Injection, anesthetic agent; lumbar or sacral nerve, transforaminal epidural

CPT 64520 is the billing code for "Injection, anesthetic agent; lumbar or sacral nerve, transforaminal epidural". Injection of anesthetic agent into lumbar or sacral nerve

Medicare pays approximately $218.66 for CPT 64520 (national average). Actual payment varies by geographic location due to GPCI adjustments. Hospital and commercial insurance rates are typically 2-4x higher than Medicare rates.

CPT 64520 has a total RVU of 4.66, broken down as: Work RVU 2.00, Practice Expense RVU 2.50, and Malpractice RVU 0.16. RVUs (Relative Value Units) determine Medicare reimbursement rates.

Key documentation requirements for CPT 64520 include: Nerve injected documented; Level documented; Anesthetic agent documented; Patient response to procedure. Missing or incomplete documentation is a leading cause of claim denials for this code.

Bundling considerations for CPT 64520: Nerve injection. Lumbar or sacral Use an NCCI bundling checker to verify specific code combinations before billing.

Common modifiers for CPT 64520 include: 59 (Distinct procedural service when multiple procedures performed), 50 (Bilateral procedure), LT (Left side). Modifiers indicate special circumstances and can affect reimbursement or prevent claim denials.

The typical time requirement for CPT 64520 is Typically 15-20 minutes. Time-based codes require documentation of the actual time spent providing the service.