Summary & Overview
CPT 64629: Image-Guided Thermal Ablation of Basivertebral Nerve (Additional Vertebra)
Headline: CPT code 64629: Thermal ablation for additional lumbar or sacral basivertebral nerves
Lead: CPT code 64629 identifies an image-guided thermal neurodestruction procedure used to destroy an intraosseous basivertebral nerve for lumbar or sacral vertebral bodies beyond the first two treated in a single session. The code clarifies billing for incremental vertebral treatments during the same operative episode.
CPT code 64629 represents a targeted, image-guided thermal ablation service for basivertebral nerves inside vertebral bodies. It matters nationally as a procedure-level code that affects coding specificity, session-level billing, and access to interventional pain management options for patients with vertebrogenic low back pain. Clear use of this code ensures proper reporting when more than two vertebral bodies are treated at one encounter.
Key payers covered in this overview include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find benchmarks for common payer coverage patterns, guidance on clinical context for use, and how the code relates to session-based reporting and facility site considerations. The publication also summarizes typical sites of service, common modifiers used in practice, and gaps in publicly available payer policy language.
This summary is organized to present the most important billing and clinical implications first, followed by operational and policy details, giving clinicians, coders, and policy analysts a concise national-level reference for CPT code 64629.
Billing Code Overview
CPT code 64629 describes a thermal (heat) neurodestruction procedure performed under imaging guidance to ablate an intraosseous basivertebral nerve. The code is intended for use when additional lumbar or sacral vertebral bodies are treated after the first two at the same session.
Service type: image-guided thermal ablation of basivertebral nerve
Typical site of service: hospital outpatient department or ambulatory surgery center, where imaging guidance and sterile interventional techniques are available.
Clinical & Coding Specifications
Clinical Context
A typical patient is a 50–70 year-old adult with chronic axial low back pain refractory to conservative care (physical therapy, medications, and epidural steroid injections). The patient reports predominant midline low back pain centered over the lumbar region, with imaging (MRI) demonstrating Modic type 1 or 2 changes of the vertebral endplates consistent with degenerative endplate disease. After specialist evaluation by an interventional pain physician or spine surgeon and documentation of failed conservative therapy, the patient is scheduled for a basivertebral nerve ablation session.
The clinical workflow includes pre-procedure evaluation with history, targeted physical exam, review of MRI findings, informed consent, and verification of laterality/levels. On the day of service the patient is positioned prone in an interventional radiology or ambulatory surgery center setting. Under fluoroscopic or CT imaging guidance, the provider advances a transpedicular or posterior approach cannula into the vertebral body to the basivertebral nerve region and performs a thermal ablation (radiofrequency/thermal) to destroy the intraosseous basivertebral nerve. 64629 is used for each additional lumbar or sacral vertebral body treated after the first two at a session. Post-procedure observation follows per facility protocols with discharge instructions and follow-up arranged with the treating physician.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
11 |