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CPT code 64636: Facet nerve ablation, additional lumbar or sacral joint2026 Medicare rate & RVUs in Virginia

Reports neurolytic treatment of each additional lumbar or sacral facet joint, typically during radiofrequency ablation for facet-mediated low back pain.

CMS RVU26DEffective Oct 1, 2026One payment locality251.3K Medicare services in 2024

In Virginia, Medicare pays $246.86 for 64636 in the office and $49.53 when it’s performed in a hospital or facility.

$246.86Office (non-facility)
$49.53Hospital or facility
−1.8%vs the national office rate ($251.51)

Check a contract rate as a % of Medicare · 64636 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 64636 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Virginia
  2. What 64636 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 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.

How Virginia compares for 64636

Across 109 of 109 payment localities, the office rate for 64636 runs from $220.10 in Arkansas to $346.82 in San Benito County, CA. Virginia pays $246.86. The RVUs are the same everywhere; the geographic indexes change the dollars.

64636 in Virginia vs other payment areas
  1. Virginia · this page$246.86
  2. Los Angeles, CA · California$290.27+$43.41
  3. Washington, DC area · District of Columbia$291.36+$44.50
  4. Miami, FL · Florida$265.74+$18.88
  5. Chicago, IL · Illinois$257.58+$10.72
  6. Manhattan, NY · New York$290.11+$43.25
  7. Alaska · Alaska$282.39+$35.53

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

Every other payment area

64636 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$223.65$48.01
ArkansasArkansas$220.10$47.67
ArizonaArizona$244.47$49.95
Bakersfield, CACalifornia$270.96$50.95
Chico, CACalifornia$270.61$50.60
El Centro, CACalifornia$270.63$50.62
Fresno, CACalifornia$270.61$50.60
Hanford, CACalifornia$270.61$50.60

64636 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.

$220.10

$308.72

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

View every state and territory as a table
64636 office rate range by state
State / territoryOffice rate rangeLocalities
AK$282.391
AL$223.651
AR$220.101
AZ$244.471
CA$270.61–$346.8229
CO$264.601
CT$269.211
DC$291.361
DE$248.811
FL$244.11–$265.743
GA$229.52–$255.722
GU$278.741
HI$278.741
IA$231.441
ID$232.771
IL$235.30–$260.284
IN$234.281
KS$229.521
KY$227.881
LA$227.19–$239.612
MA$262.50–$293.412
MD$254.11–$291.363
ME$233.31–$248.262
MI$233.70–$246.682
MN$255.011
MO$222.42–$241.433
MS$221.351
MT$251.501
NC$236.111
ND$249.331
NE$233.051
NH$259.661
NJ$272.70–$287.752
NM$234.811
NV$251.111
NY$239.91–$296.785
OH$233.261
OK$228.211
OR$249.58–$274.492
PA$234.08–$261.512
PR$253.761
RI$258.761
SC$234.991
SD$249.071
TN$230.691
TX$232.34–$263.358
UT$238.531
VA$246.86–$291.362
VI$253.761
VT$247.591
WA$262.26–$300.412
WI$240.141
WV$225.571
WY$250.551

See 64636 in every payment locality

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

Office or facility?

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.

The exact Virginia inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

7,183

Code
64636
Physician work
1.13
Practice expense
6.29
Malpractice
0.11

GPCI2026.csv

106

Locality
Virginia
Physician work
1.000
Practice expense
0.983
Malpractice
0.706
Office calculation for 64636 in Virginia
ComponentRVULocality factorAdjusted
Physician work1.13× 1.0001.1300
Practice expense6.29× 0.9836.1831
Malpractice0.11× 0.7060.0777
Total RVUs7.3907
Conversion factor× 33.4009

Office rate, Virginia$246.86

Office: (1.13 × 1 + 6.29 × 0.983 + 0.11 × 0.706) × $33.4009 = $246.86

Facility: (1.13 × 1 + 0.28 × 0.983 + 0.11 × 0.706) × $33.4009 = $49.53

Open 64636 in the RVU calculator

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

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

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).

When to use modifier 50

Codes related to 64636

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

Codes related to 64636
CodeHow it relatesOffice range, Virginia
Add-on codes
64635Facet nerve ablation, first lumbar or sacral jointReports the first lumbar or sacral facet joint treated; 64636 is added for further joints.$456.19
Same family
64634Facet ablation, each additional facet jointReports additional cervical or thoracic facet joints rather than lumbar or sacral joints.$261.63
64633Facet ablation, cervical/thoracic, first jointReports the first cervical or thoracic facet joint treated.$450.19
Used instead
64625Radiofrequency ablation, SI-joint innervationTargets nerves supplying the sacroiliac joint, not lumbar or sacral facet joints.$486.07

How 64636 has changed in Virginia

64636 · Office / nonfacility

$246.86

Effective 2026-10-01

The base rate is $24.27 higher than on 2025-10-01, moving from $222.59 to $246.86 (10.9%).

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

    $222.59changed to$246.86

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 1.16 changed to 1.13
    • Practice expense RVU 5.72 changed to 6.29
    • Malpractice RVU 0.12 changed to 0.11
    • 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

    $235.69changed to$222.59

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 5.93 changed to 5.72
    • Malpractice RVU 0.11 changed to 0.12

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $231.84changed to$235.69

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $243.01changed to$231.84

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 5.98 changed to 5.93
    • 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

    $254.98changed to$243.01

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 6.14 changed to 5.98
    • 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

    $178.97changed to$254.98

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 3.89 changed to 6.14

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $174.20changed to$178.97

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 3.60 changed to 3.89
    • 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

    $172.67changed to$174.20

    • Conversion factor 36.0391 changed to 36.0896
    • Malpractice RVU 0.09 changed to 0.11
    • 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

    $173.20changed to$172.67

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 3.62 changed to 3.60

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $171.34changed to$173.20

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 3.59 changed to 3.62
    • 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

    $173.71changed to$171.34

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 3.68 changed to 3.59
    • 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

    $171.16changed to$173.71

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 3.59 changed to 3.68

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $170.30changed to$171.16

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $177.12changed to$170.30

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 3.79 changed to 3.59
    • 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

    $166.02changed to$177.12

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 3.74 changed to 3.79
    • 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: $166.02

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$246.86$49.53RVU26D
2026-07-01$246.86$49.53RVU26C
2026-04-01$246.86$49.53RVU26B
2026-01-01$246.86$49.53RVU26A
2025-10-01$222.59$55.81RVU25D
2025-07-01$222.59$55.81RVU25C
2025-04-01$222.59$55.81RVU25B
2025-01-01$222.59$55.81RVU25A
2024-10-01$235.69$56.85RVU24D
2024-07-01$235.69$56.85RVU24C
2024-04-01$235.69$56.85RVU24B
2024-03-09$235.69$56.85RVU24AR
2024-01-01$231.84$55.92RVU24A
2023-10-01$243.01$58.16RVU23D
2023-07-01$243.01$58.16RVU23C
2023-04-01$243.01$58.16RVU23B
2023-01-01$243.01$58.16RVU23A
2022-10-01$254.98$59.40RVU22D
2022-07-01$254.98$59.40RVU22C
2022-04-01$254.98$59.40RVU22B
2022-01-01$254.98$59.40RVU22A
2021-10-01$178.97$60.24RVU21D
2021-07-01$178.97$60.24RVU21C
2021-04-01$178.97$60.24RVU21B
2021-01-01$178.97$60.24RVU21A
2020-10-01$174.20$61.54RVU20D
2020-07-01$174.20$61.54RVU20C
2020-04-01$174.20$61.54RVU20B
2020-01-01$174.20$61.54RVU20A
2019-10-01$172.67$61.10RVU19D
2019-07-01$172.67$61.10RVU19C
2019-04-01$172.67$61.10RVU19B
2019-01-01$172.67$61.10RVU19A
2018-10-01$173.20$61.03RVU18D
2018-07-01$173.20$61.03RVU18C
2018-04-01$173.20$61.03RVU18B
2018-01-01$173.20$61.03RVU18AR1
2017-10-01$171.34$60.69RVU17D
2017-07-01$171.34$60.69RVU17C
2017-04-01$171.34$60.69RVU17B
2017-01-01$171.34$60.69RVU17A
2016-10-01$173.71$61.08RVU16D
2016-07-01$173.71$61.08RVU16C
2016-04-01$173.71$61.08RVU16B
2016-01-01$173.71$61.08RVU16A
2015-10-01$171.16$61.30RVU15D
2015-07-01$171.16$61.30RVU15C
2015-04-01$170.30$61.00RVU15B
2015-01-01$170.30$61.00RVU15A
2014-10-01$177.12$61.26RVU14D
2014-07-01$177.12$61.26RVU14C
2014-04-01$177.12$61.26RVU14B
2014-01-01$177.12$61.26RVU14A
2013-10-01$166.02$57.33RVU13D
2013-07-01$166.02$57.33RVU13C
2013-04-01$166.02$57.33RVU13B
2013-01-01$166.02$57.33RVU13AR

Price 64636 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

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

Show the CMS file lines behind this rate
RVUs for 64636PPRRVU2026_Oct_nonQPP.csv, line 7,183 (RVU26D)
Geographic factors for VirginiaGPCI2026.csv, line 106 (RVU26D)

Open CMS sourceHow we calculate rates

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