2025 CPT code 64628
(Active) Effective Date: N/A Revision Date: N/A Deletion Date: N/A Surgery - Destruction by Neurolytic Agent (eg, Chemical, Thermal, Electrical or Radiofrequency) Procedures on the Somatic Nerves Surgical Procedures on the Nervous System Feed
Thermal destruction of intraosseous basivertebral nerve using imaging guidance, for the first two lumbar or sacral vertebral bodies.
Modifiers may be applicable depending on the circumstances of the procedure (e.g., 51 for multiple procedures, 22 for increased procedural services, 53 for discontinued procedure). Consult the CPT manual and payer guidelines for specific modifier application rules.
Medical necessity is established by documenting the presence of chronic low back pain unresponsive to conservative management for a minimum duration (typically 6 months), with imaging confirmation of the underlying pathology (e.g., degenerative disc disease, compression fracture) that justifies the intervention. Documentation should also show the patient is a suitable candidate for the procedure.
A physician specializing in interventional pain management or neurosurgery typically performs this procedure. Responsibilities include patient evaluation, determining the appropriate treatment plan, performing the ablation under imaging guidance, post-procedural monitoring, and managing any complications.
- Surgical Procedures on the Nervous System
- Surgical Procedures on the Nervous System > Surgical Procedures on the Extracranial Nerves, Peripheral Nerves, and Autonomic Nervous System > Destruction by Neurolytic Agent (eg, Chemical, Thermal, Electrical or Radiofrequency) and Chemodenervation Procedures on the Extracranial Nerves, Peripheral Nerves
In simple words: This code represents a procedure to treat lower back pain. A doctor uses heat to destroy a small nerve in the spine. This is done using imaging to precisely target the nerve in the lower back, and it's usually performed for persistent lower back pain.
This CPT code (64628) describes the thermal ablation (destruction) of the intraosseous basivertebral nerve(s) in the first two lumbar or sacral vertebral bodies.The procedure involves using imaging guidance (e.g., fluoroscopy, CT) to precisely target and destroy the nerve using a thermal method (e.g., radiofrequency ablation).This is typically performed to alleviate chronic low back pain originating from the vertebral endplates.
Example 1: A 55-year-old female presents with chronic low back pain for over 6 months, unresponsive to conservative management. Imaging reveals degenerative disc disease at L4-L5 and L5-S1.Basivertebral nerve ablation is chosen, and 64628 is reported for the initial treatment of two vertebral bodies (L4 and L5)., A 62-year-old male with chronic lower back pain, stemming from a previous compression fracture at L3, is scheduled for basivertebral nerve ablation. Two levels (L3 and L4) are treated. Code 64628 is used for the first two vertebral bodies., A 48-year-old female experiences intractable low back pain radiating to her right buttock due to L4-L5 and L5-S1 degenerative disc disease.Following imaging, a radiofrequency ablation targets the basivertebral nerves at L4 and L5. Code 64628 is billed for the first two vertebral bodies.
* Detailed patient history and physical examination documenting chronic low back pain.* Imaging studies (X-ray, MRI, CT) demonstrating degenerative disc disease and/or other relevant pathology.* Documentation of failed conservative management (physical therapy, medication).* Operative report detailing the procedure including technique, vertebral levels treated, and any complications.* Anesthesia record.* Post-operative instructions given to the patient.
** This code is device-intensive according to CMS, requiring reporting of associated device charges (e.g., C1889 with revenue code 0278).Always verify the most current billing guidelines with your specific payers.
- Revenue Code: 0278 (for device cost, if applicable per CMS guidelines)
- RVU: Work RVUs: 7.15; Total RVUs: 12.37 (as per one example from a payer); Payment rates vary by payer and location
- Global Days: Global period information not explicitly provided in source data.Further investigation into payer-specific guidelines is needed.
- Payment Status: Active; payment varies by payer
- Modifier TC rule: The application of a Technical Component (TC) modifier depends on payer-specific guidelines and the services provided.This may require additional clarification from the payer.
- Fee Schedule: Fee schedules vary widely by payer and geographic location.Consult payer-specific fee schedules for historical data.
- Specialties:Pain Management, Neurosurgery, Anesthesiology
- Place of Service:Office, Ambulatory Surgical Center, Hospital Outpatient Department