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CPT code 64634: Facet ablation, each additional facet joint2026 Medicare rate & RVUs in Virginia

Reports neurolytic treatment of each additional cervical or thoracic facet joint after the primary joint is treated during the same session.

CMS RVU26DEffective Oct 1, 2026One payment locality72K Medicare services in 2024

In Virginia, Medicare pays $261.63 for 64634 in the office and $56.42 when it’s performed in a hospital or facility.

$261.63Office (non-facility)
$56.42Hospital or facility
−1.8%vs the national office rate ($266.54)

Check a contract rate as a % of Medicare · 64634 nationwide

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

We’ll open 64634 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Virginia
  2. What 64634 covers
  3. Compared with other areas
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Related codes
  8. Rate history
  9. Where it applies
  10. Billing questions
  11. Sources

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.

How Virginia compares for 64634

Across 109 of 109 payment localities, the office rate for 64634 runs from $233.65 in Arkansas to $366.41 in San Benito County, CA. Virginia pays $261.63. The RVUs are the same everywhere; the geographic indexes change the dollars.

64634 in Virginia vs other payment areas
  1. Virginia · this page$261.63
  2. Los Angeles, CA · California$307.12+$45.49
  3. Washington, DC area · District of Columbia$308.38+$46.75
  4. Miami, FL · Florida$281.66+$20.03
  5. Chicago, IL · Illinois$273.13+$11.50
  6. Manhattan, NY · New York$307.20+$45.57
  7. Alaska · Alaska$300.55+$38.92

Other areas in Virginia first, then benchmark localities. Bars start at $0.

Every other payment area

64634 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$237.37$54.71
ArkansasArkansas$233.65$54.33
ArizonaArizona$259.16$56.88
Bakersfield, CACalifornia$286.86$58.06
Chico, CACalifornia$286.48$57.68
El Centro, CACalifornia$286.50$57.70
Fresno, CACalifornia$286.48$57.68
Hanford, CACalifornia$286.48$57.68

64634 rates by state

Office rate range in each state. Select a state to see its payment localities.

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

Explore a state

Local rates. Clear comparisons.

Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.

$233.65

$326.45

Color shows the midpoint of each state’s locality range.

View every state and territory as a table
64634 office rate range by state
State / territoryOffice rate rangeLocalities
AK$300.551
AL$237.371
AR$233.651
AZ$259.161
CA$286.48–$366.4129
CO$280.221
CT$285.141
DC$308.381
DE$263.721
FL$258.90–$281.663
GA$243.61–$270.992
GU$294.921
HI$294.921
IA$245.471
ID$246.871
IL$249.70–$275.864
IN$248.461
KS$243.481
KY$241.841
LA$241.13–$254.142
MA$278.05–$310.442
MD$269.27–$308.383
ME$247.47–$263.092
MI$247.96–$261.612
MN$270.081
MO$236.15–$256.013
MS$234.991
MT$266.531
NC$250.391
ND$264.161
NE$247.151
NH$275.041
NJ$288.84–$304.642
NM$249.131
NV$266.091
NY$254.38–$314.215
OH$247.481
OK$242.161
OR$264.47–$290.562
PA$248.32–$277.092
PR$268.891
RI$274.171
SC$249.261
SD$263.881
TN$244.711
TX$246.50–$278.908
UT$252.961
VA$261.63–$308.382
VI$268.891
VT$262.361
WA$277.77–$317.772
WI$254.551
WV$239.521
WY$265.501

See 64634 in every payment locality

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

Office or facility?

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.

The exact Virginia inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

7,181

Code
64634
Physician work
1.29
Practice expense
6.57
Malpractice
0.12

GPCI2026.csv

106

Locality
Virginia
Physician work
1.000
Practice expense
0.983
Malpractice
0.706
Office calculation for 64634 in Virginia
ComponentRVULocality factorAdjusted
Physician work1.29× 1.0001.2900
Practice expense6.57× 0.9836.4583
Malpractice0.12× 0.7060.0847
Total RVUs7.8330
Conversion factor× 33.4009

Office rate, Virginia$261.63

Office: (1.29 × 1 + 6.57 × 0.983 + 0.12 × 0.706) × $33.4009 = $261.63

Facility: (1.29 × 1 + 0.32 × 0.983 + 0.12 × 0.706) × $33.4009 = $56.42

Open 64634 in the RVU calculator

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

RuleCMS valueWhat it means
Global periodZZZAdd-on code: falls within the primary procedure’s global period.
Multiple procedures0No multiple-procedure reduction.
Bilateral (modifier 50)1Bilateral with modifier 50 pays 150% of the fee schedule amount.
Assistant at surgery (80/81/82/AS)1Not paid (statutory restriction).
Co-surgeons (62)0Not permitted.
Team surgery (66)0Not permitted.
Professional/technical0Physician 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).

When to use modifier 50

Codes related to 64634

Related codes aren’t interchangeable: bill the code that matches the service performed.

Codes related to 64634
CodeHow it relatesOffice range, Virginia
Add-on codes
64633Facet ablation, cervical/thoracic, first jointPrimary cervical or thoracic facet-joint ablation code required with 64634.$450.19
Used instead
64635Facet nerve ablation, first lumbar or sacral jointPrimary facet ablation code for lumbar or sacral joints rather than cervical or thoracic joints.$456.19
64636Facet nerve ablation, additional lumbar or sacral jointAdditional-joint facet ablation code for the lumbar or sacral region.$246.86
64491Facet injection, cervical/thoracic second levelAdditional cervical or thoracic facet nerve injection, rather than neurolytic ablation.$99.76

How 64634 has changed in Virginia

64634 · Office / nonfacility

$261.63

Effective 2026-10-01

The base rate is $24.38 higher than on 2025-10-01, moving from $237.25 to $261.63 (10.3%).

It is unchanged from the immediately preceding available release, effective 2026-07-01.

Base rate by release · bars start at $0 · select a bar to compare

One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.

What changed, release by release

  1. January 1, 2026

    RVU26A

    $237.25changed to$261.63

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 1.32 changed to 1.29
    • Practice expense RVU 6.01 changed to 6.57
    • Malpractice RVU 0.13 changed to 0.12
    • Work GPCI 1.002 changed to 1.000
    • Practice expense GPCI 0.984 changed to 0.983
    • Malpractice GPCI 0.755 changed to 0.706

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $251.03changed to$237.25

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 6.22 changed to 6.01

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $246.93changed to$251.03

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $258.44changed to$246.93

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 6.27 changed to 6.22
    • Malpractice RVU 0.12 changed to 0.13
    • Work GPCI 1.000 changed to 1.002
    • Practice expense GPCI 0.990 changed to 0.984
    • Malpractice GPCI 0.826 changed to 0.755

  5. January 1, 2023

    RVU23A

    $270.12changed to$258.44

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 6.41 changed to 6.27
    • Practice expense GPCI 0.995 changed to 0.990
    • Malpractice GPCI 0.897 changed to 0.826

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $196.29changed to$270.12

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 4.21 changed to 6.41
    • Malpractice RVU 0.13 changed to 0.12

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $191.03changed to$196.29

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 3.90 changed to 4.21
    • Malpractice RVU 0.12 changed to 0.13
    • Practice expense GPCI 0.991 changed to 0.995
    • Malpractice GPCI 0.903 changed to 0.897

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $190.11changed to$191.03

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 3.91 changed to 3.90
    • Malpractice RVU 0.11 changed to 0.12
    • Practice expense GPCI 0.986 changed to 0.991
    • Malpractice GPCI 0.908 changed to 0.903

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $190.61changed to$190.11

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 3.93 changed to 3.91

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $188.30changed to$190.61

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 3.89 changed to 3.93
    • Practice expense GPCI 0.985 changed to 0.986
    • Malpractice GPCI 0.866 changed to 0.908

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $190.94changed to$188.30

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 3.99 changed to 3.89
    • Practice expense GPCI 0.983 changed to 0.985
    • Malpractice GPCI 0.824 changed to 0.866

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $187.09changed to$190.94

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 3.87 changed to 3.99
    • Malpractice RVU 0.10 changed to 0.11

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $186.16changed to$187.09

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $196.04changed to$186.16

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 4.15 changed to 3.87
    • Malpractice RVU 0.11 changed to 0.10
    • Practice expense GPCI 0.980 changed to 0.983
    • Malpractice GPCI 0.778 changed to 0.824

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $184.26changed to$196.04

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 4.11 changed to 4.15
    • Practice expense GPCI 0.977 changed to 0.980
    • Malpractice GPCI 0.731 changed to 0.778

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $184.26

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$261.63$56.42RVU26D
2026-07-01$261.63$56.42RVU26C
2026-04-01$261.63$56.42RVU26B
2026-01-01$261.63$56.42RVU26A
2025-10-01$237.25$63.46RVU25D
2025-07-01$237.25$63.46RVU25C
2025-04-01$237.25$63.46RVU25B
2025-01-01$237.25$63.46RVU25A
2024-10-01$251.03$64.98RVU24D
2024-07-01$251.03$64.98RVU24C
2024-04-01$251.03$64.98RVU24B
2024-03-09$251.03$64.98RVU24AR
2024-01-01$246.93$63.92RVU24A
2023-10-01$258.44$65.87RVU23D
2023-07-01$258.44$65.87RVU23C
2023-04-01$258.44$65.87RVU23B
2023-01-01$258.44$65.87RVU23A
2022-10-01$270.12$67.31RVU22D
2022-07-01$270.12$67.31RVU22C
2022-04-01$270.12$67.31RVU22B
2022-01-01$270.12$67.31RVU22A
2021-10-01$196.29$68.53RVU21D
2021-07-01$196.29$68.53RVU21C
2021-04-01$196.29$68.53RVU21B
2021-01-01$196.29$68.53RVU21A
2020-10-01$191.03$70.15RVU20D
2020-07-01$191.03$70.15RVU20C
2020-04-01$191.03$70.15RVU20B
2020-01-01$191.03$70.15RVU20A
2019-10-01$190.11$69.65RVU19D
2019-07-01$190.11$69.65RVU19C
2019-04-01$190.11$69.65RVU19B
2019-01-01$190.11$69.65RVU19A
2018-10-01$190.61$69.93RVU18D
2018-07-01$190.61$69.93RVU18C
2018-04-01$190.61$69.93RVU18B
2018-01-01$190.61$69.93RVU18AR1
2017-10-01$188.30$69.53RVU17D
2017-07-01$188.30$69.53RVU17C
2017-04-01$188.30$69.53RVU17B
2017-01-01$188.30$69.53RVU17A
2016-10-01$190.94$69.86RVU16D
2016-07-01$190.94$69.86RVU16C
2016-04-01$190.94$69.86RVU16B
2016-01-01$190.94$69.86RVU16A
2015-10-01$187.09$69.47RVU15D
2015-07-01$187.09$69.47RVU15C
2015-04-01$186.16$69.12RVU15B
2015-01-01$186.16$69.12RVU15A
2014-10-01$196.04$70.01RVU14D
2014-07-01$196.04$70.01RVU14C
2014-04-01$196.04$70.01RVU14B
2014-01-01$196.04$70.01RVU14A
2013-10-01$184.26$65.26RVU13D
2013-07-01$184.26$65.26RVU13C
2013-04-01$184.26$65.26RVU13B
2013-01-01$184.26$65.26RVU13AR

Price 64634 for an earlier date of service

Where the Virginia rate applies

Virginia is a Medicare payment area, not a city. Our Census mapping connects it to 628 cities and communities in Virginia. Some span more than one payment area; confirm with the service ZIP.

  • Abbs Valley
  • Abingdon
  • Accomac
  • Adwolf
  • Afton
  • Alberta
  • Aldie
  • Allison Gap

Browse all communities in Virginia

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

Show the CMS file lines behind this rate
RVUs for 64634PPRRVU2026_Oct_nonQPP.csv, line 7,181 (RVU26D)
Geographic factors for VirginiaGPCI2026.csv, line 106 (RVU26D)

Open CMS sourceHow we calculate rates

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