2025 CPT code 64634
(Active) Effective Date: N/A Surgery - Surgical Procedures on the Nervous System Surgery Feed
Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT); cervical or thoracic, each additional facet joint.This is an add-on code to be used in conjunction with 64633.
Modifiers may be applicable in certain situations, such as if the procedure is discontinued (modifier 73 or 74) or if it represents a repeat procedure (modifier 76 or 77).
Medical necessity for this procedure must be clearly documented. This generally includes failed conservative treatments, persistent pain significantly impacting function, and imaging or other diagnostic tests correlating the pain with the targeted facet joints.
The physician performs the injection, including needle placement, imaging guidance, and administration of the neurolytic agent.They are responsible for ensuring proper patient selection, pre- and post-procedure care, and managing any potential complications.
In simple words: This procedure involves destroying nerves in the facet joints of the neck or upper back to treat pain. It's done with imaging guidance and uses substances like heat, chemicals, or radio waves to disable the nerves. This code is used for each additional facet joint treated during the same procedure.
Destruction by neurolytic agent (e.g., chemical, thermal, electrical, or radiofrequency) paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT); cervical or thoracic, each additional facet joint (List separately in addition to code for primary procedure). This code is used for each additional facet joint level injected after the initial, separately reportable single facet joint neurolytic injection.
Example 1: A patient with chronic neck pain has two cervical facet joints injected with a neurolytic agent under fluoroscopic guidance during the same session. 64633 is reported for the initial injection and 64634 is reported for the second injection., A patient with thoracic facet joint pain undergoes a procedure where three facet joints are treated with radiofrequency ablation under CT guidance. 64633 is billed for the first joint, and 64634 is billed twice, once for each of the two additional joints., A patient has both cervical and thoracic facet joint pain. During a single session, one cervical facet joint and two thoracic facet joints are injected with a neurolytic agent.64633 is reported for the initial cervical injection, and 64634 is reported twice for the additional thoracic joints. Even though these are in different spinal regions, 64634 is used for both as they represent additional injections beyond the initial injection.
Documentation should include the diagnosis, medical necessity for the procedure, details of the injection(s) including levels treated,imaging guidance used, type of neurolytic agent, and any complications. Pre- and post-procedure assessments should also be documented.
** For bilateral procedures, report 64634 twice. Do not report modifier 50 in conjunction with 64634. The inclusion of imaging guidance (fluoroscopy or CT) within code 64634 eliminates the need for separate reporting of these services.
- Revenue Code: P5E - AMBULATORY PROCEDURES - OTHER
- Specialties:Pain Management, Anesthesiology, Orthopedic Surgery, Neurosurgery, Physical Medicine & Rehabilitation
- Place of Service:Office, Ambulatory Surgical Center, Outpatient Hospital