CPT code 64634: Facet ablation, each additional facet joint2026 Medicare rate & RVUs in Texas
Reports neurolytic treatment of each additional cervical or thoracic facet joint after the primary joint is treated during the same session.
Medicare pays $246.50–$278.90 for 64634 in the office in Texas, from Beaumont, TX to Austin, TX. Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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On this page 9 sections
What 64634 covers
This add-on describes neurolytic treatment of an additional cervical or thoracic facet joint, commonly by radiofrequency ablation of the medial branch nerves that supply the joint. Pain-management physicians typically perform the procedure for selected patients with facet-mediated neck or upper-back pain. Imaging guidance with fluoroscopy or CT is part of the service. The unit is the additional facet joint treated, not each nerve or lesion made.
Report 64634 with the primary cervical or thoracic facet-joint ablation code 64633; it cannot stand alone. The record should identify the treated spinal region and the additional joint or joints addressed, supporting the reported count. CMS treats this as an add-on paid within the primary procedure’s global period. For a bilateral procedure, modifier 50 is paid at 150%.
This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.
Where 64634 pays more and less in Texas
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
8 payment localities
$246.50 to $278.90
8 of 8 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Austin, TX | $278.90 | $58.03 |
| Beaumont, TX | $246.50 | $56.54 |
| Brazoria, TX | $264.03 | $57.15 |
| Dallas, TX | $265.48 | $57.56 |
| Fort Worth, TX | $263.34 | $57.50 |
| Galveston, TX | $264.66 | $57.36 |
| Houston, TX | $266.85 | $59.56 |
| Rest of Texas | $254.96 | $56.85 |
How the 64634 rate is calculated
Each of 64634’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 64634
RVUs × geographic indexes × conversion factor
Work1.29
1.29 RVUs× 1.000 GPCI
Practice expense6.57
6.57 RVUs× 1.000 GPCI
Malpractice0.12
0.12 RVUs× 1.000 GPCI
Adjusted RVUs
7.9800
Conversion factor
$33.4009
Medicare rate
$266.54
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 64634
The CMS indicators that decide how 64634 is paid alongside other services.
CMS payment indicators · 64634
Facet ablation, each additional facet joint
| Rule | CMS value | What it means |
|---|---|---|
| Global period | ZZZ | Add-on code: falls within the primary procedure’s global period. |
| Multiple procedures | 0 | No multiple-procedure reduction. |
| Bilateral (modifier 50) | 1 | Bilateral with modifier 50 pays 150% of the fee schedule amount. |
| Assistant at surgery (80/81/82/AS) | 1 | Not paid (statutory restriction). |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
What modifiers do to the payment
Modifier 50 · payment effect
With and without the modifier
64634 without 50 · national office
$266.54
Facet ablation, each additional facet joint
64634-50 · Bilateral: 150%
$399.81
Both sides on one line with modifier 50 are paid at 150% of the fee schedule amount (subject to multiple-procedure rules with other procedures).
64634 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 64633Facet ablationCervical/thoracic, first joint
- 64633 reports the primary cervical or thoracic facet joint treated. Use 64634 only for each additional joint in the same session, alongside 64633.
- 64636Facet nerve ablationAdditional lumbar or sacral joint
- 64636 covers each additional lumbar or sacral facet joint; 64634 is for additional cervical or thoracic facet joints.
- 64491Facet injectionCervical/thoracic second level
- 64491 reports an additional cervical or thoracic facet nerve injection. 64634 is for neurolytic treatment of an additional joint, commonly by radiofrequency ablation.
64634 billing questions
When is 64634 reported instead of 64633?
64633 reports the primary cervical or thoracic facet joint treated. Report 64634 for each additional facet joint treated in the same session.
Can 64634 be billed by itself?
No. It is an add-on code and must be reported with the primary procedure, 64633.
Is imaging guidance separately reported?
Fluoroscopic or CT guidance is included in the facet ablation service described by this code; do not separately report guidance for the same treatment.
What supports the number of units?
Document the cervical or thoracic region and each additional facet joint treated. Units represent additional joints, not the number of nerves lesioned.
How is bilateral treatment reported?
For a bilateral procedure, report modifier 50; CMS pays the bilateral procedure at 150%.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
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