Summary & Overview
CPT 64635: Image-Guided Lumbar Facet Joint Neurolysis
CPT code 64635 denotes an image-guided neurolytic procedure in which an agent is applied to lumbar facet joint nerve tissue to ablate pain-transmitting fibers. Nationally, this procedure matters because it provides a non-open surgical option for chronic lower back pain management and can affect utilization, imaging resources, and outpatient procedural volumes. Key payers considered in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.
Readers will find a concise overview of clinical context and service setting, payer coverage patterns, typical billing considerations, common modifiers, and benchmarks where available. The publication highlights how the code fits into practice workflows—performed under fluoroscopic or CT guidance in outpatient suites, ambulatory surgery centers, or hospital outpatient departments—and summarizes what payers typically evaluate when processing claims for image-guided lumbar neurolysis. Data not available in the input is noted where applicable. The content is intended to inform billing teams, revenue cycle managers, and policy analysts about clinical intent, coding identity, and where to look next for coverage specifics and coding guidance.
Billing Code Overview
CPT code 64635 describes a procedure in which, under fluoroscopic or CT guidance, a provider applies an agent to a lower back joint to destroy nerve tissue. This is a minimally invasive neurolytic procedure targeting sensory nerves that transmit pain from the lumbar facet joints.
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Service type: Image-guided neurolytic destruction of lumbar (lower back) joint nerve tissue
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Typical site of service: Outpatient procedure suite, ambulatory surgery center, or hospital outpatient department where fluoroscopy or CT guidance is available
Data not available in the input for associated taxonomies, ICD-10 diagnoses, and related codes.
Clinical & Coding Specifications
Clinical Context
A 55-year-old patient with chronic axial low back pain and radicular symptoms refractory to conservative measures (physical therapy, oral analgesics, and epidural steroid injection) is scheduled for a lumbar facet neurolytic procedure. Under fluoroscopic or CT guidance in an outpatient ambulatory surgery center, an interventional pain physician or anesthesiologist identifies the targeted lumbar medial branch(es) or facet joint nerves, administers local anesthesia, and applies a neurolytic agent (e.g., chemical neurolysis or radiofrequency ablation technique described by code application) to destroy nerve tissue supplying the lower back joint. The workflow includes pre-procedure consent and medication reconciliation, image-guided needle placement, neurolytic application, immediate post-procedure monitoring for vital signs and neurologic status, discharge instructions with activity limitations and follow-up arranged with the referring spine specialist.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when only the physician’s interpretation or professional portion is billed separate from technical imaging or facility services |
50 | Bilateral procedure |