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CPT code 64635: Facet nerve ablation, first lumbar or sacral joint2026 Medicare rate & RVUs in King County, WA

Reports image-guided ablation of nerves supplying the first lumbar or sacral facet joint treated during a session for facet-mediated spinal pain.

CMS RVU26DEffective Oct 1, 2026One payment locality381.1K Medicare services in 2024

In King County, WA, Medicare pays $547.36 for 64635 in the office and $189.17 when it’s performed in a hospital or facility.

$547.36Office (non-facility)
$189.17Hospital or facility
+17.7%vs the national office rate ($464.94)

Check a contract rate as a % of Medicare · 64635 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 64635 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in King County, WA
  2. What 64635 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 64635 covers

An interventional pain physician typically uses a radiofrequency probe to create a lesion in nerves supplying a lumbar or sacral facet joint. Fluoroscopy or CT guides probe placement. The procedure is commonly considered for persistent axial low-back pain attributed to facet joints, often after diagnostic medial branch blocks. The target is the nerve supply to the joint, not the joint tissue itself.

Report 64635 for the first lumbar or sacral facet joint treated in the session; report 64636 for each additional joint. Document the spinal levels and sides treated, the image-guided technique, and the ablation performed. Imaging guidance is part of the service. CMS assigns a 10-day global period, so related postoperative visits in that period are included. For bilateral treatment, modifier 50 is paid at 150%. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and others at 50%. An assistant at surgery is not paid; co-surgeon and team-surgery billing are not permitted.

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 King County, WA compares for 64635

Across 109 of 109 payment localities, the office rate for 64635 runs from $411.31 in Arkansas to $625.74 in San Benito County, CA. King County, WA pays $547.36. The RVUs are the same everywhere; the geographic indexes change the dollars.

64635 in King County, WA vs other payment areas
  1. King County, WA · this page$547.36
  2. Rest of Washington · Washington$482.43−$64.93
  3. Los Angeles, CA · California$529.63−$17.73
  4. Washington, DC area · District of Columbia$533.65−$13.71
  5. Miami, FL · Florida$493.98−$53.38
  6. Chicago, IL · Illinois$479.98−$67.38
  7. Manhattan, NY · New York$533.76−$13.60

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

Every other payment area

64635 in every other Medicare payment locality
Payment localityOfficeFacility
AlaskaAlaska$537.26$226.36
AlabamaAlabama$417.36$161.92
ArkansasArkansas$411.31$160.55
ArizonaArizona$452.79$169.91
Bakersfield, CACalifornia$496.52$176.58
Chico, CACalifornia$495.60$175.65
El Centro, CACalifornia$495.65$175.70
Fresno, CACalifornia$495.60$175.65

64635 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.

$411.31

$560.67

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

View every state and territory as a table
64635 office rate range by state
State / territoryOffice rate rangeLocalities
AK$537.261
AL$417.361
AR$411.311
AZ$452.791
CA$495.60–$625.7429
CO$486.331
CT$495.861
DC$533.651
DE$460.341
FL$454.54–$493.983
GA$429.32–$472.762
GU$508.411
HI$508.411
IA$429.601
ID$432.071
IL$440.20–$482.554
IN$434.631
KS$426.821
KY$425.601
LA$424.62–$445.782
MA$483.10–$535.642
MD$469.39–$533.653
ME$433.52–$458.242
MI$436.00–$459.442
MN$468.191
MO$416.80–$448.303
MS$414.171
MT$464.921
NC$438.191
ND$459.191
NE$432.191
NH$477.961
NJ$502.14–$527.942
NM$438.081
NV$463.671
NY$444.71–$545.765
OH$434.831
OK$425.651
OR$460.68–$502.712
PA$435.95–$482.992
PR$468.611
RI$477.401
SC$437.111
SD$458.511
TN$428.881
TX$433.02–$484.188
UT$443.131
VA$456.19–$533.652
VI$468.611
VT$456.691
WA$482.43–$547.362
WI$443.661
WV$423.651
WY$462.421

See 64635 in every payment locality

How the 64635 rate is calculated

Each of 64635’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 · 64635

RVUs × geographic indexes × conversion factor

Office or facility?

Work3.24

3.24 RVUs× 1.000 GPCI

Practice expense10.39

10.39 RVUs× 1.000 GPCI

Malpractice0.29

0.29 RVUs× 1.000 GPCI

Adjusted RVUs

13.9200

Conversion factor

$33.4009

Medicare rate

$464.94

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

The exact King County, WA inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

7,182

Code
64635
Physician work
3.24
Practice expense
10.39
Malpractice
0.29

GPCI2026.csv

108

Locality
King County, WA
Physician work
1.050
Practice expense
1.227
Malpractice
0.817
Office calculation for 64635 in King County, WA
ComponentRVULocality factorAdjusted
Physician work3.24× 1.0503.4020
Practice expense10.39× 1.22712.7485
Malpractice0.29× 0.8170.2369
Total RVUs16.3875
Conversion factor× 33.4009

Office rate, King County, WA$547.36

Office: (3.24 × 1.05 + 10.39 × 1.227 + 0.29 × 0.817) × $33.4009 = $547.36

Facility: (3.24 × 1.05 + 1.65 × 1.227 + 0.29 × 0.817) × $33.4009 = $189.17

Open 64635 in the RVU calculator

Payment rules and modifiers for 64635

64635 has a 10-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 64635

Facet nerve ablation, first lumbar or sacral joint

RuleCMS valueWhat it means
Global period010Minor procedure: the day of the procedure plus 10 days after are included.
Multiple procedures2Standard reduction: highest-valued procedure at 100%, others at 50%.
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.
Split (54/55/56)0.10/0.80/0.10Share of the payment for pre-op, the procedure itself, and post-op care.

Global surgery period · 64635

Facet nerve ablation, first lumbar or sacral joint

10-day global period ends

Oct 11, 2026

Covers Oct 1, 2026 through Oct 11, 2026 (11 days).

Visit on Oct 31, 2026

After the global period ends: visits and procedures are billed normally.

SurgeryVisit
Sep 28, 2026Oct 14, 2026

What modifiers do to the payment

Modifier 50 · payment effect

With and without the modifier

64635 without 50 · national office

$464.94

Facet nerve ablation, first lumbar or sacral joint

64635-50 · Bilateral: 150%

$697.41

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 64635

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

Codes related to 64635
CodeHow it relatesOffice range, King County, WA
Add-on codes
64636Facet nerve ablation, additional lumbar or sacral jointAdd-on code for each additional lumbar or sacral facet joint treated.$300.41
Used instead
64633Facet ablation, cervical/thoracic, first jointUsed for the first facet joint treated in the cervical or thoracic region.$539.84
64625Radiofrequency ablation, SI-joint innervationAblates nerves associated with the sacroiliac joint rather than lumbar or sacral facet joints.$584.10
64628Basivertebral ablation, first two lumbar or sacral bodiesTargets intraosseous basivertebral nerves for a different source of vertebral pain.No office rate

How 64635 has changed in King County, WA

64635 · Office / nonfacility

$547.36

Effective 2026-10-01

The base rate is $56.80 higher than on 2025-10-01, moving from $490.56 to $547.36 (11.6%).

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

    $490.56changed to$547.36

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 3.32 changed to 3.24
    • Practice expense RVU 9.39 changed to 10.39
    • Work GPCI 1.043 changed to 1.050
    • Practice expense GPCI 1.220 changed to 1.227
    • Malpractice GPCI 0.853 changed to 0.817

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $515.03changed to$490.56

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 9.62 changed to 9.39
    • Malpractice RVU 0.32 changed to 0.29

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $506.62changed to$515.03

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $517.84changed to$506.62

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 9.60 changed to 9.62
    • Malpractice RVU 0.30 changed to 0.32
    • Work GPCI 1.039 changed to 1.043
    • Practice expense GPCI 1.207 changed to 1.220
    • Malpractice GPCI 0.815 changed to 0.853

  5. January 1, 2023

    RVU23A

    $530.08changed to$517.84

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 9.74 changed to 9.60
    • Malpractice RVU 0.32 changed to 0.30
    • Work GPCI 1.036 changed to 1.039
    • Practice expense GPCI 1.194 changed to 1.207
    • Malpractice GPCI 0.776 changed to 0.815

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $491.36changed to$530.08

    • Conversion factor 34.8931 changed to 34.6062
    • Work RVU 3.78 changed to 3.32
    • Practice expense RVU 8.28 changed to 9.74
    • Malpractice RVU 0.36 changed to 0.32

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $475.72changed to$491.36

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 7.68 changed to 8.28
    • Malpractice RVU 0.35 changed to 0.36
    • Work GPCI 1.031 changed to 1.036
    • Practice expense GPCI 1.170 changed to 1.194
    • Malpractice GPCI 0.854 changed to 0.776

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $467.16changed to$475.72

    • Conversion factor 36.0391 changed to 36.0896
    • Malpractice RVU 0.30 changed to 0.35
    • Work GPCI 1.027 changed to 1.031
    • Practice expense GPCI 1.146 changed to 1.170
    • Malpractice GPCI 0.931 changed to 0.854

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $467.96changed to$467.16

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 7.72 changed to 7.68
    • Malpractice RVU 0.29 changed to 0.30

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $463.28changed to$467.96

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 7.66 changed to 7.72
    • Malpractice RVU 0.30 changed to 0.29
    • Work GPCI 1.026 changed to 1.027
    • Practice expense GPCI 1.151 changed to 1.146
    • Malpractice GPCI 0.713 changed to 0.931

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $468.26changed to$463.28

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 7.84 changed to 7.66
    • Work GPCI 1.025 changed to 1.026
    • Practice expense GPCI 1.155 changed to 1.151
    • Malpractice GPCI 0.495 changed to 0.713

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $462.65changed to$468.26

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 7.66 changed to 7.84
    • Malpractice RVU 0.31 changed to 0.30

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $460.35changed to$462.65

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $477.65changed to$460.35

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 8.04 changed to 7.66
    • Practice expense GPCI 1.150 changed to 1.155
    • Malpractice GPCI 0.688 changed to 0.495

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $449.68changed to$477.65

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 7.92 changed to 8.04
    • Malpractice RVU 0.32 changed to 0.31
    • Practice expense GPCI 1.144 changed to 1.150
    • Malpractice GPCI 0.881 changed to 0.688

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $449.68

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$547.36$189.17RVU26D
2026-07-01$547.36$189.17RVU26C
2026-04-01$547.36$189.17RVU26B
2026-01-01$547.36$189.17RVU26A
2025-10-01$490.56$205.25RVU25D
2025-07-01$490.56$205.25RVU25C
2025-04-01$490.56$205.25RVU25B
2025-01-01$490.56$205.25RVU25A
2024-10-01$515.03$210.04RVU24D
2024-07-01$515.03$210.04RVU24C
2024-04-01$515.03$210.04RVU24B
2024-03-09$515.03$210.04RVU24AR
2024-01-01$506.62$206.61RVU24A
2023-10-01$517.84$208.62RVU23D
2023-07-01$517.84$208.62RVU23C
2023-04-01$517.84$208.62RVU23B
2023-01-01$517.84$208.62RVU23A
2022-10-01$530.08$209.44RVU22D
2022-07-01$530.08$209.44RVU22C
2022-04-01$530.08$209.44RVU22B
2022-01-01$530.08$209.44RVU22A
2021-10-01$491.36$243.47RVU21D
2021-07-01$491.36$243.47RVU21C
2021-04-01$491.36$243.47RVU21B
2021-01-01$491.36$243.47RVU21A
2020-10-01$475.72$246.02RVU20D
2020-07-01$475.72$246.02RVU20C
2020-04-01$475.72$246.02RVU20B
2020-01-01$475.72$246.02RVU20A
2019-10-01$467.16$243.31RVU19D
2019-07-01$467.16$243.31RVU19C
2019-04-01$467.16$243.31RVU19B
2019-01-01$467.16$243.31RVU19A
2018-10-01$467.96$244.36RVU18D
2018-07-01$467.96$244.36RVU18C
2018-04-01$467.96$244.36RVU18B
2018-01-01$467.96$244.36RVU18AR1
2017-10-01$463.28$241.87RVU17D
2017-07-01$463.28$241.87RVU17C
2017-04-01$463.28$241.87RVU17B
2017-01-01$463.28$241.87RVU17A
2016-10-01$468.26$242.05RVU16D
2016-07-01$468.26$242.05RVU16C
2016-04-01$468.26$242.05RVU16B
2016-01-01$468.26$242.05RVU16A
2015-10-01$462.65$242.69RVU15D
2015-07-01$462.65$242.69RVU15C
2015-04-01$460.35$241.48RVU15B
2015-01-01$460.35$241.48RVU15A
2014-10-01$477.65$244.89RVU14D
2014-07-01$477.65$244.89RVU14C
2014-04-01$477.65$244.89RVU14B
2014-01-01$477.65$244.89RVU14A
2013-10-01$449.68$232.10RVU13D
2013-07-01$449.68$232.10RVU13C
2013-04-01$449.68$232.10RVU13B
2013-01-01$449.68$232.10RVU13AR

Price 64635 for an earlier date of service

Where the King County, WA rate applies

King County, WA is a Medicare payment area, not a city. Our Census mapping connects it to 63 cities and communities in Washington. Some span more than one payment area; confirm with the service ZIP.

  • Seattle
  • Algona
  • Ames Lake
  • 64635 in Auburn · multiple payment areas
  • Baring
  • Beaux Arts Village
  • Bellevue
  • Black Diamond

Browse all communities in Washington

64635 billing questions

When do I report 64635 instead of 64636?

Use 64635 for the first lumbar or sacral facet joint treated in the session. Use 64636 for each additional joint.

Does the code count nerves, lesions, or facet joints?

The reporting unit is the facet joint treated, not each nerve or lesion. Document the treated levels and laterality to support the unit count.

Can fluoroscopy or CT guidance be billed separately?

Imaging guidance is included in the ablation service described by this code. Do not report separate guidance for the same procedure.

How is bilateral treatment reported?

CMS identifies this as a bilateral procedure; modifier 50 is paid at 150%. Document treatment on both sides.

What happens when another procedure is performed in the same session?

Under the standard multiple procedure reduction, the highest-valued procedure is paid in full and the others at 50%. Related postoperative visits are included during the 10-day global period.

Can an assistant or co-surgeon be billed?

CMS does not pay an assistant at surgery for this code. Co-surgeon and team-surgery billing are not permitted.

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 64635PPRRVU2026_Oct_nonQPP.csv, line 7,182 (RVU26D)
Geographic factors for King County, WAGPCI2026.csv, line 108 (RVU26D)

Open CMS sourceHow we calculate rates

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