A Current Procedural Terminology (CPT) code is a standardized five-digit identifier used by medical professionals and insurers to describe a specific service or procedure performed on a patient. Managed by the American Medical Association, these codes serve as the common language for medical billing, ensuring providers are reimbursed correctly. CPT 64483 precisely defines a specific medical intervention and its technical components.
The Official Definition and Location
CPT 64483 officially describes the procedure as: “Injection(s), anesthetic agent(s) and/or steroid; transforaminal epidural, with imaging guidance (fluoroscopy or CT), lumbar or sacral, single level.” This means the code is used for a Transforaminal Epidural Steroid Injection (TFESI) delivered into the lower back or sacrum. The term “transforaminal” indicates the medication is injected through the neural foramen, which is the small opening where a spinal nerve root exits the bony structure of the spine. It is designated for only a single vertebral level, such as L4-L5 or L5-S1, meaning it covers the treatment of one spinal nerve root.
It is important to note that although the procedure is often confused with a Lumbar Medial Branch Block (LMBB), they are distinct interventions. A Lumbar Medial Branch Block, which is coded under CPT 64493 for the first level, targets the medial branch nerves that innervate the facet joints, a different anatomical structure. CPT 64483, the TFESI, focuses on the larger spinal nerve root as it exits the spine, typically addressing pain that radiates down the leg.
Clinical Application: Why This Procedure Is Necessary
The Transforaminal Epidural Steroid Injection (TFESI) represented by CPT 64483 is primarily indicated for pain originating from compression or irritation of a specific spinal nerve root. This condition, known as radiculopathy, is commonly caused by a herniated intervertebral disc, bony spurs, or spinal stenosis, where the nerve is physically pinched or inflamed. The goal of the injection is to deliver a potent anti-inflammatory agent, usually a corticosteroid, directly to the source of the nerve irritation.
A TFESI is generally performed after conservative treatments, such as physical therapy, anti-inflammatory medications, and rest, have failed to provide sufficient relief. The injection often includes an anesthetic agent, which serves a dual purpose: it provides immediate, temporary pain relief and acts as a diagnostic tool. The steroid component reduces inflammation around the nerve root, providing longer-lasting pain relief that can persist for weeks or months. This reduction in pain allows the patient to participate more effectively in physical rehabilitation, addressing the underlying mechanical issues.
Procedural Details and Imaging Requirements
The patient is positioned, typically lying prone, and the skin over the target area in the lower back is sterilized and numbed with a local anesthetic. The practitioner then uses a specialized needle to access the spinal column.
A fundamental requirement of CPT 64483 is the mandatory use of image guidance, specifically fluoroscopy (a type of real-time X-ray) or computed tomography (CT) guidance. This imaging is necessary to ensure the needle is positioned safely and accurately within the neural foramen, avoiding inadvertent contact with the nerve root, blood vessels, or the spinal cord itself. The imaging component is so integral to the procedure’s safety and effectiveness that the cost of the guidance is included within the CPT 64483 code and cannot be billed separately.
Once the needle is correctly placed, a small amount of contrast dye is injected, which appears brightly on the fluoroscopic screen. This contrast injection confirms that the medication will flow into the epidural space and not into an unintended structure, such as a blood vessel. Finally, the therapeutic mixture of anesthetic and steroid medication is injected, coating the inflamed nerve root before the needle is removed and a small dressing is applied.
Coding Relationships and Billing Context
CPT 64483 is the base code for a single-level Transforaminal Epidural Steroid Injection in the lumbar or sacral region, but its use often involves a secondary code and modifiers to reflect the full scope of the service provided. When a patient requires injections at more than one spinal level, a separate code, CPT 64484, must be used for each subsequent level. For instance, if a patient receives injections at both L3-L4 and L4-L5, CPT 64483 is billed for the first level, and the add-on code CPT 64484 is billed for the second level.
The concept of a bilateral procedure, where the injection is performed on both the left and right sides of the spine at the same level, requires the use of a specific billing modifier. In this scenario, the primary code, CPT 64483, is reported with modifier -50, which signifies a bilateral service was performed. Accurate billing requires careful documentation of the exact spinal levels treated and the side of the body, often using anatomical modifiers like -RT (right) or -LT (left) when a bilateral modifier is not applicable or preferred by the insurer.