CPT code 64493: Facet joint injection, lumbar or sacral, one level2026 Medicare rate & RVUs

Medicare pays $190.39 for 64493 nationally in the office and $81.50 in a hospital or facility. Local office rates run $168.90–$253.89.

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

What 64493 covers

A physician, commonly a pain specialist, anesthesiologist, or radiologist, uses fluoroscopy or CT to guide an injection to a lumbar or sacral paravertebral facet joint or the nerves supplying it. The injection may be diagnostic, such as evaluating suspected facet-mediated back pain, or therapeutic. The code represents one spinal level, not one needle or one side; the documented target must be in the lumbar or sacral region.

Report 64493 for the first treated level. Document the spinal level, side, target, clinical reason, and image guidance. The imaging guidance is part of the service. CMS assigns a 0-day global period, so same-day preoperative and postoperative care is included. For multiple procedures in one session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Bilateral reporting with modifier 50 is paid at 150%. An assistant at surgery may be paid; co-surgeons and team surgery are not permitted.

This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.

Where 64493 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

64493 rates by state

Office rate range in each state. Select a state to see its payment localities.

How the 64493 rate is calculated

Each of 64493’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.

Payment rules and modifiers for 64493

The CMS indicators that decide how 64493 is paid alongside other services.

What modifiers do to the payment

When to use modifier 50

64493 compared with similar codes

How to choose

64494Facet joint injectionLumbar/sacral, second level

64493 is the first lumbar or sacral level; 64494 is the add-on for the second level in the same region.

64495Facet injectionThird and additional levels

64495 is the add-on for a third lumbar or sacral level; it does not replace 64493 for the first level.

64490Facet injectionCervical or thoracic, one level

Both describe a single-level facet-joint injection, but 64490 is for the cervical or thoracic region and 64493 is for the lumbar or sacral region.

64483Transforaminal epidural injectionLumbar or sacral, first level

64483 is a transforaminal epidural injection targeting a nerve root; 64493 targets a lumbar or sacral facet joint or its innervating nerves.

Codes related to 64493

Related codes aren’t interchangeable: bill the code that matches the service performed.

Where these rates come from

FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.

CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027

Open CMS sourceHow we calculate rates