Add-on for a third or later lumbar or sacral facet joint or medial branch level injected in one session, with imaging guidance included.
- Medicare
- $98.87
- Work RVU
- 0.98
- Global, days
- Region
- Spine
Documentation requirements
What must appear in the operative or office note to support the claim.
Source · Editorial brief grounded in 3 cited references ↓
- All three levels and sides named
- Clinical reason for the third level
- Imaging guidance with saved images
- Pain scores for diagnostic blocks
- Signed ABN for Medicare when beyond LCD limits
- Medication and volumes
Applicable modifiers
Modifiers commonly billed with this code.
Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual
What this code covers
Source · Editorial summary grounded in 3 cited references ↓
64495 is the third-level lumbar facet add-on. It requires 64493 and 64494 on the same claim and is reported only once per day regardless of how many extra levels were treated.
Medicare facet joint LCDs cap the number of levels per session, and a third lumbar level often falls outside that cap. If the surgeon or pain physician believes three levels are needed, for example L3-4 through L5-S1 after a prior fusion changed the pain pattern, the practice needs a signed ABN and modifier GA on the line.
Some commercial payers allow a third level with documentation. Many follow the Medicare limit. Imaging guidance is bundled, and frequency limits for the lumbar region still apply. Write each level's reason into the note so a reviewer can see why the third joint was included.
RVU & reimbursement
Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.
Source · CMS Physician Fee Schedule, RVU26A · January 2026
Work RVU vs. total RVU
The work RVU (0.98) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (2.96) adds practice overhead and malpractice, and is what drives the Medicare payment below.
| Work RVU | 0.98 |
| Practice expense RVU | 1.9 |
| Malpractice RVU | 0.08 |
| Total RVU | 2.96 |
| Medicare national rate | $98.87 |
| Global period | days |
Payment by site of service
Medicare pays different rates by setting. HOPD typically pays substantially more than ASC for the same procedure.
Source · CMS OPPS Addendum B·ASC HCPCS payment rates·2026
| Setting | Medicare rate (national) |
|---|---|
Office (PFS non-facility) Procedure performed in physician's office | $98.87 |
Common denial reasons
The recurring reasons claims for CPT 64495 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Medicare level limit exceeded
- More than one unit billed
- Missing 64493 or 64494
- No ABN for a Medicare non-covered service
- Insufficient support for the third level
- Region frequency limit exceeded
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 3 cited references ↓
01Will Medicare pay 64495?
02How many units of 64495 are allowed?
03Which codes must accompany 64495?
Sources & references
Editorial content was developed using the following public sources.
Mira Scribe
Mira Scribe captures why each lumbar level was targeted, so a three-level session has the clinical reasoning in the note instead of only on the order.
See how Mira captures CPT 64495 documentation