per CPT book, it states Image guidance (fluoroscopy or CT) and any injection of contrast are inclusive components of 64490-64495. Imaging guidance and localization are required for the performance of paravertebral facet joint injections described by codes 64490-64495. If imaging guidance is not used, report 20550-20553. If ultrasound guidance is used report 64999 or 0213T-0218T. Hopefully you can show him the CPT book and point this out about 20550-20553.
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