Add-on for each additional lumbar or sacral facet joint whose nerves are destroyed by radiofrequency or other thermal method in the same session.
- Medicare
- $251.51
- Work RVU
- 1.13
- 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 ↓
- Each additional joint ablated, by level and side
- Diagnostic block results for that level
- Technique and settings
- Imaging guidance with saved images
- Relief from prior RFA if a repeat
- ABN if beyond Medicare level limits
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 ↓
64636 adds each lumbar or sacral facet joint beyond the first during an RFA session. It is billed with 64635 and never alone. It is a ZZZ add-on, so it follows the global of the primary code.
The common two-joint lumbar RFA, L4-5 and L5-S1, is 64635 plus one unit of 64636. If both are done on both sides, each line carries modifier 50. Billing two units of 64636 to show the opposite side is a frequent error and will deny or underpay.
Medicare facet LCDs cap the levels in one ablation session. Before billing more than one unit of 64636 to Medicare, check your MAC's billing article and get an ABN if you are past the cap. The levels on the RFA should match the levels that responded to the diagnostic blocks. Imaging guidance is 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 (1.13) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (7.53) adds practice overhead and malpractice, and is what drives the Medicare payment below.
| Work RVU | 1.13 |
| Practice expense RVU | 6.29 |
| Malpractice RVU | 0.11 |
| Total RVU | 7.53 |
| Medicare national rate | $251.51 |
| 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 | $251.51 |
Common denial reasons
The recurring reasons claims for CPT 64636 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Billed without 64635
- Units used for bilateral instead of modifier 50
- Level limit exceeded under the LCD
- Level was not part of the diagnostic blocks
- Repeat session frequency exceeded
- Imaging billed separately
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 3 cited references ↓
01Can 64636 be billed alone?
02How many units of 64636 does Medicare allow?
03Is 64636 billed with modifier 50 for bilateral?
Sources & references
Editorial content was developed using the following public sources.
Mira Scribe
Mira Scribe lists each ablated joint and side in the note, so the add-on units match the procedure record line for line.
See how Mira captures CPT 64636 documentation