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

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 King County, WA, Medicare pays $300.41 for 64636 in the office and $54.11 when it’s performed in a hospital or facility.

$300.41Office (non-facility)
$54.11Hospital or facility
+19.4%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 King County, WA
  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 King County, WA 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. King County, WA pays $300.41. The RVUs are the same everywhere; the geographic indexes change the dollars.

64636 in King County, WA vs other payment areas
  1. King County, WA · this page$300.41
  2. Rest of Washington · Washington$262.26−$38.15
  3. Los Angeles, CA · California$290.27−$10.14
  4. Washington, DC area · District of Columbia$291.36−$9.05
  5. Miami, FL · Florida$265.74−$34.67
  6. Chicago, IL · Illinois$257.58−$42.83
  7. Manhattan, NY · New York$290.11−$10.30

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

Every other payment area

64636 in every other Medicare payment locality
Payment localityOfficeFacility
AlaskaAlaska$282.39$68.60
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

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 King County, WA 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

108

Locality
King County, WA
Physician work
1.050
Practice expense
1.227
Malpractice
0.817
Office calculation for 64636 in King County, WA
ComponentRVULocality factorAdjusted
Physician work1.13× 1.0501.1865
Practice expense6.29× 1.2277.7178
Malpractice0.11× 0.8170.0899
Total RVUs8.9942
Conversion factor× 33.4009

Office rate, King County, WA$300.41

Office: (1.13 × 1.05 + 6.29 × 1.227 + 0.11 × 0.817) × $33.4009 = $300.41

Facility: (1.13 × 1.05 + 0.28 × 1.227 + 0.11 × 0.817) × $33.4009 = $54.11

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, King County, WA
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.$547.36
Same family
64634Facet ablation, each additional facet jointReports additional cervical or thoracic facet joints rather than lumbar or sacral joints.$317.77
64633Facet ablation, cervical/thoracic, first jointReports the first cervical or thoracic facet joint treated.$539.84
Used instead
64625Radiofrequency ablation, SI-joint innervationTargets nerves supplying the sacroiliac joint, not lumbar or sacral facet joints.$584.10

How 64636 has changed in King County, WA

64636 · Office / nonfacility

$300.41

Effective 2026-10-01

The base rate is $32.24 higher than on 2025-10-01, moving from $268.17 to $300.41 (12.0%).

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

    $268.17changed to$300.41

    • 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 1.043 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

    $284.22changed to$268.17

    • 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

    $279.58changed to$284.22

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $288.47changed to$279.58

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

    $298.25changed to$288.47

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

    $206.98changed to$298.25

    • 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

    $198.56changed to$206.98

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

    $194.64changed to$198.56

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

    $195.25changed to$194.64

    • 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

    $193.31changed to$195.25

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

    $196.35changed to$193.31

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

    $193.32changed to$196.35

    • 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

    $192.36changed to$193.32

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $200.95changed to$192.36

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

    $188.72changed to$200.95

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 3.74 changed to 3.79
    • 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: $188.72

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$300.41$54.11RVU26D
2026-07-01$300.41$54.11RVU26C
2026-04-01$300.41$54.11RVU26B
2026-01-01$300.41$54.11RVU26A
2025-10-01$268.17$61.39RVU25D
2025-07-01$268.17$61.39RVU25C
2025-04-01$268.17$61.39RVU25B
2025-01-01$268.17$61.39RVU25A
2024-10-01$284.22$62.48RVU24D
2024-07-01$284.22$62.48RVU24C
2024-04-01$284.22$62.48RVU24B
2024-03-09$284.22$62.48RVU24AR
2024-01-01$279.58$61.46RVU24A
2023-10-01$288.47$63.10RVU23D
2023-07-01$288.47$63.10RVU23C
2023-04-01$288.47$63.10RVU23B
2023-01-01$288.47$63.10RVU23A
2022-10-01$298.25$63.55RVU22D
2022-07-01$298.25$63.55RVU22C
2022-04-01$298.25$63.55RVU22B
2022-01-01$298.25$63.55RVU22A
2021-10-01$206.98$64.49RVU21D
2021-07-01$206.98$64.49RVU21C
2021-04-01$206.98$64.49RVU21B
2021-01-01$206.98$64.49RVU21A
2020-10-01$198.56$65.55RVU20D
2020-07-01$198.56$65.55RVU20C
2020-04-01$198.56$65.55RVU20B
2020-01-01$198.56$65.55RVU20A
2019-10-01$194.64$64.95RVU19D
2019-07-01$194.64$64.95RVU19C
2019-04-01$194.64$64.95RVU19B
2019-01-01$194.64$64.95RVU19A
2018-10-01$195.25$64.88RVU18D
2018-07-01$195.25$64.88RVU18C
2018-04-01$195.25$64.88RVU18B
2018-01-01$195.25$64.88RVU18AR1
2017-10-01$193.31$64.02RVU17D
2017-07-01$193.31$64.02RVU17C
2017-04-01$193.31$64.02RVU17B
2017-01-01$193.31$64.02RVU17A
2016-10-01$196.35$64.02RVU16D
2016-07-01$196.35$64.02RVU16C
2016-04-01$196.35$64.02RVU16B
2016-01-01$196.35$64.02RVU16A
2015-10-01$193.32$64.25RVU15D
2015-07-01$193.32$64.25RVU15C
2015-04-01$192.36$63.93RVU15B
2015-01-01$192.36$63.93RVU15A
2014-10-01$200.95$65.00RVU14D
2014-07-01$200.95$65.00RVU14C
2014-04-01$200.95$65.00RVU14B
2014-01-01$200.95$65.00RVU14A
2013-10-01$188.72$61.44RVU13D
2013-07-01$188.72$61.44RVU13C
2013-04-01$188.72$61.44RVU13B
2013-01-01$188.72$61.44RVU13AR

Price 64636 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
  • 64636 in Auburn · multiple payment areas
  • Baring
  • Beaux Arts Village
  • Bellevue
  • Black Diamond

Browse all communities in Washington

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 King County, WAGPCI2026.csv, line 108 (RVU26D)

Open CMS sourceHow we calculate rates

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