CPT code 77003: Fluoroscopic guidance, spinal or paraspinal injection2026 Medicare rate & RVUs

Medicare pays $104.54 for 77003 nationally in the office. Local office rates run $92.01–$142.70.

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

What 77003 covers

This service uses fluoroscopy to guide a needle or catheter during a spinal or paraspinal injection, helping the practitioner advance and position it at the intended site. It is commonly performed by pain medicine physicians, anesthesiologists, radiologists, and other clinicians performing image-guided spine procedures in office or facility settings. Examples include guidance for an epidural injection or an injection near spinal structures when the associated procedure code does not include imaging guidance.

Report 77003 only as an add-on to an eligible primary procedure; CMS places its payment within that procedure’s global period. The primary code must describe the injection, and its coding rules must permit separate reporting of guidance. Documentation should identify the spinal or paraspinal target, the fluoroscopic guidance performed, and support the service with saved images and a written report. CMS separately prices professional and technical components: modifier 26 identifies the interpretation, modifier TC identifies equipment and staff, and billing without either modifier represents the global service.

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 77003 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

77003 rates by state

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

How the 77003 rate is calculated

Each of 77003’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 77003

The CMS indicators that decide how 77003 is paid alongside other services.

What modifiers do to the payment

When to use modifier 26

77003 compared with similar codes

How to choose

62323Lumbar epidural injectionInterlaminar or caudal, with imaging guidance

This code describes a lumbar or sacral epidural injection that includes imaging guidance. Do not separately report 77003 for guidance already included in that service.

77002Fluoroscopy guidanceNeedle placement

77002 is fluoroscopic needle guidance for targets outside the spine and paraspinal region; 77003 is specific to spinal or paraspinal injection guidance.

77012CT guidanceNeedle placement

77012 reports CT guidance for needle placement. Use 77003 when fluoroscopy guides the spinal or paraspinal injection instead.

Codes related to 77003

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