SJH Procedures - Pain Management Service New Name Old Name CPT Code Service BLOCK, FACET JOINT, LUMBAR LUMBAR FACET NERVE BLOCK 64493 Injection(s), diagnostic or therapeutic agent, paravertebral Pain Management facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), lumbar or sacral; single level 64494 Injection(s), diagnostic or therapeutic agent, paravertebral Pain Management facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), lumbar or sacral; second level (List separately in addition to code for primary procedure) 64495 Injection(s), diagnostic or therapeutic agent, paravertebral Pain Management facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), lumbar or sacral; third and any additional level(s) (List separately in addition to code f BLOCK, SPINAL NERVE ROOT, LUMBAR, TRANSFORAMINAL APPROACH LUMBAR TRANSFORAMINAL NERVE BLOCK 0230T Injection(s), anesthetic agent and/or steroid, transforaminal Pain Management epidural, with ultrasound guidance, lumbar or sacral; single level 64483 Injection(s), anesthetic agent and/or steroid, transforaminal Pain Management epidural, with imaging guidance (fluoroscopy or CT); lumbar or sacral, single level 64484 Injection(s), anesthetic agent and/or steroid, transforaminal Pain Management epidural, with imaging guidance (fluoroscopy or CT); lumbar or sacral, each additional level (List separately in addition to code for primary procedure) INJECTION, COCCYX COCCYGEAL INJECTION 20610 Arthrocentesis, aspiration and/or injection, major joint or Pain Management bursa (eg, shoulder, hip, knee, subacromial bursa); without ultrasound guidance INJECTION, FACET JOINT, LUMBAR LUMBAR FACET INJECTION 0216T Injection(s), diagnostic or therapeutic agent, paravertebral Pain Management facet (zygapophyseal) joint (or nerves innervating that joint) with ultrasound guidance, lumbar or sacral; single level 0217T Injection(s), diagnostic or therapeutic agent, paravertebral Pain Management facet (zygapophyseal) joint (or nerves innervating that joint) with ultrasound guidance, lumbar or sacral; second level (List separately in addition to code for primary procedure) 0218T Injection(s), diagnostic or therapeutic agent, paravertebral Pain Management facet (zygapophyseal) joint (or nerves innervating that joint) with ultrasound guidance, lumbar or sacral; third and any additional level(s) (List separately in addition to code for primary proc 64493 Injection(s), diagnostic or therapeutic agent, paravertebral Pain Management facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), lumbar or sacral; single level 64494 Injection(s), diagnostic or therapeutic agent, paravertebral Pain Management facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), lumbar or sacral; second level (List separately in addition to code for primary procedure)

Page 1 of 4 * Indicates Inpatient only CPT Code/Procedure SJH Procedures - Pain Management Service New Name Old Name CPT Code Service INJECTION, FACET JOINT, LUMBAR LUMBAR FACET INJECTION 64495 Injection(s), diagnostic or therapeutic agent, paravertebral Pain Management facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), lumbar or sacral; third and any additional level(s) (List separately in addition to code f INJECTION, MUSCLE, PIRIFORMIS PIRIFORMIS MUSCLE INJECTION 20552 Injection(s); single or multiple trigger point(s), 1 or 2 muscle(s) Pain Management INJECTION, SACROILIAC JOINT SACRO ILIAC JOINT INJECTION 27096 Injection procedure for sacroiliac joint, anesthetic/steroid, Pain Management with image guidance (fluoroscopy or CT) including arthrography when performed INJECTION, SPINE, LUMBAR, EPIDURAL LUMBAR EPIDURAL INJECTION 0230T Injection(s), anesthetic agent and/or steroid, transforaminal Pain Management epidural, with ultrasound guidance, lumbar or sacral; single level 0231T Injection(s), anesthetic agent and/or steroid, transforaminal Pain Management epidural, with ultrasound guidance, lumbar or sacral; each additional level (List separately in addition to code for primary procedure) 62322 Injection(s), of diagnostic or therapeutic substance(s) (eg, Pain Management anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, including needle or catheter placement, interlaminar epidural or subarachnoid, lumbar or sacral 62323 Injection(s), of diagnostic or therapeutic substance(s) (eg, Pain Management anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, including needle or catheter placement, interlaminar epidural or subarachnoid, lumbar or sacral 62326 Injection(s), including indwelling catheter placement, Pain Management continuous infusion or intermittent bolus, of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, interlaminar 62327 Injection(s), including indwelling catheter placement, Pain Management continuous infusion or intermittent bolus, of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, interlaminar 64483 Injection(s), anesthetic agent and/or steroid, transforaminal Pain Management epidural, with imaging guidance (fluoroscopy or CT); lumbar or sacral, single level 64484 Injection(s), anesthetic agent and/or steroid, transforaminal Pain Management epidural, with imaging guidance (fluoroscopy or CT); lumbar or sacral, each additional level (List separately in addition to code for primary procedure) INJECTION, SPINE, LUMBAR, EPIDURAL, TRANSFORAMINAL APPROACH LUMBAR TRANSFORAMINAL EPIDURAL 0230T Injection(s), anesthetic agent and/or steroid, transforaminal Pain Management epidural, with ultrasound guidance, lumbar or sacral; single level

Page 2 of 4 * Indicates Inpatient only CPT Code/Procedure SJH Procedures - Pain Management Service New Name Old Name CPT Code Service INJECTION, SPINE, LUMBAR, EPIDURAL, TRANSFORAMINAL APPROACH LUMBAR TRANSFORAMINAL EPIDURAL 0231T Injection(s), anesthetic agent and/or steroid, transforaminal Pain Management epidural, with ultrasound guidance, lumbar or sacral; each additional level (List separately in addition to code for primary procedure) 64483 Injection(s), anesthetic agent and/or steroid, transforaminal Pain Management epidural, with imaging guidance (fluoroscopy or CT); lumbar or sacral, single level 64484 Injection(s), anesthetic agent and/or steroid, transforaminal Pain Management epidural, with imaging guidance (fluoroscopy or CT); lumbar or sacral, each additional level (List separately in addition to code for primary procedure) INSERTION, MORPHINE PUMP INSERTION OF MORPHINE PUMP 62360 Implantation or replacement of device for intrathecal or Pain Management epidural drug infusion; subcutaneous reservoir 62361 Implantation or replacement of device for intrathecal or Pain Management epidural drug infusion; nonprogrammable pump 62362 Implantation or replacement of device for intrathecal or Pain Management epidural drug infusion; programmable pump, including preparation of pump, with or without programming INSERTION, PERMANENT ELECTRODE LEAD AND PULSE GENERATOR, PERCUTANEOUS SPINAL CORD STIMULATOR PULSE GENERATOR AND 63650 Percutaneous implantation of neurostimulator electrode array, Pain Management SPINAL CORD STIMULATOR, PERCUTANEOUS ELECTRODES PERMANENT IMPLANTATION epidural 63685 Insertion or replacement of spinal neurostimulator pulse Pain Management generator or receiver, direct or inductive coupling INSERTION, PULSE GENERATOR, NEUROSTIMULATOR, OCCIPITAL INSERTION OCCIPITAL NERVE STIMULATOR WITH GENERATOR 61885 Insertion or replacement of cranial neurostimulator pulse Pain Management generator or receiver, direct or inductive coupling; with connection to a single electrode array INSERTION, SPINAL CORD STIMULATOR, STAGE 2 SPINAL CORD STIMULATION STAGE 2 63685 Insertion or replacement of spinal neurostimulator pulse Pain Management generator or receiver, direct or inductive coupling LAMINECTOMY, SPINE, CERVICAL, WITH PULSE GENERATOR AND SPINAL CERVICAL LAMINECTOMY INSERT SPINAL CORD STIMULATOR WITH 63655 Laminectomy for implantation of neurostimulator electrodes, Pain Management CORD STIMULATOR INSERTION GENERATOR plate/paddle, epidural 63685 Insertion or replacement of spinal neurostimulator pulse Pain Management generator or receiver, direct or inductive coupling LAMINECTOMY, SPINE, THORACIC, WITH PULSE GENERATOR AND SPINAL THORACIC LAMINECTOMY INSERT SPINAL CORD STIMULATOR WITH 63655 Laminectomy for implantation of neurostimulator electrodes, Pain Management CORD STIMULATOR INSERTION GENERATOR plate/paddle, epidural 63685 Insertion or replacement of spinal neurostimulator pulse Pain Management generator or receiver, direct or inductive coupling LAMINECTOMY, SPINE, THORACOLUMBAR, WITH PULSE GENERATOR AND THORACOLUMBAR LAMINECTOMY INSERT SPINAL CORD STIMULATOR 63655 Laminectomy for implantation of neurostimulator electrodes, Pain Management SPINAL CORD STIMULATOR INSERTION WITH GENERATOR plate/paddle, epidural 63685 Insertion or replacement of spinal neurostimulator pulse Pain Management generator or receiver, direct or inductive coupling RADIOFREQUENCY ABLATION, FACET JOINT, LUMBAR LUMBAR FACET JOINT RADIOFREQUENCY ABLATION 64635 Destruction by neurolytic agent, paravertebral facet joint Pain Management nerve(s), with imaging guidance (fluoroscopy or CT); lumbar or sacral, single facet joint 64636 Destruction by neurolytic agent, paravertebral facet joint Pain Management nerve(s), with imaging guidance (fluoroscopy or CT); lumbar or sacral, each additional facet joint (List separately in addition to code for primary procedure) REMOVAL, NEUROSTIMULATOR, SPINAL SPINAL CORD STIMULATION REMOVAL 63661 Removal of spinal neurostimulator electrode percutaneous Pain Management array(s), including fluoroscopy, when performed Page 3 of 4 * Indicates Inpatient only CPT Code/Procedure SJH Procedures - Pain Management Service New Name Old Name CPT Code Service REMOVAL, NEUROSTIMULATOR, SPINAL SPINAL CORD STIMULATION REMOVAL 63662 Removal of spinal neurostimulator electrode plate/paddle(s) Pain Management placed via laminotomy or laminectomy, including fluoroscopy, when performed 63663 Revision including replacement, when performed, of spinal Pain Management neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed 63664 Revision including replacement, when performed, of spinal Pain Management neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy, including fluoroscopy, when performed 63688 Revision or removal of implanted spinal neurostimulator pulse Pain Management generator or receiver 64585 Revision or removal of peripheral neurostimulator electrode Pain Management array REPLACEMENT, ELECTRODE LEAD AND PULSE GENERATOR, SPINAL CORD SPINAL CORD STIMULATION GENERATOR AND LEAD 63663 Revision including replacement, when performed, of spinal Pain Management STIMULATOR REPLACEMENT/EXCHANGE neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed 63685 Insertion or replacement of spinal neurostimulator pulse Pain Management generator or receiver, direct or inductive coupling REPLACEMENT, ELECTRODE LEAD, SPINAL CORD STIMULATOR SPINAL CORD STIMULATION LEAD REPLACEMENT 63663 Revision including replacement, when performed, of spinal Pain Management neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed 63664 Revision including replacement, when performed, of spinal Pain Management neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy, including fluoroscopy, when performed REPLACEMENT, PULSE GENERATOR, SPINAL CORD STIMULATOR SPINAL CORD STIMULATION GENERATOR REPLACEMENT/EXCHANGE 63685 Insertion or replacement of spinal neurostimulator pulse Pain Management generator or receiver, direct or inductive coupling REPOSITIONING, ELECTRODE LEAD, SPINAL CORD STIMULATOR SPINAL CORD STIMULATION REPOSITION LEAD 63663 Revision including replacement, when performed, of spinal Pain Management neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed 63664 Revision including replacement, when performed, of spinal Pain Management neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy, including fluoroscopy, when performed

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