Facet Joint Injection Cost: $190 in an Office, $985 in a Hospital
A lumbar facet joint injection or medial branch block, CPT 64493, is allowed at $190.39 in a doctor's office and $985.13 in a hospital outpatient department. That is a 5.2x swing, the second widest on any spinal injection, and nothing about the procedure changes. Medicare also draws two hard lines on these that show up directly on bills: never more than two levels, and therapeutic injections are not covered at all unless the record explains why ablation could not be done instead.
- The building is worth $794.74 per injection. Office $190.39, surgery center $567.01, hospital outpatient $985.13, for an identical lumbar facet block.
- A third level is explicitly non-covered. Medicare's facet policy says three and four-level procedures are not medically necessary and therefore non-covered. The market already knows: CPT 64495 was billed 887 times nationally in 2024 against 383,086 second-level claims.
- Repeat therapeutic facet injections are not covered unless the chart documents why you are not a candidate for radiofrequency ablation. Routine repeat blocks every few months are outside the policy.
What You Are Actually Having Done
Facet joints are the small paired joints at the back of each spinal segment. When they are the pain source, the pain is usually axial, meaning in the back or neck itself rather than shooting down a leg or arm. That is the opposite of sciatica, which is why facet injections and epidural steroid injections are not interchangeable even though both are spinal injections done the same way with the same imaging.
The same codes cover two different things. A medial branch block numbs the nerves that supply the joint and is used diagnostically: if your pain drops by at least 80%, the joint is the culprit. An intra-articular injection puts steroid into the joint itself and is therapeutic. Medicare bills both under 64490 through 64495 and applies different rules to each, which is the source of most of the denials on these.
What Medicare Allows, by Code and by Place
National rates for October 1 through December 31, 2026. Facility totals add the doctor's professional fee and the facility's own fee, because a facility procedure generates two bills.
| Procedure (CPT) | Office | Surgery center | Hospital outpatient |
|---|---|---|---|
| Facet joint injection, lumbar or sacral, 1 level (64493) | $190.39 | $567.01 | $985.13 |
| Facet joint injection, cervical or thoracic, 1 level (64490) | $205.08 | $579.70 | $997.82 |
| Second level, lumbar (64494) | +$95.86 | +$43.76 | +$43.76 |
| Second level, cervical or thoracic (64491) | +$101.87 | +$50.77 | +$50.77 |
| Third level, lumbar (64495)Non-covered under Medicare facet policy | $98.87 | $45.09 | $45.09 |
| Sacroiliac joint injection with imaging (27096) | $175.69 | $461.28 | $794.99 |
Third-level figures are the fee schedule amounts, shown for reference only. Medicare's facet policy treats three and four-level procedures as non-covered, so these are amounts you would owe in full, not amounts Medicare pays. Sacroiliac facility rates use HCPCS G0260, the code hospitals and surgery centers bill for that procedure.
Your 20% Share
| What you are having done | Office | Surgery center | Hospital |
|---|---|---|---|
| One-level lumbar facet block | $38.08 | $113.40 | $197.03 |
| Two-level lumbar facet block, the usual procedure | $57.25 | $122.15 | $205.78 |
| Sacroiliac joint injection | $35.14 | $92.26 | $159.00 |
| The yearly maximum: four two-level sessions | $229.00 | $488.62 | $823.11 |
Add the $283 Part B deductible if you have not met it. Original Medicare has no annual out-of-pocket cap.
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The Third Level Nobody Bills
Medicare's facet joint policy is unusually blunt here: "One to two levels, either unilateral or bilateral, are allowed per session per spine region. Three or four-level procedures are not medically necessary and therefore are non-covered."
You can see that rule working in the claims data. In 2024, CPT 64494, the second lumbar level, was billed 383,086 times. CPT 64495, the third level, was billed 887 times. The entire country billed a third level about twice a day. If it is on your bill, you are in rare company, and the amount is yours to pay unless you were given an advance beneficiary notice before the procedure.
Bilateral is not a third level
The policy allows one or two levels "either unilateral or bilateral." Injecting both sides of two levels is still a two-level procedure, billed with a bilateral modifier, not four units. Four unmodified units of 64493 and 64494 on one date is the shape of a coding error.
The Rules Medicare Applies
From LCD L38773, Facet Joint Interventions for Pain Management, revised July 23, 2026. Most of these are checkable against your own bill and your own calendar.
A diagnostic block has to actually work to justify the next step
The first diagnostic facet procedure needs a consistent positive response of at least 80% relief of the primary pain, lasting as long as the anesthetic should last. Without that documented response, the follow-on procedures are not supported.
Four diagnostic and four therapeutic sessions per region per year
Each capped at four per spinal region per rolling twelve months, and limited to one spinal region per session. A session means everything done on the same day, so stacking procedures does not create extra sessions.
Therapeutic injections need a reason ablation was not used
This one surprises people. The policy says therapeutic facet injections are not covered unless the documentation justifies why radiofrequency ablation cannot be performed, for example an implanted electrical device or an established spinal pseudarthrosis. If you have been getting repeat steroid injections into the same joints for years with no such note in the chart, the claims are outside the policy. What ablation costs instead.
Imaging is required, and ultrasound does not count
Facet interventions done without CT or fluoroscopic guidance are not reasonable and necessary. That explicitly includes procedures done under ultrasound or MRI guidance. The guidance is also included in the injection codes themselves, so a separate fluoroscopy line is a duplicate.
Sedation is not covered, and anxiety is not a reason
Moderate or deep sedation, general anesthesia and monitored anesthesia care are not considered medically reasonable and necessary during facet injections. The policy states that patient anxiety or preference alone is not sufficient justification. What to do about an anesthesia charge.
Not for generalized pain conditions
Facet procedures for fibromyalgia or chronic centralized pain syndromes are not reasonable and necessary. Neither is combining them with epidurals, sympathetic blocks or trigger point injections on the same day, which the policy warns can lead to improper diagnosis.
What Providers Charge for These
2024 Medicare claims, professional fee only, services performed in a facility. The facility's own charge is separate and on top.
| Code | Average charge | Average allowed | Multiple |
|---|---|---|---|
| 64493 lumbar facet, 1 level | $2,276.48 | $248.12 | 9.2x |
| 64490 cervical facet, 1 level | $2,305.33 | $258.47 | 8.9x |
| 64494 lumbar facet, second level | $745.29 | $68.13 | 10.9x |
| 27096 sacroiliac joint injection | $962.38 | $97.86 | 9.8x |
These were common procedures in 2024: 620,251 first-level lumbar facet injections, 220,805 cervical, and 306,924 sacroiliac joint injections, in traditional Medicare alone.
How to Pay Less
Ask whether the clinic bills as an office or a hospital department
Worth $794.74 per injection, $158.95 of it yours. A pain practice owned by a hospital system often sits in an ordinary office building and still bills as a hospital outpatient department. Ask for the place-of-service code they will use.
Ask what is being injected and why
A diagnostic medial branch block and a therapeutic steroid injection use the same codes but follow different rules. If the plan is repeat therapeutic injections, ask for the note explaining why ablation is not an option, because the policy requires it and its absence is the most common denial on these.
Count levels before you sign
Two levels per region per session is the ceiling. If the plan is three, ask what happens to the third on the claim and whether you will be asked to sign an advance beneficiary notice for it.
Decline sedation
It is a separate professional bill and the policy says anxiety alone does not justify it.
Related Guides
Common Questions
How much does a facet joint injection cost?
Medicare allows $190.39 for a one-level lumbar facet injection in a doctor's office, $567.01 in an ambulatory surgery center and $985.13 in a hospital outpatient department, at national rates for October through December 2026. Your 20% is $38.08, $113.40 or $197.03 plus the $283 Part B deductible. A second level adds $95.86 in an office and $43.76 in a facility. The average charge providers submitted for the professional fee alone in 2024 was $2,276.48.
Does Medicare cover facet joint injections?
Yes, with specific limits. Up to four diagnostic and four therapeutic sessions per spinal region per rolling twelve months, one spinal region per session, a maximum of two levels per session, and only with CT or fluoroscopic guidance. A diagnostic block needs to produce at least 80% relief to support further treatment, and repeat therapeutic injections require documentation of why radiofrequency ablation cannot be done instead.
How many levels can be injected at once?
Two per spinal region per session, either unilateral or bilateral. Medicare's facet policy states that three and four-level procedures are not medically necessary and are therefore non-covered. In practice almost nobody bills a third level: CPT 64495 appeared on 887 claims nationally in 2024 against 383,086 for the second level.
What is the difference between a facet injection and an epidural?
A facet injection targets the small joints at the back of the spine and is used for axial pain, meaning pain in the back or neck itself. An epidural steroid injection targets an irritated nerve root and is used for radicular pain, meaning pain travelling down a leg or arm, which is what sciatica is. They are different procedures with different codes, different coverage policies and different prices.
Why do I keep getting facet injections instead of ablation?
Worth asking directly. Medicare's facet policy says therapeutic facet injections are not covered unless the record documents why you are not a candidate for radiofrequency ablation, giving examples such as an implanted electrical device or established spinal pseudarthrosis. Ablation is also the procedure the diagnostic blocks are meant to qualify you for. If repeat injections are the plan with no such documentation, the claims sit outside the policy.
My facet injection claim was denied. What now?
Denials on these usually cite one of a short list: more than two levels, more than one spinal region on the same day, exceeding four sessions in twelve months, missing documentation of 80% relief from the diagnostic block, missing justification for a therapeutic injection instead of ablation, or no fluoroscopic or CT guidance. Get the denial reason in writing, get the chart notes, and answer the specific criterion. If the documentation exists and was simply not submitted, that is the most winnable kind of appeal.
Sources
- CMS, CY2026 Physician Fee Schedule Relative Value File, October release. Non-facility and facility total RVUs for CPT 64490, 64491, 64493, 64494, 64495 and 27096. Conversion factor $33.4009.
- CMS, Hospital Outpatient Prospective Payment System Addendum B, October 2026 quarterly update. APC assignments, status indicators and payment rates, including HCPCS G0260 for sacroiliac joint injection.
- CMS, Ambulatory Surgical Center Payment Addendum AA, October 2026 quarterly update.
- CMS Medicare Coverage Database, LCD L38773, Facet Joint Interventions for Pain Management (CGS Administrators), original effective May 2, 2021, revision effective July 23, 2026. Covered indications, limitations and frequency limits.
- CMS, Medicare Physician and Other Practitioners by Geography and Service, 2024 data year. National service counts, average submitted charges and average allowed amounts by HCPCS code and place of service.