$495.60–$625.74
64635 covers the first lumbar or sacral facet joint treated. Use 64636 only for each additional joint in the same procedure.
On this page
CMS RVU26D · Effective 2026-10-01
64636 Facet nerve ablation Medicare reimbursement rates in California
Reports neurolytic treatment of each additional lumbar or sacral facet joint, typically during radiofrequency ablation for facet-mediated low back pain. Compare 64636 office and facility rates across CMS payment localities in California.
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
What does Medicare pay for 64636 in California?
California has 29 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 29 payment areas shown below, using the same CMS release.
Office / nonfacility
$270.61–$346.82
29 of 29 localities have a supported rate.
Lowest: Chico
Highest: San Jose-Sunnyvale-Santa Clara (San Benito Cnty)
A spread of $76.21 per service.
Facility setting
$50.60–$57.35
29 of 29 localities have a supported rate.
Lowest: Chico
Highest: San Jose-Sunnyvale-Santa Clara (San Benito Cnty)
A spread of $6.75 per service.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Where 64636 pays more and less in California
29 payment localities
$270.61 to $346.82
Interventional pain
About 64636: Additional lumbar or sacral facet nerve ablation
Reports neurolytic treatment of each additional lumbar or sacral facet joint, typically during radiofrequency ablation for facet-mediated low back pain.
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.
CMS billing rules for 64636
- Global period
- Add-on code: billed only together with a primary procedure and paid within that procedure's global period.
- Bilateral procedures
- Bilateral procedure with modifier 50 is paid at 150%.
Where the value comes from
- Work RVU1.13 · 15%
- Practice expense (office) RVU6.29 · 84%
- Malpractice RVU0.11 · 1%
251.3K
Medicare services in 2024 · #345 by national volume
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.
64636 compared with similar codes
Office rates for California, from the same CMS release.
$286.48–$366.41
64634 is for additional cervical or thoracic facet joints; 64636 is for additional lumbar or sacral facet joints.
$528.35–$668.06
64625 addresses nerve destruction for sacroiliac joint pain. Code 64636 applies to additional lumbar or sacral facet joints.
Compare 64636 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
29 of 29 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Bakersfield | Office $270.96 | Facility $50.95 |
| Chico | Office $270.61 | Facility $50.60 |
| El Centro | Office $270.63 | Facility $50.62 |
| Fresno | Office $270.61 | Facility $50.60 |
| Hanford-Corcoran | Office $270.61 | Facility $50.60 |
| Los Angeles-Long Beach-Anaheim (Los Angeles/Orange Cnty) | Office $290.27 | Facility $52.79 |
| Madera | Office $270.61 | Facility $50.60 |
| Merced | Office $270.61 | Facility $50.60 |
| Modesto | Office $270.61 | Facility $50.60 |
| Napa | Office $318.89 | Facility $54.31 |
| Oxnard-Thousand Oaks-Ventura | Office $289.42 | Facility $52.14 |
| Redding | Office $270.61 | Facility $50.60 |
| Rest Of California | Office $270.61 | Facility $50.60 |
| Riverside-San Bernardino-Ontario | Office $271.82 | Facility $51.81 |
| Sacramento-Roseville-Folsom | Office $285.41 | Facility $51.95 |
| Salinas | Office $284.38 | Facility $51.72 |
| San Diego-Chula Vista-Carlsbad | Office $292.14 | Facility $52.05 |
| San Francisco-Oakland-Berkeley (Marin Cnty) | Office $339.24 | Facility $56.20 |
| San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty) | Office $339.12 | Facility $56.08 |
| San Jose-Sunnyvale-Santa Clara (San Benito Cnty) | Office $346.82 | Facility $57.35 |
| San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty) | Office $346.31 | Facility $56.84 |
| San Luis Obispo-Paso Robles | Office $279.65 | Facility $51.01 |
| Santa Cruz-Watsonville | Office $295.77 | Facility $51.87 |
| Santa Maria-Santa Barbara | Office $285.74 | Facility $51.67 |
| Santa Rosa-Petaluma | Office $298.84 | Facility $52.33 |
| Stockton | Office $270.61 | Facility $50.60 |
| Vallejo | Office $318.71 | Facility $54.13 |
| Visalia | Office $270.61 | Facility $50.60 |
| Yuba City | Office $270.61 | Facility $50.60 |
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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 indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
7,18064633,,Destroy cerv/thor facet jnt,A,,3.24,10.20,,1.63,,0.30,13.74,5.17,0,010,0.10,0.80,0.10,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,18164634,,Destroy c/th facet jnt addl,A,,1.29,6.57,,0.32,,0.12,7.98,1.73,0,ZZZ,0.00,0.00,0.00,0,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,18264635,,Destroy lumb/sac facet jnt,A,,3.24,10.39,,1.65,,0.29,13.92,5.18,0,010,0.10,0.80,0.10,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,18364636,,Destroy l/s facet jnt addl,A,,1.13,6.29,,0.28,,0.11,7.53,1.52,0,ZZZ,0.00,0.00,0.00,0,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,18464640,,Injection treatment of nerve,A,,1.93,5.86,,1.19,,0.22,8.01,3.34,0,010,0.10,0.80,0.10,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,18564642,,Chemodenerv 1 extremity 1-4,A,,1.61,2.89,,0.88,,0.39,4.89,2.88,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,18664643,,Chemodenerv 1 extrem 1-4 ea,A,,1.19,1.57,,0.37,,0.23,2.99,1.79,0,ZZZ,0.00,0.00,0.00,0,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00