2025 CPT code 64625
(Active) Effective Date: N/A Revision Date: N/A Surgery - Surgical Procedures on the Nervous System Surgery Feed
Radiofrequency ablation of nerves supplying the sacroiliac joint, using fluoroscopy or computed tomography for guidance.
Modifier 50 (bilateral procedure) is applicable if the procedure is performed on both sides.Other modifiers may be appropriate based on individual circumstances.Consult the most current CPT modifier guidelines.
Medical necessity is established when a patient has chronic sacroiliac joint pain refractory to conservative management (pharmacologic and physical therapy interventions).Documentation of pain level, functional limitations, and failure of other treatments is essential to demonstrate medical necessity.Payer specific requirements should be consulted.
The procedure is performed by a physician specializing in pain management or interventional radiology. The physician is responsible for patient preparation, proper needle placement under imaging guidance, application of radiofrequency energy, and post-procedure care.
In simple words: This procedure uses heat (from radio waves) to carefully damage nerves that cause low back and sacroiliac joint pain.Doctors use imaging like X-rays to precisely target the nerves.It's done to relieve pain that hasn't responded to other treatments.
This CPT code encompasses radiofrequency ablation of the nerves innervating the sacroiliac (SI) joint.The procedure involves using image guidance (fluoroscopy or computed tomography) to precisely target and destroy the nerves using radiofrequency energy. This creates lesions in the targeted nerves to alleviate pain. The procedure is performed under appropriate sedation and preparation. Cannulas are inserted near the dorsal branches of the SI joint nerves, positioned 4-6mm apart, and radiofrequency energy is applied at 90 degrees Celsius for approximately 2-2.5 minutes to create contiguous lesions.
Example 1: A 55-year-old female presents with chronic low back pain radiating to the right buttock, diagnosed as sacroiliac joint pain unresponsive to conservative management.Radiofrequency ablation of the right SI joint nerves is performed using fluoroscopy guidance., A 40-year-old male with severe sacroiliac joint pain from an old injury undergoes bilateral radiofrequency ablation under CT guidance.Modifier 50 is appended due to the bilateral nature of the procedure., A 60-year-old patient with persistent low back pain is diagnosed with sacroiliac joint dysfunction.After failing conservative measures, the physician performs a single-sided radiofrequency ablation, guided by fluoroscopy.
* Comprehensive history and physical examination documenting the source and nature of pain.* Imaging studies (X-ray, MRI, CT) demonstrating sacroiliac joint pathology.* Documentation of failed conservative management (e.g., physical therapy, medication).* Operative report detailing the technique used, number of nerves treated, temperature and duration of ablation, and any complications.* Post-procedure pain assessment.
** The procedure should be performed by a qualified physician experienced in pain management techniques and image-guided procedures.Variations in technique may exist but the fundamental principle remains the same: image-guided radiofrequency ablation of nerves innervating the sacroiliac joint.
- Revenue Code: P6C (Medicare Fee Schedule: MINOR PROCEDURES - OTHER)
- RVU: Information not available in provided text.Consult the most current Medicare Physician Fee Schedule.
- Global Days : 0 days. This is a single-procedure code.
- Payment Status: Active
- Modifier TC rule: Not applicable.This is a complete procedure.
- Fee Schedule : Information not available. Refer to historical Medicare Physician Fee Schedules.
- Specialties:Pain Management, Interventional Radiology, Anesthesiology
- Place of Service:Office, Ambulatory Surgical Center, Outpatient Hospital