Does 64635 require prior authorization?

No, 64635 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 64635?

Medicare facility rate: $173.02. Non-facility rate: $464.94. Work RVU: 3.24.

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

3.24

Facility

$173.02

Non-Facility

$464.94

The record must contain the performing provider’s assessment related to the complaint, relevant medical history, results of pertinent tests/procedures, and signed and dated office visit or operative reports.
The medical record must include a valid ICD-10-CM diagnosis code that best describes the patient’s condition; claims without a valid diagnosis will be returned as incomplete under Section 1833(e).
All documentation must be legible, include patient identification and dates of service, and bear the legible signature of the physician or NPP responsible for care.
For therapeutic injection procedures, documentation must explain why the patient is not a candidate for RFA.

Diagnostic or therapeutic injection into the paravertebral facet joint or the nerves innervating that joint for pain management is covered for cervical/thoracic and lumbar/sacral regions when consistent with the LCD.
Thermal neurolytic destruction (radiofrequency ablation) of nerves innervating facet joints is covered in cervical/thoracic and lumbar/sacral regions per CPT codes 64633–64636 when documentation supports medical necessity.
Unilateral or bilateral facet interventions are permitted during the same session and a bilateral intervention at the same vertebral level is considered a single level for counting/reporting purposes.
Diagnostic injections that meet KX modifier criteria (typically the two initial diagnostic injections or additional diagnostic injections at different levels when prior injections were non-diagnostic) are permitted when documented.
Image-guided (fluoroscopy or CT) single-level facet injections and neurolytic procedures performed with fluoroscopy or CT are covered when documentation supports the procedure codes used.
Diagnostic or therapeutic paravertebral facet joint injections (CPT 64490-64495) for cervical/thoracic or lumbar/sacral facet-mediated pain are covered when reasonable and necessary and supported by documentation consistent with LCD L33930.

L38841 — Facet Joint Interventions for Pain Management

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A58477 — Billing and Coding: Facet Joint Interventions for Pain Management

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A57826 — Billing and Coding: Facet Joint Interventions for Pain Management

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L35936 — Facet Joint Interventions for Pain Management

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Ask Verity about documentation requirements, denial risks, or coverage in your state.