CPT 64635
Global 010 ActiveDestroy lumb/sac facet jnt
CPT 64635 Billing & Documentation Guide
CPT code 64635 (Destroy lumb/sac facet jnt) is classified under Surgery (Endocrine/Nervous/Eye/Ear) with a global period indicator of 010. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 3.24, a non-facility practice expense RVU of 10.39, and a malpractice RVU of 0.29, a total non-facility RVU of 13.92 and facility RVU of 5.18. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $480.9, though rates vary from $411.31 to $625.74 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 64635, ensure documentation supports medical necessity and the specific components required for the code's level of service. For E/M codes, document MDM (medical decision-making) elements: problems addressed, data reviewed, and risk. For procedural codes, document the indication, technique, and any complications. Always verify NCCI edits before bundling 64635 with related codes; this code has 10 PTP bundling relationships on file (see table below).
Payment Status & Global Period
Active code (paid under MPFS)
10-day global period (minor procedure: pre-op day + procedure + 10 days post-op)
MUE Limit (Medically Unlikely Edits)
Submitting more than 1 units of 64635 for the same patient on the same date triggers automatic line denial unless an appropriate modifier and supporting documentation justify the higher quantity.
RVU Breakdown, CPT 64635
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 3.24 | 3.24 |
| Practice Expense RVU | 10.39 | 1.65 |
| Malpractice RVU | 0.29 | 0.29 |
| Total RVU | 13.92 | 5.18 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 64635
State-level averages across all MAC localities. Non-facility rates typically apply to office-based services; facility rates apply to hospital outpatient / inpatient.
| State | Non-Facility | Facility | Range (Non-Fac) | Localities |
|---|---|---|---|---|
| California | $527.99 | $182.56 | $495.6 - $625.74 | 29 |
| Florida | $475.27 | $182.37 | $454.54 - $493.98 | 3 |
| Georgia | $451.04 | $172.55 | $429.32 - $472.76 | 2 |
| Illinois | $462.43 | $180.36 | $440.2 - $482.55 | 4 |
| Michigan | $447.72 | $173.6 | $436 - $459.44 | 2 |
| North Carolina | $438.19 | $165.83 | $438.19 - $438.19 | 1 |
| New York | $513.67 | $188 | $444.71 - $545.76 | 5 |
| Ohio | $434.83 | $168.3 | $434.83 - $434.83 | 1 |
| Pennsylvania | $459.47 | $173.53 | $435.95 - $482.99 | 2 |
| Texas | $459.47 | $172.07 | $433.02 - $484.18 | 8 |
Source: CMS PFSRVU 2026 · Updated 2026-04-01. Full locality-level detail available for all 53 states, contact us for custom reports.
NCCI Bundling Edits, CPT 64635
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 64635 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 0213T | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
| 0216T | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 0228T | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
| 0230T | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
| 0333T | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 0464T | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 0596T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 0597T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 0708T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0709T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
Frequently Asked Questions, CPT 64635
What does CPT code 64635 mean? +
CPT code 64635 represents: Destroy lumb/sac facet jnt. It's in the Surgery (Endocrine/Nervous/Eye/Ear) category with a global period of 010.
What is the Medicare reimbursement for CPT 64635? +
The 2026 Medicare national average non-facility payment for CPT 64635 is $480.9. Rates range from $411.31 to $625.74 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 64635? +
Surgery codes commonly use modifier 22 (increased procedural services), 50 (bilateral), 51 (multiple procedures), 52 (reduced services), 58/78/79 (staged, unplanned return, unrelated within global), 62 (co-surgeons), 80/82 (assistant surgeon), and 59 or the X{EPSU} subset for distinct procedural service.
What bundling edits apply to CPT 64635? +
This code has 10 NCCI PTP bundling relationships. See the NCCI Bundling section below for full list.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on May 31, 2026.
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