Radiofrequency or other thermal destruction of the nerves supplying one cervical or thoracic facet joint, with imaging guidance included in the code.
- Medicare
- $458.93
- Work RVU
- 3.24
- Global, days
- 10
- 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 ↓
- Two diagnostic medial branch blocks with pain scores and percentage relief
- Joint level and side ablated
- Technique and settings (thermal RF)
- Imaging guidance with saved images
- Relief from any prior RFA and its duration
- Duration of pain and conservative care
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 ↓
64633 reports ablation of the medial branches supplying the first cervical or thoracic facet joint. Each additional joint goes to add-on 64634. Imaging guidance is included. The code has a 10-day global.
The usual path in an ortho spine practice is chronic axial neck pain, two positive diagnostic medial branch blocks, then RFA. The blocks are the gatekeeper. Medicare facet joint LCDs require two diagnostic blocks with a high percentage of relief before the first ablation, and limit repeat ablation of the same region to a set number of sessions in a 12-month window with a minimum interval between them. Repeat RFA also needs documented relief from the last one.
Bilateral ablation at one level is one unit with modifier 50. Chemical, low-grade thermal, and pulsed RF techniques are generally not what this code describes, and most payers will not cover them under it. Watch the global: an E/M visit within 10 days for the same problem is not payable.
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 (3.24) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (13.74) adds practice overhead and malpractice, and is what drives the Medicare payment below.
| Work RVU | 3.24 |
| Practice expense RVU | 10.2 |
| Malpractice RVU | 0.3 |
| Total RVU | 13.74 |
| Medicare national rate | $458.93 |
| Global period | 10 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 | $458.93 |
HOPD (APC 5431) Hospital outpatient department | $1,995.02 |
ASC (PI G2) Ambulatory surgical center (freestanding) | $948.66 |
Common denial reasons
The recurring reasons claims for CPT 64633 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Only one diagnostic block documented
- Relief from diagnostic blocks below the LCD threshold
- Repeat RFA too soon or too often in 12 months
- Pulsed RF billed under the thermal destruction code
- E/M billed within the 10-day global
- Levels on RFA do not match the blocked levels
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 3 cited references ↓
01How many diagnostic blocks are needed before cervical RFA?
02What is the add-on code for a second cervical RFA level?
03What is the global period for 64633?
04Is pulsed radiofrequency billed with 64633?
Sources & references
Editorial content was developed using the following public sources.
Mira Scribe
Mira Scribe notes carry forward the block results and prior RFA relief in plain terms, so the ablation note already answers the questions an LCD reviewer asks.
See how Mira captures CPT 64633 documentation