When coding bilateral lumbar facet blocks L3-4, L4-5, and L5-S1 I use 64493-50, 64494, 64494, 64495, 64495. Most insurance companies are denying the 2nd 64494 and 64495 as duplicates or exceeding number this code can be reported. According to the AMA CPT manual page 439 only code 64493 is the only code you can use modifier -50 on. Is anyone else having this same issue? I'm appealing but no luck so far. They still think they are duplicates. I even attach a copy of the CPT code book page to support this.