Radiofrequency or other thermal destruction of the nerves supplying one lumbar or sacral facet joint, with imaging guidance included in the code.
- Medicare
- $464.94
- 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 ↓
- Results of two diagnostic medial branch blocks with percentage relief
- Joint level and side ablated
- Thermal RF technique and settings
- Imaging guidance with saved images
- Relief and duration from any prior RFA
- Pain duration 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 ↓
64635 is the primary code for lumbar or sacral facet RFA at one joint. Each additional joint goes to 64636. Imaging guidance is included, and there is a 10-day global.
Ortho spine and pain practices use it after two positive diagnostic medial branch blocks for axial low back pain from facet arthropathy, typically at L4-5 and L5-S1. Bilateral at one joint is a single unit with modifier 50.
Medicare facet joint LCDs control most of the outcome. Expect requirements for two diagnostic blocks with a high relief threshold, a limit on how many RFA sessions a region can get per rolling 12 months, a minimum gap between sessions, and documented relief from the prior ablation before a repeat. Do not use 64635 for the sacroiliac joint. That has its own code, 64625. Pulsed RF and chemical techniques generally are not covered under this code.
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 (13.92) adds practice overhead and malpractice, and is what drives the Medicare payment below.
| Work RVU | 3.24 |
| Practice expense RVU | 10.39 |
| Malpractice RVU | 0.29 |
| Total RVU | 13.92 |
| Medicare national rate | $464.94 |
| 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 | $464.94 |
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 64635 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Second diagnostic block missing or below relief threshold
- Repeat session too soon in 12 months
- SI joint ablation billed as lumbar facet
- Pulsed RF billed under 64635
- Levels ablated do not match levels blocked
- E/M within the 10-day global without a valid modifier
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 3 cited references ↓
01What is the difference between 64635 and 64625?
02How often can lumbar RFA be repeated for Medicare?
03How do you bill bilateral L4-5 and L5-S1 RFA?
04Is imaging guidance billable with 64635?
Sources & references
Editorial content was developed using the following public sources.
Mira Scribe
Mira Scribe notes document the two block results, the relief from prior ablation, and the treated levels, which covers what Medicare reviewers check on lumbar RFA.
See how Mira captures CPT 64635 documentation