Billing for CPT Transforaminal 64483, 64484 and Interlaminar Epidural 62323 together Unbundling

A Question from one of my Blog Readers:

“So the question is – can you bill and report for CPT  Transforaminal 64483, 64484 with Interlaminar Epidural 62323 together on the same day, same session, same patient and the same Provider?”

Let’s begin this question by taking time to understand the code descriptor:

Interlaminar Epidural Injection CPT Code 62323  

Injection(s), of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, including needle or catheter placement, interlaminar epidural or subarachnoid, lumbar or sacral (caudal); with imaging guidance (ie, fluoroscopy or CT)

CPT 62323 – CCI Edits
Modifier “1” “Special Circumstance”
72275, 76000, 76001, 76800, 76942, 76970, 76998, 77001, 77002, 77003, 77012
Modifier “0” 62284, 62322
Mutually Exclusive with 64483

Lumbar/ Sacral Transforaminal Epidural Injection

CPT 64483

Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with imaging guidance (fluoroscopy or CT); lumbar or sacral, single level

Add-on CPT Code +64484

Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with imaging guidance (fluoroscopy or CT); lumbar or sacral, each additional level (List separately in addition to code for primary procedure)

Let’s look at the CCI Edits and do your judgment!

Billing for CPT Transforaminal 64483, 64484 and Interlaminar Epidural 62323 together Unbundling

As you can see 62323 is MUTUALLY EXCLUSIVE with CPT 64483

I also found this guideline from one of the local Medicare Carrier Part B:

  1. “For caudal or interlaminar injections, only one level may be performed, and NOT in conjunction with transforaminal injection in the same region. Caudal or interlaminar injection is not considered medically reasonable and necessary in conjunction with transforaminal injections at the same session, for the same level, or within three contiguous levels of the same region (lumbosacral or cervicothoracic)”   Source: Local Coverage Determination (LCD):  Epidural Injections for Pain Management (L36920)

So the answer to your question:  “can you bill and report for CPT  Transforaminal 64483, 64484 with Interlaminar Epidural 62323 together”

IS YES or NO …. and why is that? Because it really depends on the Insurance Payer’s Clinical and Reimbursement Guideline if they will accept it with a modifier or they don’t allow it based on the policy. So it is best to always verify this with your payers.

Learn more how to properly bill for Epidurals Injections – click here!

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Author: Pinky Maniri

Ms. Pinky, as she is fondly called - is a Reputable Professional Consultant and Expert in Practice Administration, Medical Billing, Coding, Health Information Technology, Insurance Credentialing and Compliance for Physician Offices. Well-educated with a Degree in Computer Systems Engineering and a background in Clinical Nursing and Small Business Management. Her professional mission is to make sure her clients/physicians maximize reimbursement while they remain compliant with the current rules, changes, guidelines and policies. Read More About Ms. Pinky here and See what Other's say about her Expertise Testimonials

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