CPT code 64636: Facet nerve ablation, additional lumbar or sacral joint2026 Medicare rate & RVUs
Reports neurolytic treatment of each additional lumbar or sacral facet joint, typically during radiofrequency ablation for facet-mediated low back pain.
Medicare pays $251.51 for 64636 nationally in the office and $50.77 in a hospital or facility. Local office rates run $220.10–$346.82.
Medicare rate · 64636
Facet nerve ablation, additional lumbar or sacral joint
- Work RVUs
- 1.13
- Total RVUs
- 7.53
- Global days
- ZZZ
National rate · 2026
$251.51
Office setting, before claim adjustments.
See every locality for 64636 →Billed by an NP, PA or therapist? →
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 10 sections
What 64636 covers
This add-on code represents neurolytic treatment of another lumbar or sacral facet joint after the first joint is treated. In a common radiofrequency procedure, an interventional pain physician uses imaging to guide treatment of the medial branch nerves that supply the targeted facet joint. The procedure is used for selected patients with chronic axial low back pain attributed to lumbar or sacral facet joints, often after diagnostic medial branch blocks. Imaging guidance is included in the procedure.
Report 64636 for each additional lumbar or sacral facet joint treated, alongside 64635 for the first joint. The procedure note should identify the treated joint levels, laterality, nerves targeted, and imaging guidance. CMS classifies 64636 as an add-on code: it must be billed with its primary procedure and is paid within that procedure's global period. For a bilateral procedure reported with modifier 50, CMS pays 150% of the applicable amount.
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 64636 pays more and less
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
109 payment localities
$220.10 to $346.82
109 of 109 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Alabama | $223.65 | $48.01 |
| Alaska | $282.39 | $68.60 |
| Arizona | $244.47 | $49.95 |
| Arkansas | $220.10 | $47.67 |
| Atlanta, GA | $255.72 | $51.77 |
| Austin, TX | $263.35 | $50.97 |
| Bakersfield, CA | $270.96 | $50.95 |
| Baltimore area, MD | $268.32 | $52.93 |
| Beaumont, TX | $232.34 | $49.67 |
| Brazoria, TX | $249.11 | $50.18 |
| Chicago, IL | $257.58 | $55.84 |
| Chico, CA | $270.61 | $50.60 |
| Colorado | $264.60 | $51.02 |
| Connecticut | $269.21 | $53.02 |
| Dallas, TX | $250.49 | $50.55 |
| Delaware | $248.81 | $50.47 |
| Detroit, MI | $246.68 | $52.96 |
| East St. Louis, IL | $238.43 | $53.75 |
| El Centro, CA | $270.63 | $50.62 |
| Fort Lauderdale, FL | $257.21 | $53.86 |
| Fort Worth, TX | $248.43 | $50.50 |
| Fresno, CA | $270.61 | $50.60 |
| Galveston, TX | $249.71 | $50.37 |
| Hanford, CA | $270.61 | $50.60 |
| Hawaii, Guam, HI | $278.74 | $50.50 |
| Houston, TX | $251.72 | $52.39 |
| Idaho | $232.77 | $48.08 |
| Indiana | $234.28 | $48.20 |
| Iowa | $231.44 | $47.76 |
| Kansas | $229.52 | $48.05 |
| Kentucky | $227.88 | $49.42 |
| King County, WA | $300.41 | $54.11 |
| Los Angeles, CA | $290.27 | $52.79 |
| Madera, CA | $270.61 | $50.60 |
| Manhattan, NY | $290.11 | $56.85 |
| Marin County, CA | $339.24 | $56.20 |
| Merced, CA | $270.61 | $50.60 |
| Metropolitan Boston, MA | $293.41 | $53.73 |
| Metropolitan Kansas City, MO | $238.61 | $50.11 |
| Metropolitan Philadelphia, PA | $261.51 | $52.54 |
| Metropolitan St. Louis, MO | $241.43 | $50.33 |
| Miami, FL | $265.74 | $56.77 |
| Minnesota | $255.01 | $48.45 |
| Mississippi | $221.35 | $48.51 |
| Modesto, CA | $270.61 | $50.60 |
| Montana | $251.50 | $50.76 |
| Napa, CA | $318.89 | $54.31 |
| Nebraska | $233.05 | $47.76 |
| Nevada | $251.11 | $50.17 |
| New Hampshire | $259.66 | $50.69 |
| New Mexico | $234.81 | $50.73 |
| New Orleans, LA | $239.61 | $50.72 |
| North Carolina | $236.11 | $48.82 |
| North Dakota | $249.33 | $48.59 |
| Northern New Jersey | $287.75 | $54.89 |
| NYC suburbs and Long Island, NY | $296.78 | $58.10 |
| Ohio | $233.26 | $49.99 |
| Oklahoma | $228.21 | $48.95 |
| Oxnard, CA | $289.42 | $52.14 |
| Portland, OR | $274.49 | $51.47 |
| Poughkeepsie and northern NYC suburbs, NY | $273.94 | $54.13 |
| Puerto Rico | $253.76 | $50.82 |
| Queens, NY | $293.78 | $56.51 |
| Redding, CA | $270.61 | $50.60 |
| Rest of California | $270.61 | $50.60 |
| Rest of Florida | $244.11 | $52.21 |
| Rest of Georgia | $229.52 | $50.46 |
| Rest of Illinois | $235.30 | $52.02 |
| Rest of Louisiana | $227.19 | $49.54 |
| Rest of Maine | $233.31 | $48.63 |
| Rest of Maryland | $254.11 | $50.96 |
| Rest of Massachusetts | $262.50 | $51.12 |
| Rest of Michigan | $233.70 | $50.43 |
| Rest of Missouri | $222.42 | $49.38 |
| Rest of New Jersey | $272.70 | $53.50 |
| Rest of New York | $239.91 | $49.21 |
| Rest of Oregon | $249.58 | $49.64 |
| Rest of Pennsylvania | $234.08 | $49.80 |
| Rest of Texas | $240.44 | $49.94 |
| Rest of Washington | $262.26 | $50.88 |
| Rhode Island | $258.76 | $51.40 |
| Riverside, CA | $271.82 | $51.81 |
| Sacramento, CA | $285.41 | $51.95 |
| Salinas, CA | $284.38 | $51.72 |
| San Benito County, CA | $346.82 | $57.35 |
| San Diego, CA | $292.14 | $52.05 |
| San Francisco, CA | $339.12 | $56.08 |
| San Luis Obispo, CA | $279.65 | $51.01 |
| Santa Clara County, CA | $346.31 | $56.84 |
| Santa Cruz, CA | $295.77 | $51.87 |
| Santa Maria, CA | $285.74 | $51.67 |
| Santa Rosa, CA | $298.84 | $52.33 |
| South Carolina | $234.99 | $49.51 |
| South Dakota | $249.07 | $48.33 |
| Southern Maine, ME | $248.26 | $49.33 |
| Stockton, CA | $270.61 | $50.60 |
| Suburban Chicago, IL | $260.28 | $54.12 |
| Tennessee | $230.69 | $48.22 |
| Utah | $238.53 | $49.83 |
| Vallejo, CA | $318.71 | $54.13 |
| Vermont | $247.59 | $48.86 |
| Virgin Islands, VI | $253.76 | $50.82 |
| Virginia | $246.86 | $49.53 |
| Visalia, CA | $270.61 | $50.60 |
| Washington, DC area | $291.36 | $54.89 |
| West Virginia | $225.57 | $51.13 |
| Wisconsin | $240.14 | $47.83 |
| Wyoming | $250.55 | $49.81 |
| Yuba City, CA | $270.61 | $50.60 |
64636 rates by state
Office rate range in each state. Select a state to see its payment localities.
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.
$220.10
$308.72
Color shows the midpoint of each state’s locality range.
View every state and territory as a table
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | $282.39 | 1 |
| AL | $223.65 | 1 |
| AR | $220.10 | 1 |
| AZ | $244.47 | 1 |
| CA | $270.61–$346.82 | 29 |
| CO | $264.60 | 1 |
| CT | $269.21 | 1 |
| DC | $291.36 | 1 |
| DE | $248.81 | 1 |
| FL | $244.11–$265.74 | 3 |
| GA | $229.52–$255.72 | 2 |
| GU | $278.74 | 1 |
| HI | $278.74 | 1 |
| IA | $231.44 | 1 |
| ID | $232.77 | 1 |
| IL | $235.30–$260.28 | 4 |
| IN | $234.28 | 1 |
| KS | $229.52 | 1 |
| KY | $227.88 | 1 |
| LA | $227.19–$239.61 | 2 |
| MA | $262.50–$293.41 | 2 |
| MD | $254.11–$291.36 | 3 |
| ME | $233.31–$248.26 | 2 |
| MI | $233.70–$246.68 | 2 |
| MN | $255.01 | 1 |
| MO | $222.42–$241.43 | 3 |
| MS | $221.35 | 1 |
| MT | $251.50 | 1 |
| NC | $236.11 | 1 |
| ND | $249.33 | 1 |
| NE | $233.05 | 1 |
| NH | $259.66 | 1 |
| NJ | $272.70–$287.75 | 2 |
| NM | $234.81 | 1 |
| NV | $251.11 | 1 |
| NY | $239.91–$296.78 | 5 |
| OH | $233.26 | 1 |
| OK | $228.21 | 1 |
| OR | $249.58–$274.49 | 2 |
| PA | $234.08–$261.51 | 2 |
| PR | $253.76 | 1 |
| RI | $258.76 | 1 |
| SC | $234.99 | 1 |
| SD | $249.07 | 1 |
| TN | $230.69 | 1 |
| TX | $232.34–$263.35 | 8 |
| UT | $238.53 | 1 |
| VA | $246.86–$291.36 | 2 |
| VI | $253.76 | 1 |
| VT | $247.59 | 1 |
| WA | $262.26–$300.41 | 2 |
| WI | $240.14 | 1 |
| WV | $225.57 | 1 |
| WY | $250.55 | 1 |
How the 64636 rate is calculated
Each of 64636’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 · 64636
RVUs × geographic indexes × conversion factor
Work1.13
1.13 RVUs× 1.000 GPCI
Practice expense6.29
6.29 RVUs× 1.000 GPCI
Malpractice0.11
0.11 RVUs× 1.000 GPCI
Adjusted RVUs
7.5300
Conversion factor
$33.4009
Medicare rate
$251.51
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 64636
The CMS indicators that decide how 64636 is paid alongside other services.
CMS payment indicators · 64636
Facet nerve ablation, additional lumbar or sacral 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
64636 without 50 · national office
$251.51
Facet nerve ablation, additional lumbar or sacral joint
64636-50 · Bilateral: 150%
$377.27
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).
64636 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 64635Facet nerve ablationFirst lumbar or sacral joint
- 64635 covers the first lumbar or sacral facet joint treated. Use 64636 only for each additional joint in the same procedure.
- 64634Facet ablationEach additional facet joint
- 64634 is for additional cervical or thoracic facet joints; 64636 is for additional lumbar or sacral facet joints.
- 64625Radiofrequency ablationSI-joint innervation
- 64625 addresses nerve destruction for sacroiliac joint pain. Code 64636 applies to additional lumbar or sacral facet joints.
64636 billing questions
When should 64636 be reported instead of 64635?
Use 64635 for the first lumbar or sacral facet joint treated. Report 64636 for each additional joint treated in the same procedure.
Is 64636 reported per nerve or per facet joint?
It is reported for each additional facet joint, not for each individual medial branch nerve treated to reach that joint.
Can 64636 be billed by itself?
No. It is an add-on code and must be billed with the primary procedure, 64635, for the first lumbar or sacral facet joint.
Can imaging guidance be billed separately?
Imaging guidance for the facet nerve destruction procedure is included in the code. The documentation should identify the guidance used.
How is bilateral treatment reported?
For a bilateral procedure reported with modifier 50, CMS pays 150% of the applicable amount.
What documentation supports multiple units of 64636?
Document each additional lumbar or sacral facet joint treated, its laterality, the nerves targeted, and the imaging guidance used.
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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