Destruction of a peripheral nerve or branch using a neurolytic agent — chemical, thermal, electrical, or radiofrequency — for pain relief.

Verified May 8, 2026 · 6 sources ↓

Medicare: $267.54
Total RVUs: 8.01
Global, days: 10
Region: General

Drawn from CMSIoveraproPublic-inspection

Documentation requirements

What must appear in the operative or office note to support the claim.

Source · Editorial brief grounded in 6 cited references ↓

Identify each nerve or branch by anatomical name — 'peripheral nerve' alone is insufficient for audit purposes.
Document the specific neurolytic modality used (e.g., radiofrequency ablation, chemical neurolysis, thermal ablation) to confirm destructive intent.
Confirm and record that the technique is destructive, not modulatory — pulsed RFA does not qualify for 64640.
Record the number of distinct nerves or branches treated when billing multiple units of 64640 in the same session.
If imaging guidance was used, document the modality, real-time supervision, and image archival separately from the 64640 note.
Include pre-procedure diagnosis, clinical indication, and failed conservative measures where required by LCD coverage criteria.

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 50 Bilateral procedure 52 Reduced services 59 Distinct service 76 Repeat, same physician 77 Repeat, another physician LT Left side RT Right side XS Separate structure

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 64640 covers destruction of a peripheral nerve or branch by a neurolytic agent. Qualifying modalities include chemical injection, thermal ablation, electrical neurolysis, and radiofrequency ablation (RFA). The key word is destruction — the technique must be intended to ablate the target nerve, not temporarily modulate it. Pulsed radiofrequency, which does not destroy nerve tissue, does not meet that threshold; use 64999 for pulsed RFA.

The code is billed per nerve or branch treated, which means multiple units are reportable when multiple distinct nerves are ablated in the same session. The MUE caps how many units Medicare will pay — check the current MUE table before submitting more than five units. Imaging guidance (fluoroscopy, ultrasound, CT) is not bundled into 64640 and may be billed separately when performed and documented.

A significant payer split exists for cryoneurolysis (e.g., Iovera device): CPT Assistant confirmed in 2019 that cryoneurolysis may be reported with 64640 when the procedure meets the nerve destruction criteria, rescinding prior guidance to use 64999. However, two Noridian LCDs (A59752, A59753) explicitly state that the Iovera system is temporary and non-destructive, making 64640 inappropriate for Medicare billing in those jurisdictions — Noridian directs billing to 0440T, 0441T, or 0442T instead. Verify MAC policy before billing 64640 for cryoneurolysis.

RVU & reimbursement

Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	1.93
Practice expense RVU	5.86
Malpractice RVU	0.22
Total RVU	8.01
Medicare national rate	$267.54
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	$267.54
HOPD (APC 5443) Hospital outpatient department	$903.63
ASC (PI P3) Ambulatory surgical center (freestanding)	$197.04

Common denial reasons

The recurring reasons claims for CPT 64640 get rejected.

Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓

Cryoneurolysis billed as 64640 under Noridian jurisdiction — Noridian considers the Iovera system non-destructive and requires 0440T–0442T instead.
Pulsed radiofrequency billed under 64640 — pulsed RFA is non-destructive and requires 64999 per CPT guidelines.
Units exceed the MUE allowance without supporting documentation of the number of distinct nerves treated.
Missing or non-specific nerve identification in the operative/procedure note — documentation must name each target nerve.
Imaging guidance billed without separate real-time supervision documentation when added to 64640.
Lack of medical necessity documentation or failure to meet LCD coverage criteria for nerve destruction procedures.

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 6 cited references ↓

01Can I bill 64640 for cryoneurolysis with the Iovera device?

It depends on your MAC. CPT Assistant (April 2019) affirmed that cryoneurolysis may be reported with 64640 when destruction criteria are met. But Noridian (LCDs A59752 and A59753) explicitly prohibits 64640 for the Iovera system on Medicare claims, directing coders to 0440T, 0441T, or 0442T. Confirm your MAC's LCD before submitting.

02Can I bill 64640 for pulsed radiofrequency ablation?

No. CPT guidelines state that pulsed RFA is non-destructive and must be reported with 64999, the unlisted nervous system procedure code. Using 64640 for pulsed RFA is a common audit target.

03How many units of 64640 can I bill when treating multiple nerves in one session?

64640 is billed per nerve or branch treated, so multiple units are appropriate when multiple distinct nerves are ablated. The MUE limits how many units Medicare will pay without additional review — five units is a commonly referenced ceiling for cryoneurolysis contexts, but verify the current MUE in the CMS MUE table. Each nerve must be individually named in the procedure note.

04Is imaging guidance bundled into 64640?

No. Imaging guidance (ultrasound 76942, fluoroscopy 77003, or CT) is not included in 64640 and may be billed separately when real-time guidance was performed, documented, and images were archived. Some MACs and payers have specific bundling edits — check NCCI before billing.

05What is the global period for 64640, and what does it cover?

64640 carries a 010-day global period. That covers the day of the procedure and the nine days following. Unrelated E/M services during that window need modifier 24; a separately identifiable E/M on the same day needs modifier 25.

06Can 64640 and 64624 both be billed for the same knee nerve ablation session?

Yes, in the right clinical scenario. 64624 covers the three specific genicular nerve branches (superolateral, superomedial, inferomedial) as one billable unit. 64640 covers other peripheral nerves — such as the anterior femoral cutaneous nerve or infrapatellar saphenous nerve branch — billed per nerve. When both sets of nerves are treated, both codes may be reportable with modifier 59 or XS to indicate distinct structures. Verify payer-specific bundling edits.

Sources & references

Editorial content was developed using the following public sources. Last verified May 8, 2026.

Mira AI Scribe

Mira's AI scribe captures the specific nerve or branch name, the neurolytic modality (radiofrequency, chemical, thermal), confirmation that the technique was destructive rather than modulatory, the number of nerves treated, and whether imaging guidance was performed and by whom. That documentation locks down the unit count, prevents pulsed-RFA-versus-ablation coding errors, and supports separate imaging guidance billing — the three most common audit flags on this code.

See how Mira captures CPT 64640 documentation