2025 CPT code 64636
(Active) Effective Date: N/A Revision Date: N/A Surgery - Surgical Procedures on the Nervous System Surgery Feed
Destruction of each additional lumbar or sacral paravertebral facet joint nerve using neurolytic agents with imaging guidance.
Modifiers may apply, including laterality modifiers (-RT, -LT) for bilateral procedures in specific scenarios (e.g. ASC settings). Consult current coding guidelines.
The procedure should only be performed after other conservative treatments have failed to adequately control the patient's pain.The patient must have clinically documented chronic spinal pain directly related to the target facet joint. Proper documentation must support the medical necessity of the procedure.
The physician is responsible for pre-operative assessment, obtaining informed consent, performing the procedure under appropriate image guidance, ensuring accurate targeting of the nerve, administering the neurolytic agent, managing any complications, and providing post-operative care and instructions.
- Surgery
- Destruction by Neurolytic Agent (eg, Chemical, Thermal, Electrical or Radiofrequency) Procedures on the Somatic Nerves
In simple words: This code describes a procedure to relieve back pain.The doctor uses heat, electricity, or a special medicine to destroy a nerve in the lower back, using imaging guidance to make sure the right nerve is targeted. This is done after a main procedure to treat a similar nerve in the same area.
This CPT code, 64636, represents the destruction of each additional lumbar or sacral paravertebral facet joint nerve(s) using a neurolytic agent (e.g., chemical, thermal, electrical, or radiofrequency) with imaging guidance (fluoroscopy or CT).This is an add-on code and must be reported in addition to the primary procedure code (64635) for a single facet joint neurolytic injection performed on the same day.Image guidance is included in the code.The procedure involves the injection of a neurolytic agent to destroy the nerve, aiming to alleviate spinal pain. This code should not be reported in conjunction with codes 77003 or 77012.
Example 1: A patient presents with chronic lower back pain stemming from a lumbar facet joint.A single-level radiofrequency ablation is performed (64635), and a second level is also treated on the same day, requiring 64636 to be added., A patient experiences bilateral lower back pain due to facet joint issues. The physician performs radiofrequency ablation on both sides of a single level and a second level. 64636 would be reported twice, representing the additional levels, on separate lines., During a lumbar facet injection, the physician identifies the need to address an additional facet joint at another level, for which they perform the same procedure.64636 is billed in addition to the initial procedure.
Complete medical history, physical examination findings, imaging studies (pre- and post-procedure if applicable), informed consent, operative report detailing the technique used (chemical, thermal, electrical, or radiofrequency), needle placement confirmation using imaging, the number of levels treated, and post-operative care instructions.
** Always refer to the most current CPT and NCCI guidelines to ensure accurate coding.Documentation should clearly support the medical necessity and clinical details of the procedure.This code is only for additional facet joint injections following an initial injection; each additional level should be reported as a separate unit.The number of levels treated must be carefully documented.
- Revenue Code: P5E (Ambulatory Procedures - Other)
- RVU: RVUs will vary depending on geographic location and other factors. Consult the appropriate fee schedule for current values.
- Global Days: The global period is not specified for this add-on code; it is dependent upon the global period of the primary procedure (64635).
- Payment Status: Active
- Modifier TC rule: Not applicable as this is an add-on code.
- Fee Schedule: Fee schedules vary based on location, payer, and other factors. Historical fee data can be obtained from your local Medicare Administrative Contractor (MAC) or commercial payer.
- Specialties:Pain Management, Anesthesiology, Neurosurgery, Orthopedic Surgery
- Place of Service:Office, Ambulatory Surgical Center, Hospital Outpatient