64490 is to be reported for either an intra-articular facet joint injection OR blocking BOTH medial branches that provide sensory innervation to that joint. So if the physician injection into the C4-C5 joint itself OR blocked both the C4 and the C5 medial branches it would still only be 64490.
Check the code descriptor "Injection, diagnostic or therapeutic agent, paravertebral facet joint (zygapophyseal) joint (OR NERVES INNERVATING THAT JOINT) with image guidance (fluoroscopy or CT), ...
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