CPT 64628 Basivertebral Nerve | Reimbursement | OpenPayer

Summary & Overview

CPT 64628: Image-Guided Thermal Ablation of Basivertebral Nerve

CPT code 64628 represents image-guided thermal ablation of an intraosseous basivertebral nerve, used for treatment of vertebral body–originating pain. The code covers the first two lumbar or sacral vertebral bodies treated in a session and reflects a minimally invasive spine intervention that has grown in clinical attention as an option for chronic vertebrogenic pain. Nationally, this procedure matters because it affects utilization patterns in outpatient surgical settings and informs payer coverage policies for spine pain interventions.

Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The analysis addresses payer coverage trends and benchmarking where available and highlights the procedural context for hospital outpatient departments and ambulatory surgical centers.

Readers will learn what CPT code 64628 denotes clinically, which payers are commonly relevant for coverage considerations, and what types of benchmarks and policy updates are typically examined for procedures of this type. The publication provides clinical context for the service, summaries of typical sites of service, and notes where input data are not available. Data not available in the input are explicitly identified so readers understand the scope of the report.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare64628CPTspinethermal ablationbasivertebral nerveimage-guided procedureoutpatient surgeryvertebrogenic pain

Billing Code Overview

CPT code 64628 describes a procedure in which a provider uses a thermal (heat) method under imaging guidance to destroy an intraosseous basivertebral nerve. This procedure is intended to treat pain originating from the vertebral body by targeting the basivertebral nerve within the bone.

Service type: Image-guided thermal ablation of intraosseous basivertebral nerve

Typical site of service: Hospital outpatient department or ambulatory surgical center, using fluoroscopic or other imaging guidance to locate and ablate the basivertebral nerve within lumbar or sacral vertebral bodies.

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

An adult patient in their 50s–70s with chronic axial low back pain refractory to conservative management presents for basivertebral nerve ablation. The patient has focal midline lumbar back pain without radicular symptoms, has failed trial(s) of physical therapy, nonsteroidal anti-inflammatory drugs, and opioid-sparing analgesics, and demonstrates imaging findings consistent with Modic type 1 or 2 changes at the vertebral endplates on lumbar MRI. After multidisciplinary evaluation by a pain medicine physician or interventional spine specialist, the decision is made to perform image-guided intraosseous thermal ablation of the basivertebral nerve targeting the principal pain-generating vertebral bodies.

The clinical workflow includes pre-procedure evaluation with informed consent, review of MRI to identify target vertebral levels (commonly L3–S1), pre-procedural optimization and NPO instructions, peri-procedural intravenous access and conscious sedation or monitored anesthesia care, fluoroscopic or CT guidance to place an intraosseous access device into the posterior vertebral body, deployment of the thermal ablation probe to denervate the basivertebral nerve, confirmation of adequate lesioning per device protocol, hemostasis and dressing, post-procedure monitoring for recovery and complications, and discharge with activity restrictions and follow-up arranged with the referring physician. Typical site of service is an ambulatory surgery center or hospital outpatient department. Service type is image-guided percutaneous thermal neurotomy of the intraosseous basivertebral nerve for lumbar/sacral vertebral bodies (first two vertebral bodies billed with 64628).

Coding Specifications

Modifier	Description	When to Use

CPT 64617: Percutaneous Laryngeal Chemodenervation, Unilateral

64633-DESTRUCTION-BY-NEUROLYTIC-AGENT-EG-CHEMICAL-THERMAL

CPT 64633: Neurolytic Destruction of Cervical/Thoracic Facet Joint Nerves

64645-CHEMODENERVATION-OF-ONE-EXTREMITY-EACH-ADDITIONAL-EXTREMITY

CPT 64645: Chemodenervation of Additional Extremity, 5 or More Muscles

CPT-64635-LUMBAR-FACET-JOINT-NEUROLYSIS-IMAGE-GUIDED

CPT 64635: Image-Guided Lumbar Facet Joint Neurolysis

CPT-64620-INTERCOSTAL-NERVE-ABLATION

CPT 64620: Intercostal Nerve Ablation Procedure

CPT-64624-GENICULAR-NERVE-NEUROLYSIS-KNEE

CPT 64624: Genicular Nerve Neurolysis for Knee Pain

CPT-64616-UNILATERAL-CERVICAL-MUSCLE-CHEMICAL-DENERVATION

CPT 64616: Unilateral Cervical Muscle Chemical Denervation

CPT-64636-LUMBAR-SACRAL-FACET-NEUROLYSIS-ADD-ON-LEVEL

CPT 64636: Lumbar/Sacral Facet Joint Neurolysis, Additional Level

CPT-64655-BARO-REFLEX-ACTIVATION-THERAPY-LEAD-REVISION

CPT 64655: Baroreflex Activation Therapy Lead Revision or Replacement

CPT-64640-NEUROLYSIS-NERVE-DESTRUCTION-PAIN-MANAGEMENT

CPT 64640: Neurolysis by Chemical, Heat, or Radiofrequency Techniques

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`00`	Anesthesia by provider (not commonly used clinically; CMS placeholder)	Rarely used; include only if payer specifically requires this administrative modifier.
`11`	Office or other outpatient visit for the evaluation and management if separately reported	Use when an E/M service unrelated to the procedure is billed by the same provider on the same date and documentation supports a separately identifiable E/M.
`22`	Increased procedural service	Use when work substantially exceeds typical service time/effort and documentation justifies increased intensity.
`50`	Bilateral procedure	Use if bilateral vertebral bodies are treated and payer requires anatomic laterality reporting; many payers do not accept bilateral for this code.
`51`	Multiple procedures	Use when `64628` is billed with additional unrelated CPT procedures during the same session (payer-dependent bundling rules apply).
`52`	Reduced services	Use when procedure is partially reduced or not completed as planned and documentation explains reason.
`53`	Discontinued procedure	Use when procedure is started but terminated due to patient safety concerns before therapeutic ablation is performed.
`62`	Two surgeons	Use when two surgeons of different specialties are required and both meet payer criteria for reporting shared operative work.
`63`	Procedure performed on infants less than 4 kg (pediatric)	Rare for basivertebral procedures; use if applicable per patient size and payer rules.
`66`	Surgical team approach	Use only when a documented team approach meets payer policy and all team members are appropriately credentialed.
`78`	Return to the operating/procedure room for a related procedure during the postoperative period	Use if a related takeback procedure is required during the global period.
`79`	Unrelated procedure or service by the same physician during the postoperative period	Use when an unrelated, distinct procedure is performed within the global period and documentation supports unrelatedness.
`80`	Assistant surgeon	Use when an assistant surgeon performs qualifying assistance and payer allows assistant surgeon reporting.
`LT`	Left side	Use when laterality is required by payer for documentation of which vertebral side or pedicle approach was used; many payers do not require laterality for midline vertebral procedures.

Taxonomy Code	Specialty	Notes
2084P0800X	Pain Medicine	Interventional pain physicians commonly perform image-guided basivertebral nerve ablation.
207L00000X	Physical Medicine & Rehabilitation	PM&R specialists with interventional training perform this procedure and manage peri-procedural rehabilitation.
2086S0122X	Neurology (Interventional)	Neurologists with interventional spine experience may perform or co-manage patients undergoing ablation.
2086N0402X	Orthopedic Spine Surgery	Spine surgeons may perform image-guided procedures in an outpatient or hospital setting.
207K00000X	Anesthesiology	Anesthesiologists provide monitored anesthesia care or sedation during the procedure.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`M54.5`	Low back pain	Common presenting symptom indicating axial lumbar pain potentially originating from vertebral endplates and basivertebral nerve.
`M51.36`	Other intervertebral disc degeneration, lumbar region	Degenerative disc disease often coexists with endplate changes and chronic axial low back pain considered for basivertebral ablation.
`M47.816`	Spondylosis without myelopathy or radiculopathy, lumbosacral region	Degenerative changes that can be associated with vertebral endplate changes and chronic axial pain.
`M48.06`	Spinal stenosis, lumbar region	May coexist with axial pain; patient selection for isolated basivertebral ablation requires addressing predominant axial pain.
`M46.96`	Unspecified inflammatory spondylopathy, site unspecified	Inflammatory endplate changes (Modic type) can contribute to axial vertebral pain targeted by basivertebral nerve ablation.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`64628`	Destruction by neurolytic agent; basivertebral nerve, intraosseous, thermal (first two lumbar or sacral vertebral bodies)	Primary procedure code used to report image-guided thermal ablation of the basivertebral nerve for the first two treated vertebral bodies at a session.
`77012`	CT guidance for needle placement (diagnostic or therapeutic)	Used when CT imaging guidance is employed to place intraosseous access or ablation probe during the procedure.
`77002`	Fluoroscopic guidance and needle placement (radiology guidance)	Used when fluoroscopic guidance is employed for probe placement; report per payer guidance.
`99152`	Moderate sedation service provided by the physician performing the procedure (initial 15 minutes)	Used when the operating physician provides moderate sedation/analgesia as part of the procedure; many payers restrict reporting.
`99153`	Each additional 15 minutes of moderate sedation by the physician	Sequential add-on to `99152` when sedation time exceeds the initial interval.
`01999`	Unlisted anesthesia procedure	May be used when anesthesia services for this specific procedure do not have a listed anesthesia CPT code and payer requires anesthesia reporting.

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