CPT code 62328 – Image-guided diagnostic lumbar puncture

Key takeaways

CPT code 62328 reports a diagnostic lumbar puncture performed with fluoroscopic or CT guidance, and the imaging is included in the code.

Without fluoroscopy or CT, the same diagnostic puncture is 62270, while a therapeutic CSF drainage under that imaging is 62329.

Do not add 77003 or 77012 to 62328, and report an ultrasound- or MR-guided tap as 62270 plus 76942 or 77021.

In 2026, Medicare’s national rate for 62328 is $216.51 non-facility and $73.85 facility at the qualifying APM conversion factor.

Pabau’s practice software submits claims through Claim.MD and tracks eligibility and ERA remittance, so your team can follow each 62328 claim to payment.

CPT code 62328: Official descriptor and clinical scope

CPT code 62328 describes a spinal puncture, lumbar, diagnostic; with fluoroscopic or CT guidance. The provider enters the subarachnoid space at a lumbar level and collects cerebrospinal fluid for laboratory testing. Fluoroscopy or CT guides the needle, and that guidance is part of the code.

The code arrived in CPT 2020, when 62270 and 62272 became parent codes for two image-guided child codes, 62328 and 62329. That is why the descriptor reads as the 62270 stem followed by “with fluoroscopic or CT guidance.”

62328 sits in the Surgery section of the CPT code set, under Nervous System. Within it, the code falls in the injection, drainage, or aspiration range for the spine and spinal cord (62263-62329). It has a 0-day global period. The American Medical Association’s CPT code set overview explains how the AMA maintains these descriptors.

When a diagnostic lumbar puncture needs image guidance

Most diagnostic lumbar punctures are done at the bedside by landmark, and those are reported with 62270. Fluoroscopy or CT is usually requested when a landmark approach is likely to fail or already has. Common reasons include obesity, prior lumbar surgery or fusion, scoliosis and advanced degenerative change.

The patient typically lies prone on the fluoroscopy table or in the CT gantry. The provider localizes the interspace, advances the spinal needle under imaging and measures the opening pressure where ordered. CSF is then collected into numbered tubes for the requested tests.

CPT 62328 vs 62270 and 62329: Choosing the right lumbar puncture code

Two questions pick the code: was the puncture diagnostic or therapeutic, and did fluoroscopy or CT guide it? 62328 is the diagnostic, image-guided answer. 62270 is the same diagnostic puncture without that guidance. 62329 is a guided therapeutic drainage, and 62272 is the unguided drainage.

Work RVUs come from the CMS 2026 PFS relative value file, October release.

Read the indication first and the imaging second. A guided tap to test CSF for suspected meningitis is 62328. A guided tap to lower pressure in idiopathic intracranial hypertension is 62329, even if some fluid goes to the lab. Without fluoroscopy or CT, the same two taps drop to 62270 and 62272. The map below lays out every route.

Ultrasound and MR guidance are not 62328

The 62328 descriptor names only fluoroscopy and CT. When ultrasound guides a diagnostic lumbar puncture, report 62270 with 76942. When MR guides it, report 62270 with 77021. Billing 62328 for an ultrasound-guided tap is a wrong-code error, and a payer that reviews the note can recode or deny it.

How 62328 differs from lumbar epidural injection codes

62328 is sometimes confused with the lumbar epidural codes, because both put a needle into the lumbar spine under fluoroscopy. An interlaminar epidural injection of steroid or anesthetic at a lumbar or sacral level is 62322 without imaging, or 62323 with it. Catheter-based epidural infusions at that level are 62326 and 62327.

62328 enters the subarachnoid space to collect CSF, and no therapeutic substance is delivered. If the note describes an injected steroid, the service does not belong on 62328.

What CPT code 62328 includes and excludes

62328 pays for the guided puncture as one service. Knowing what sits inside the code, and what moves to another code, prevents both unbundling and the wrong-code denials that follow.

• Included in 62328: local anesthetic at the puncture site, fluoroscopic or CT localization and needle guidance, pressure measurement and CSF collection.
• Not reported with 62328: 77003 or 77012 for the same guidance. CPT instructs coders not to report them together.
• One puncture, one code: do not report 62270 and 62328 for the same puncture. Choose 62328 when fluoroscopy or CT was used.
• Billed separately: laboratory analysis of the CSF, which the lab reports under its own codes.

Contrast injected for a myelogram moves the service out of 62328. Myelography via lumbar injection is reported with 62302-62305, or with the injection code 62284 when the injection and the imaging are reported separately.

Sedation or anesthesia from a separate anesthesia provider is not part of 62328 either. That provider reports the service with 00635.

Does 62328 split into professional and technical components?

No. CMS assigns 62328 a PC/TC indicator of 0, so modifiers 26 and TC do not apply. A radiologist used to billing 77003 with modifier 26 in the hospital reports 62328 without a modifier. Medicare pays the facility rate in that setting.

ICD-10 codes commonly paired with CPT code 62328

Medical necessity for 62328 rests on a diagnosis or set of signs that explains why CSF had to be tested. On outpatient claims, Section IV.H of the ICD-10-CM guidelines says not to code a diagnosis documented as suspected, probable or rule out. Code the presenting signs and symptoms instead, and the confirmed condition once results support it.

Codes and titles match the current ICD-10-CM code set from CMS. Since October 1, 2025, G35 has been a header code rather than a billable one. Report an MS subtype such as G35.A, or G35.D when the type is not documented.

When you code symptoms, code every documented sign that points to the concern behind the tap. Headache alone (R51.9) rarely explains why CSF was needed. Fever, neck stiffness and confusion together tell the payer why the puncture was done.

A large-volume tap to relieve normal pressure hydrocephalus is therapeutic drainage, so it belongs on 62329 when imaging guides it.

Documentation requirements for CPT code 62328

A clean 62328 claim starts with a procedure note that shows a diagnostic purpose and documents the imaging. If the note never mentions fluoroscopy or CT, a payer can recode the claim to 62270 or deny it.

The procedure note should record these elements:

• Indication: the condition being investigated and why CSF testing was needed.
• Reason for imaging: why fluoroscopy or CT was used, such as body habitus, prior spinal surgery or a failed landmark attempt.
• Guidance modality: fluoroscopy or CT, plus the needle position confirmed on imaging.
• Positioning and level: prone, lateral or seated, and the interspace accessed.
• Technique: needle type and gauge, and the number of passes.
• Pressure: opening pressure in cmH2O where it was measured.
• CSF collected: the volume, the appearance of the fluid and the tests ordered.
• Complications: any complication and the action taken.

Medicare reimbursement rate for CPT code 62328

Medicare pays 62328 at different rates in facility and non-facility settings, because the practice expense RVU changes with the setting. The figures below come from the CMS 2026 PFS relative value file, October release.

For 2026, CMS set two conversion factors: $33.5675 for qualifying APM participants and $33.4009 for everyone else.

Each payment is the total RVU multiplied by the conversion factor, before the locality adjustment. Confirm your local rate in the CMS Physician Fee Schedule Look-Up Tool. Commercial rates are negotiated separately.

The same file gives 62328 a multiple procedure indicator of 2. The standard reduction applies when it is billed with other procedures on the same day. Its bilateral indicator is 0, so the 150% bilateral adjustment does not apply.

Prior authorization and payer requirements for CPT code 62328

Prior authorization rules for 62328 depend on the payer, so check the patient’s plan before an elective guided puncture. Build that check into scheduling so it runs for every elective case.

• Traditional Medicare: prior authorization is not generally required for 62328.
• Medicare Advantage: requirements vary by plan, so verify with the plan before scheduling.
• Medicaid: requirements vary by state program.
• Commercial payers: policies vary, so confirm the rule for the specific plan and setting.
• What to send if authorization is needed: the order with 62328 specified and the supporting ICD-10 codes. Add the clinical note showing the indication and the reason for imaging.

Urgent punctures, such as suspected meningitis or subarachnoid hemorrhage, usually go ahead before any authorization. Record the urgency in the note and follow the plan’s retro-authorization process.

Common claim denial reasons for CPT code 62328

Denials on 62328 follow a predictable set of patterns. Each one has a front-end fix, and good denial management workflows apply it before the claim goes out.

How claims management software supports CPT code 62328 billing

Radiology and neurology practices billing 62328 often track eligibility, claim status and remittances across several payer portals. Pabau connects to Claim.MD, a US medical claims clearinghouse, to submit CMS-1500 and 837P claims.

Through that connection, your team can check a patient’s eligibility before the puncture is scheduled. After submission, Pabau tracks claim status and processes ERA (835) remittances, including the CARC reason codes on any denial. Your billers see why a 62328 claim came back without calling the payer.

Pabau’s medical claims management submits and tracks the claim data your team enters. Code selection and the procedure note stay with your providers and coders, so the documentation checks above still belong in your own pre-bill review.

Track every image-guided procedure claim to payment

Pabau submits CPT 62328 claims through Claim.MD, checks eligibility before the procedure, and tracks ERA remittance so your team can follow each claim to payment.

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Conclusion

CPT code 62328 is the right code only when the note shows a diagnostic lumbar puncture guided by fluoroscopy or CT. Drop the imaging and the claim belongs on 62270. Change the purpose to drainage and it belongs on 62329.

Ultrasound and MR guidance sit outside 62328, so check the modality as well as the purpose before the claim goes out. Pair the puncture with the signs or diagnosis that justified the tap. Book a demo to see how Pabau submits and tracks your spinal procedure claims through Claim.MD.

Continue your research

Need to understand denial codes on returned claims? Denial codes in medical billing covers CARC and RARC code meanings and how to act on each.

Want to reduce your overall claim rejection rate? Medical claims clearinghouse guide explains how electronic clearinghouse submission reduces edit errors before claims reach payers.

Verifying patient coverage before scheduling? Insurance eligibility verification walks through real-time eligibility checks and what to confirm before a spinal procedure date.

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