CPT 64635: radiofrequency ablation of a lumbar facet joint
64635 reports heat destruction of the medial branch nerves that supply one lumbar or sacral facet joint, done under fluoroscopy or CT. It is a first-level code: each added joint at another level goes on the add-on 64636, and the unit is the joint, never the nerve.
Written by Salman Saeed, CEO and Co-Founder · Reviewed by a Certified Medical Coder · Last reviewed October 2026In short: 64635 bills one lumbar or sacral facet ablation per joint, with 64636 for each added level and modifier 50 on a line done on both sides. It has a 010 global, and Novitas policy allows 2 ablation sessions per spinal region in a rolling 12 months.
What does CPT 64635 report?
64635 reports thermal radiofrequency destruction (ablation, also called neurotomy) of the medial branch nerves that supply one lumbar or sacral facet joint, done under fluoroscopy or CT. CMS labels it "Destroy lumb/sac facet jnt". It is the first-level code. Each added joint at a different level in the same region goes on the add-on 64636.
| Item in RVU26D and the MUE table | 64635 | 64636 (add-on) |
|---|---|---|
| Payment status | A | A |
| Work RVU | 3.24 | 1.13 |
| Total RVU, non-facility | 13.92 | 7.53 |
| Total RVU, facility | 5.18 | 1.52 |
| Global period | 010 | ZZZ |
| Bilateral surgery indicator | 1 | 1 |
| Practitioner MUE, effective 10-01-2026 | 1 (indicator 2) | 4 (indicator 3) |
How many units and levels can you bill?
The unit is the joint, not the nerve. Article A56670 says 64633 through 64636 are reported per joint, and although two nerves supply each facet joint, only 1 unit may be reported per joint however many nerves were treated. The first lumbar or sacral joint is 64635 and each additional joint at a different level in that region is 64636.
The same article puts the junction between regions in a specific place: neurolytic destruction of the nerves supplying the T12-L1 joint is reported with 64633, the cervical and thoracic code. The LCD allows 1 to 2 levels per session in a spine region, and says three or four levels are not medically necessary and are non-covered.
A physician ablates the L4-5 and L5-S1 joints on both sides in one session. The claim has 64635 with modifier 50 and 1 unit, and 64636 with modifier 50 and 1 unit. That is two levels, the most the LCD allows for a lumbar session.
How are both sides reported?
The file's bilateral indicator for 64635 is 1, which means payment is the lower of the billed amount or 150 percent of the single-side amount. NCCI Chapter I says a bilateral procedure with that indicator is reported with 1 unit and modifier 50 on one line.
Article A56670 says each unilateral or bilateral intervention is 1 unit, with RT or LT on a one-sided line and modifier 50 on a bilateral line. An ambulatory surgery center facility reports two lines of 1 unit each with RT and LT, while the physician still uses modifier 50.
What do Medicare contractors require before and between ablations?
These rules come from the Novitas LCD L34892 and article A56670, which apply in Novitas jurisdictions H and L. Other contractors write their own policies. For the first ablation the LCD requires at least two diagnostic medial branch blocks, each giving a consistent minimum of 80 percent sustained relief of the main pain.
Article A56670 limits codes 64633 through 64636 to no more than 2 sessions per spinal region per rolling 12 months. A session is all facet procedures done on the same date. The LCD also limits a session to one spinal region.
For a repeat ablation, the version in force now requires a consistent improvement of at least 50 percent in pain for at least six months and at least 50 percent improvement in the ability to perform painful movements and daily activities. A revised LCD effective December 6, 2026 changes the "and" to "or", so either improvement will qualify.
What else is excluded or restricted?
- Pulsed or other non-thermal denervation is not reported with 64633 to 64636. It goes on 64999, which the article says is non-covered for that use.
- Sedation: moderate sedation for ablation is considered only with documented need. Patient anxiety or preference alone is not enough.
- Same-day blocks: the LCD says it is not routinely necessary to give epidural injections, sympathetic blocks or trigger point injections on the same day, and each one needs its own documented necessity.
For the matching epidural rules, see CPT 62323. For authorization and documentation across pain procedures, see pain management billing.
Can you bill a visit with 64635?
Yes, if it is significant and separately identifiable, with modifier 25. A 010 global makes 64635 a minor procedure under NCCI Chapter I, so the decision to treat is included. Chapter 12 of the Claims Processing Manual adds that follow-up care within 10 days that relates to recovery is not paid separately.
How are side and level shown for 64635?
A lumbar facet ablation is one line for the first joint, 64635 in Item 24D with RT or LT, 1 unit in Item 24G and a pointer in Item 24E to the facet pain diagnosis. RVU26D sets the bilateral indicator to 1. Additional levels use the add-on code on their own line.
On a hospital outpatient bill, the revenue code goes in FL 42, 64635 in FL 44, the date in FL 45 and units in FL 46. The file shows a 010 global and the MUE table allows 1 per date with indicator 2.
Example: A patient has the right L4-L5 facet joint treated on 10/22. The line is 64635 RT, pointer A (M47.816), 1 unit, $1,250.00. A left side done the same day takes its own LT line.
Why is 64635 denied?
| CARC | What X12 says | What usually causes it |
|---|---|---|
| 151 | Payment adjusted because the payer deems the information submitted does not support this many/frequency of services | A third session in 12 months for one region, or 2 units on one joint |
| 50 | Non-covered services because this is not deemed a 'medical necessity' by the payer | No documented diagnostic blocks at 80 percent relief |
| 96 | Non-covered charge(s) | Three or four levels, or pulsed radiofrequency billed as 64635 |
| 4 | The procedure code is inconsistent with the modifier used | Missing 50, RT or LT on the line |
If these denials keep coming back, our denial management team can work them. See also CPT 20610 and the LCD and NCD rule.
Related codes
- Physician Fee Schedule relative value files, RVU26D (October 2026) · CMS
- Medicare NCCI Medically Unlikely Edits, practitioner and outpatient hospital tables, effective 10-01-2026 · CMS
- LCD L34892, Facet Joint Interventions for Pain Management (Novitas), version effective 12/06/2026 · CMS Medicare Coverage Database
- Billing and Coding Article A56670, Facet Joint Interventions for Pain Management · CMS Medicare Coverage Database
- 2026 NCCI Medicare Policy Manual, Chapter I: General Correct Coding Policies · CMS
- Medicare Claims Processing Manual, Chapter 12: Physicians/Nonphysician Practitioners · CMS
- Claim Adjustment Reason Codes · X12
- Place of service code set · CMS
- Medicare Claims Processing Manual, Chapter 26: Completing and Processing Form CMS-1500 Data Set · CMS
- Medicare Claims Processing Manual, Chapter 25: Completing and Processing the Form CMS-1450 Data Set · CMS
We check every rule, code and deadline against the official source. See our editorial policy.
Common questions
Straight answers from the team that does the work.
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01What does CPT 64635 mean?
It reports thermal radiofrequency destruction of the medial branch nerves for one lumbar or sacral facet joint, done under fluoroscopy or CT. CMS labels it "Destroy lumb/sac facet jnt". It has a 010-day global and its add-on, 64636, reports each extra joint at another level.
02How often can radiofrequency ablation be repeated?
Article A56670 limits 64633 to 64636 to 2 sessions per spinal region per rolling 12 months in Novitas jurisdictions. A repeat also needs lasting benefit: at least 50 percent pain improvement for six months, and from December 6, 2026, either that or improved function. Other contractors set their own limits.
03Is T12-L1 reported with 64635?
No. Article A56670 says neurolytic destruction of the nerves supplying the T12-L1 facet joint is reported with 64633, the cervical and thoracic code. 64635 starts at the lumbar and sacral region, and 64636 adds each further joint in that region.
04Does 64635 include the fluoroscopy?
The code describes destruction performed with image guidance, fluoroscopy or CT, according to Article A56670. The LCD also treats facet interventions without CT or fluoroscopy as not reasonable and necessary, so the guidance is part of the procedure and not a separate billable service.
05Can pulsed radiofrequency be billed as 64635?
No. Article A56670 says non-thermal denervation, including chemical, low grade thermal energy below 80 degrees Celsius or any pulsed radiofrequency, is not reported with 64633 to 64636. It goes on 64999, which the article says is non-covered when used for that purpose.
Ablation claims hitting the session limit?
We check the rolling 12-month count, the levels and the modifier 50 line before the claim goes out.