$247.59
Use 64635 for the first lumbar or sacral facet joint treated in the session. Use 64636 for each additional joint.
On this page
CMS RVU26D · Effective 2026-10-01
64635 Facet nerve ablation Medicare reimbursement rates in Vermont
Reports image-guided ablation of nerves supplying the first lumbar or sacral facet joint treated during a session for facet-mediated spinal pain. Compare 64635 office and facility rates across CMS payment localities in Vermont.
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 64635 in Vermont?
Vermont has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
$456.69
1 of 1 localities have a supported rate.
Payment area: Vermont
One mapped payment locality.
Facility setting
$167.68
1 of 1 localities have a supported rate.
Payment area: Vermont
One mapped payment locality.
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.
Pain management
About 64635: Lumbar or sacral facet nerve ablation
Reports image-guided ablation of nerves supplying the first lumbar or sacral facet joint treated during a session for facet-mediated spinal pain.
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.
CMS billing rules for 64635
- Global period
- Minor procedure with a 10-day global period: related postoperative visits for 10 days are included.
- Multiple procedures
- Standard multiple procedure reduction: the highest-valued procedure is paid in full and others at 50% when performed in the same session.
- Bilateral procedures
- Bilateral procedure with modifier 50 is paid at 150%.
- Assistant at surgery
- Statutory restriction: assistant at surgery is not paid.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU3.24 · 23%
- Practice expense (office) RVU10.39 · 75%
- Malpractice RVU0.29 · 2%
381.1K
Medicare services in 2024 · #267 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.
64635 compared with similar codes
Office rates for Vermont, from the same CMS release.
$450.57
64633 applies to the first facet joint treated in the cervical or thoracic region; 64635 is for the lumbar or sacral region.
$486.48
64625 targets nerves associated with the sacroiliac joint. Use 64635 when the treated target is a lumbar or sacral facet joint.
No office rate
64628 treats intraosseous basivertebral nerves, not the nerves supplying facet joints targeted by 64635.
Compare 64635 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.
1 of 1 payment localities
Vermont →
Office / nonfacility
$456.69
Facility
$167.68
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How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 64635 in Vermont.
PPRRVU2026_Oct_nonQPP.csv
7,182
- Code
- 64635
- Physician work
- 3.24
- Practice expense
- 10.39
- Malpractice
- 0.29
GPCI2026.csv
105
- Locality
- Vermont
- Physician work
- 1.000
- Practice expense
- 0.990
- Malpractice
- 0.506
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 3.24 | × 1.000 | 3.2400 |
| Practice expense | 10.39 | × 0.990 | 10.2861 |
| Malpractice | 0.29 | × 0.506 | 0.1467 |
| Total RVUs | 13.6728 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Vermont$456.69
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 3.24 | 1 |
| Practice expense | 10.39 | 0.99 |
| Malpractice | 0.29 | 0.506 |
(3.24 × 1 + 10.39 × 0.99 + 0.29 × 0.506) × $33.4009 = $456.69
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 3.24 | 1 |
| Practice expense | 1.65 | 0.99 |
| Malpractice | 0.29 | 0.506 |
(3.24 × 1 + 1.65 × 0.99 + 0.29 × 0.506) × $33.4009 = $167.68
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
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 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.
7,17964632,,N block inj common digit,A,,1.20,1.41,,0.56,,0.09,2.70,1.85,0,010,0.10,0.80,0.10,2,1,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
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
10204412,TX,18,HOUSTON,1.008,0.993,1.376
10304412,TX,99,REST OF TEXAS,1.000,0.949,0.903
10403502,UT,09,UTAH,1.000,0.940,0.898
10514512,VT,50,VERMONT,1.000,0.990,0.506
10611302,VA,00,VIRGINIA,1.000,0.983,0.706
10709202,VI,50,VIRGIN ISLANDS,1.000,1.011,0.985
10802402,WA,02,SEATTLE (KING CNTY),1.050,1.227,0.817