o F-wave (each): 95900
  • Motor NCS with F-wave (each): 95903
  • H-reflex (gastrocnemius/soleus): 95934
  • H-reflex (other than gastroc/soleus): 95936
  • Blink reflex (orbicularis oculi): 95933 (only once per study)
  • EMG guidance during botulinum toxin injections: 95874
    • Add modifier -26 if you don't own the EMG machine you're using
  • EMG w/NCS, each extremity, "limited" (4 or fewer muscles): 95885
  • EMG w/NCS, each extremity, "complete" (5+ muscles, innervated by 3+ nerves or 4+ spinal levels): 95886
  • EMG w/o NCS on same day:  one extremity = 95860, two extremities = 95861, three = 95863, four = 95864
  • Cranial nerves
    • EMG (unilateral): 95867
    • EMG (bilateral ): 95868
  • Note:   EMG needles can not be billed separately, as they are included in the EMG codes
  • Muscle testing before the study
    • Extremity w/o hand (must include a report of this): 95831
    • Hand: 95832
  • 2013 CPT Coding Changes for Nerve Conduction Studies – Effective January 1, 2013
    • Each conduction study is counted as one for sensory, motor with or without F-wave, or H-reflex.  Orthodromic and antidromic tests on the same nerve count only once.
    • Example: Bilateral sensory and motor median and ulnar NCS is performed.  This is eight (8) separate tests, so the proper code now is 95910.  Adding a radial sensory on one side would then make it a 95911.
    • 1-2 NCS = 95907
    • 3-4 NCS = 95908
    • 5-6 NCS = 95909
    • 7-8 NCS = 95910
    • 9-10 NCS = 95911
    • 11-12 NCS = 95912
    • 13+ NCS = 95913

Evaluation and Management (E&M) codes

  • New patients
    • Straightforward – 10 minutes: 99201
    • Straightforward – 20 minutes: 99202
    • Low complexity – 30 minutes: 99203
    • Moderate complexity – 45 minutes: 99204
    • High complexity – 60 minutes: 99205
  • Established patients
    • Brief – 5 minutes: 99211
    • Straightforward – 10 minutes: 99212
    • Low complexity – 15 minutes: 99213
    • Moderate complexity – 25 minutes: 99214
    • High complexity – 40 minutes: 99215
  • Independent medical examination (IME): 99456