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CPT 64634: Add-on Cervical/Thoracic Facet Joint Nerve Neurolysis

CPT code 64634 is an add-on code for destruction of a cervical or thoracic facet joint nerve using neurolytic methods (thermal, electrical, or chemical) with imaging guidance. It is reported when an additional facet joint level is treated after an initial, separately reportable neurolytic injection. Nationally, this code matters for procedural billing of image-guided spine pain interventions and contributes to utilization and coverage decisions for interventional pain management.

Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of the clinical intent of the procedure, typical sites of service, common coding and reporting contexts, and the payer landscape that affects coverage and reimbursement. The publication also outlines benchmark topics and policy considerations relevant to payers and health systems, including when to apply add-on reporting and how imaging guidance is documented.

This summary provides a concise reference for billing managers, coding professionals, and policy analysts seeking clarity on coding practices and payer interactions for image-guided facet joint neurolysis at additional spinal levels. Data not available in the input is noted where applicable in subsequent sections.

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Billing Code Overview

CPT code 64634 describes an add-on neurolytic procedure targeting a cervical or thoracic facet joint nerve. The provider performs destruction of the facet joint nerve using neurolytic agents such as heat, electric current, or chemical compounds, and uses imaging guidance via fluoroscopy or CT to target the nerve accurately. This code is reported for an additional facet joint level when an initial, separately reportable single facet joint neurolytic injection has already been performed.

Service type: Image-guided neurolytic facet joint nerve destruction (add-on level)

Typical site of service: Ambulatory surgical center or hospital outpatient department, with procedures performed under imaging guidance (fluoroscopy or CT).

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CPT 64634: Add-on Cervical/Thoracic Facet Joint Nerve Neurolysis

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Billing Code Overview

Service type: Image-guided neurolytic facet joint nerve destruction (add-on level)

Typical site of service: Ambulatory surgical center or hospital outpatient department, with procedures performed under imaging guidance (fluoroscopy or CT).

Clinical & Coding Specifications

Clinical Context

A 55-year-old patient with chronic cervicothoracic axial pain and prior diagnostic medial branch blocks presents for radiofrequency neurotomy of additional facet joint levels. The patient has persistent focal facet-mediated pain after conservative measures (physical therapy, medication management) and prior single-level neurolytic injection with partial relief. The interventional pain physician performs an add-on procedure to ablate an additional cervical or thoracic facet joint nerve using thermal radiofrequency energy under fluoroscopic guidance in an outpatient ambulatory surgery center. The clinical workflow includes pre-procedure consent and time-out, IV access and monitoring, local anesthetic at the skin entry site, fluoroscopic localization of the targeted facet level, placement of radiofrequency cannula, sensory and motor stimulation testing when indicated, application of neurolytic energy (heat), post-procedure observation for recovery, and discharge with post-procedure instructions. Typical documentation includes level(s) treated, imaging modality used (fluoroscopy or CT), laterality if applicable, medications administered, start and stop times, and any immediate complications.

Coding Specifications

Modifier	Description	When to Use
`59`	Distinct Procedural Service	Use when reporting an additional independent procedure not normally reported together with another CPT on the same date when documentation supports distinct procedural service at another anatomic site or separate session.
`76`	Repeat Procedure by Same Physician	Use when the same physician performs the neurolytic injection again later the same day.
`77`	Repeat Procedure by Another Physician	Use when a second physician repeats the same procedure on the same day.
`50`	Bilateral Procedure	Use when the add-on level(s) are treated bilaterally and payer requires modifier for bilateral procedures (note: many interventional codes are laterality-neutral; follow payer rules).
`52`	Reduced Services	Use when a documented reduction in service occurs (e.g., procedure attempted but not completed as planned).
`53`	Discontinued Procedure	Use when the procedure is terminated due to extenuating circumstances after initiation.
`62`	Two Surgeons	Use when two surgeons are required to work together as primary surgeons for a complex operative case involving this procedure.
`76`	Repeat Procedure by Same Physician	Use when the same physician performs the neurolytic injection again later the same day.
`59`	Distinct Procedural Service	Use when reporting an additional independent procedure not normally reported together with another CPT on the same date when documentation supports distinct procedural service at another anatomic site or separate session.
`LT`	Left Side	Use to indicate service performed on the left side when payer requires side-specific reporting.
`RT`	Right Side	Use to indicate service performed on the right side when payer requires side-specific reporting.
`62`	Two Surgeons	Use when two surgeons are required to work together as primary surgeons for a complex operative case involving this procedure.

Taxonomy Code	Specialty	Notes
`2084P0800X`	Pain Medicine	Interventional pain specialists commonly perform cervical/thoracic facet neurotomy.
`207L00000X`	Physical Medicine & Rehabilitation	Physiatrists with interventional training perform these procedures in outpatient settings.
`2086S0123X`	Anesthesiology	Anesthesiologists with pain certification frequently perform image-guided radiofrequency neurotomy.
`363LP0800X`	Neurology	Neurologists with procedural training may perform targeted neurolytic procedures.
`2080P0221X`	Orthopedic Surgery (Spine)	Spine surgeons may perform facet neurotomy as part of interventional pain management.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`M54.2`	Cervicalgia	Localized neck pain often arising from cervical facet arthropathy targeted by cervical facet neurotomy.
`M54.3`	Sciatica	(Included as a commonly associated code for spinal pain patterns; less commonly direct indication for cervical/thoracic neurotomy)
`M50.30`	Other cervical disc degeneration, unspecified cervical region	Cervical degenerative changes associated with facet-mediated pain amenable to neurolytic procedures.
`M47.812`	Spondylosis without myelopathy or radiculopathy, cervical region	Cervical spondylosis causing facet joint arthropathy and chronic axial neck pain treated with facet neurotomy.
`M54.6`	Pain in thoracic spine	Localized thoracic spinal pain where thoracic facet neurotomy may be indicated.
`M48.02`	Spinal stenosis, cervical region	Degenerative conditions with facet joint involvement contributing to axial pain addressed by neurolytic procedures.
`G44.209`	Chronic tension-type headache, unspecified	Cervicogenic headache syndromes related to cervical facet pathology that may be treated with cervical medial branch neurotomy.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`64635`	Destruction by neurolytic agent; lumbar or sacral facet joint nerve(s), single level (add-on)	Similar add-on code for lumbar levels; used in lumbar procedures analogous to `64634` for cervical/thoracic levels.
`64633`	Destruction by neurolytic agent; cervical or thoracic, single level (primary)	The primary, reportable single-level cervical/thoracic medial branch neurolytic injection that is reported before using the add-on `64634` for additional levels.
`77003`	Fluoroscopic guidance for needle placement (eg, for neurolytic procedures)	Reported when fluoroscopic imaging guidance is performed to place the radiofrequency cannula during the neurotomy.
`77012`	CT guidance for needle placement	Reported when CT imaging guidance is used instead of fluoroscopy for needle localization.
`99152`	Moderate sedation services provided by the same physician performing the procedure, initial 15 minutes	Used when monitored anesthesia care or moderate sedation is provided during the neurolytic procedure and must be reported per payer rules.

CPT 64600: Trigeminal Nerve Neurodestructive Injection

CPT-64605-TRIGEMINAL-NERVE-NEURODESTRUCTIVE-INJECTION

CPT 64605: Trigeminal Nerve Neurodestructive Injection

CPT-64610-TRIGEMINAL-NERVE-NEURODESTRUCTIVE-INJECTION

CPT 64610: Trigeminal Nerve Neurodestructive Injection

CPT-64611-SALIVARY-GLAND-CHEMICAL-DENERVATION-BILATERAL

CPT 64611: Bilateral Salivary Gland Injection to Reduce Saliva Production

CPT-64612-FACIAL-NERVE-CHEMICAL-NEUROLYSIS-UNILATERAL

CPT 64612: Unilateral Facial Nerve Chemical Neurolysis

CPT-64615-BILATERAL-CHEMICAL-DENERVATION-FACIAL-CERVICAL-MUSCLES

CPT 64615: Bilateral Chemical Denervation of Facial/Cervical Muscles

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

CPT 64616: Unilateral Cervical Muscle Chemical Denervation

CPT-64617-PERCUTANEOUS-LARYNGEAL-CHEMODENERVATION-UNILATERAL

CPT 64617: Percutaneous Laryngeal Chemodenervation, Unilateral

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

Showing 1–10 of 26

Frequently Asked Questions

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

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Clinical & Coding Specifications

Clinical Context

Coding Specifications

Modifier	Description	When to Use
`59`	Distinct Procedural Service	Use when reporting an additional independent procedure not normally reported together with another CPT on the same date when documentation supports distinct procedural service at another anatomic site or separate session.
`76`	Repeat Procedure by Same Physician	Use when the same physician performs the neurolytic injection again later the same day.
`77`	Repeat Procedure by Another Physician	Use when a second physician repeats the same procedure on the same day.
`50`	Bilateral Procedure	Use when the add-on level(s) are treated bilaterally and payer requires modifier for bilateral procedures (note: many interventional codes are laterality-neutral; follow payer rules).
`52`	Reduced Services	Use when a documented reduction in service occurs (e.g., procedure attempted but not completed as planned).
`53`	Discontinued Procedure	Use when the procedure is terminated due to extenuating circumstances after initiation.
`62`	Two Surgeons	Use when two surgeons are required to work together as primary surgeons for a complex operative case involving this procedure.
`76`	Repeat Procedure by Same Physician	Use when the same physician performs the neurolytic injection again later the same day.
`59`	Distinct Procedural Service	Use when reporting an additional independent procedure not normally reported together with another CPT on the same date when documentation supports distinct procedural service at another anatomic site or separate session.
`LT`	Left Side	Use to indicate service performed on the left side when payer requires side-specific reporting.
`RT`	Right Side	Use to indicate service performed on the right side when payer requires side-specific reporting.
`62`	Two Surgeons	Use when two surgeons are required to work together as primary surgeons for a complex operative case involving this procedure.

Taxonomy Code	Specialty	Notes
`2084P0800X`	Pain Medicine	Interventional pain specialists commonly perform cervical/thoracic facet neurotomy.
`207L00000X`	Physical Medicine & Rehabilitation	Physiatrists with interventional training perform these procedures in outpatient settings.
`2086S0123X`	Anesthesiology	Anesthesiologists with pain certification frequently perform image-guided radiofrequency neurotomy.
`363LP0800X`	Neurology	Neurologists with procedural training may perform targeted neurolytic procedures.
`2080P0221X`	Orthopedic Surgery (Spine)	Spine surgeons may perform facet neurotomy as part of interventional pain management.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`M54.2`	Cervicalgia	Localized neck pain often arising from cervical facet arthropathy targeted by cervical facet neurotomy.
`M54.3`	Sciatica	(Included as a commonly associated code for spinal pain patterns; less commonly direct indication for cervical/thoracic neurotomy)
`M50.30`	Other cervical disc degeneration, unspecified cervical region	Cervical degenerative changes associated with facet-mediated pain amenable to neurolytic procedures.
`M47.812`	Spondylosis without myelopathy or radiculopathy, cervical region	Cervical spondylosis causing facet joint arthropathy and chronic axial neck pain treated with facet neurotomy.
`M54.6`	Pain in thoracic spine	Localized thoracic spinal pain where thoracic facet neurotomy may be indicated.
`M48.02`	Spinal stenosis, cervical region	Degenerative conditions with facet joint involvement contributing to axial pain addressed by neurolytic procedures.
`G44.209`	Chronic tension-type headache, unspecified	Cervicogenic headache syndromes related to cervical facet pathology that may be treated with cervical medial branch neurotomy.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`64635`	Destruction by neurolytic agent; lumbar or sacral facet joint nerve(s), single level (add-on)	Similar add-on code for lumbar levels; used in lumbar procedures analogous to `64634` for cervical/thoracic levels.
`64633`	Destruction by neurolytic agent; cervical or thoracic, single level (primary)	The primary, reportable single-level cervical/thoracic medial branch neurolytic injection that is reported before using the add-on `64634` for additional levels.
`77003`	Fluoroscopic guidance for needle placement (eg, for neurolytic procedures)	Reported when fluoroscopic imaging guidance is performed to place the radiofrequency cannula during the neurotomy.
`77012`	CT guidance for needle placement	Reported when CT imaging guidance is used instead of fluoroscopy for needle localization.
`99152`	Moderate sedation services provided by the same physician performing the procedure, initial 15 minutes	Used when monitored anesthesia care or moderate sedation is provided during the neurolytic procedure and must be reported per payer rules.

CPT 64600: Trigeminal Nerve Neurodestructive Injection

CPT-64605-TRIGEMINAL-NERVE-NEURODESTRUCTIVE-INJECTION

CPT 64605: Trigeminal Nerve Neurodestructive Injection

CPT-64610-TRIGEMINAL-NERVE-NEURODESTRUCTIVE-INJECTION

CPT 64610: Trigeminal Nerve Neurodestructive Injection

CPT-64611-SALIVARY-GLAND-CHEMICAL-DENERVATION-BILATERAL

CPT 64611: Bilateral Salivary Gland Injection to Reduce Saliva Production

CPT-64612-FACIAL-NERVE-CHEMICAL-NEUROLYSIS-UNILATERAL

CPT 64612: Unilateral Facial Nerve Chemical Neurolysis

CPT-64615-BILATERAL-CHEMICAL-DENERVATION-FACIAL-CERVICAL-MUSCLES

CPT 64615: Bilateral Chemical Denervation of Facial/Cervical Muscles

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

CPT 64616: Unilateral Cervical Muscle Chemical Denervation

CPT-64617-PERCUTANEOUS-LARYNGEAL-CHEMODENERVATION-UNILATERAL

CPT 64617: Percutaneous Laryngeal Chemodenervation, Unilateral

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

Showing 1–10 of 26

Frequently Asked Questions

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

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CPT 64634: Add-on Cervical/Thoracic Facet Joint Nerve Neurolysis

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Billing Code Overview

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CPT 64634: Add-on Cervical/Thoracic Facet Joint Nerve Neurolysis

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Billing Code Overview

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References

CPT 64634: Add-on Cervical/Thoracic Facet Joint Nerve Neurolysis

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Billing Code Overview

CPT 64634: Add-on Cervical/Thoracic Facet Joint Nerve Neurolysis

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Billing Code Overview

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

When should CPT 64634 be reported?

What imaging guidance is appropriate and how is it reported for this procedure?

Which modifiers are commonly used with CPT 64634 and when are they applied?

How does CPT 64634 relate to CPT codes 64633 and 64635?

What procedural and documentation elements are typically required for billing this add-on neurolytic procedure?

References

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

When should CPT 64634 be reported?

What imaging guidance is appropriate and how is it reported for this procedure?

Which modifiers are commonly used with CPT 64634 and when are they applied?

How does CPT 64634 relate to CPT codes 64633 and 64635?

What procedural and documentation elements are typically required for billing this add-on neurolytic procedure?

References