Billing code 64635: Facet nerve ablationMedicare rate & RVUs in Washington
Reports image-guided ablation of nerves supplying the first lumbar or sacral facet joint treated during a session for facet-mediated spinal pain.
Medicare pays $482.43–$547.36 for 64635 in the office in Washington, from Rest Of Washington to Seattle (King Cnty). Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 9 sections
What 64635 covers
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.
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 64635 pays more and less in Washington
| Payment locality | Office | Facility |
|---|---|---|
| Rest Of Washington | $482.43 | $175.03 |
| Seattle (King Cnty) | $547.36 | $189.17 |
How the 64635 rate is calculated
Each of 64635’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 · 64635
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 3.24Practice expense 10.39Malpractice 0.29
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 64635
64635 has a 10-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 64635
Facet nerve ablation
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 010 | Minor procedure: the day of the procedure plus 10 days after are included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| 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. |
| Split (54/55/56) | 0.10/0.80/0.10 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 64635
Facet nerve ablation
10-day global period ends
Oct 11, 2026
Covers Oct 1, 2026 through Oct 11, 2026 (11 days).
Visit on Oct 31, 2026
After the global period ends: visits and procedures are billed normally.
What modifiers do to the payment
Modifier 50 · payment effect
With and without the modifier
64635 without 50 · national office
$464.94
Facet nerve ablation
64635-50 · Bilateral: 150%
$697.41
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).
64635 compared with similar codes
Compare codes
64635 vs 64636 vs 64633 vs 64625 vs 64628: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 64636Facet nerve ablation
- Use 64635 for the first lumbar or sacral facet joint treated in the session. Use 64636 for each additional joint.
- 64633Facet ablation
- 64633 applies to the first facet joint treated in the cervical or thoracic region; 64635 is for the lumbar or sacral region.
- 64625Radiofrequency ablation
- 64625 targets nerves associated with the sacroiliac joint. Use 64635 when the treated target is a lumbar or sacral facet joint.
- 64628Basivertebral ablation
- 64628 treats intraosseous basivertebral nerves, not the nerves supplying facet joints targeted by 64635.
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 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
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