Radiofrequency ablation of the nerves supplying the sacroiliac joint, with fluoroscopic or CT guidance included in the code.
- Medicare
- $495.67
- Work RVU
- 3.31
- Global, days
- 10
- Region
- Spine
Documentation requirements
What must appear in the operative or office note to support the claim.
Source · Editorial brief grounded in 3 cited references ↓
- SI joint provocation tests and findings
- Diagnostic SI or lateral branch block results with pain scores
- Nerves ablated and side
- Imaging guidance with saved images
- Conservative care tried and duration
- Signed ABN or prior authorization as applicable
Applicable modifiers
Modifiers commonly billed with this code.
Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual
What this code covers
Source · Editorial summary grounded in 3 cited references ↓
64625 is the code for radiofrequency ablation of the nerves that supply the sacroiliac joint, usually the lateral branches of S1 to S3 and the L5 dorsal ramus. Before this code existed, practices billed SI joint RFA as unlisted 64999. Imaging guidance is included.
In ortho spine practices it is used for SI joint pain confirmed by physical exam provocation tests and diagnostic blocks, often in patients who are not fusion candidates or who still hurt after a lumbar fusion. Bilateral procedures are reported with modifier 50 where the payer accepts it.
Coverage is the problem. Medicare facet joint LCDs do not extend coverage to SI joint ablation, and several contractors and commercial payers treat it as not medically necessary. Check the policy before scheduling. For Medicare patients, collect an ABN and use GA. For commercial patients, get prior authorization in writing and keep the diagnostic block results in the chart.
RVU & reimbursement
Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.
Source · CMS Physician Fee Schedule, RVU26A · January 2026
Work RVU vs. total RVU
The work RVU (3.31) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (14.84) adds practice overhead and malpractice, and is what drives the Medicare payment below.
| Work RVU | 3.31 |
| Practice expense RVU | 11.2 |
| Malpractice RVU | 0.33 |
| Total RVU | 14.84 |
| Medicare national rate | $495.67 |
| Global period | 10 days |
Payment by site of service
Medicare pays different rates by setting. HOPD typically pays substantially more than ASC for the same procedure.
Source · CMS OPPS Addendum B·ASC HCPCS payment rates·2026
| Setting | Medicare rate (national) |
|---|---|
Office (PFS non-facility) Procedure performed in physician's office | $495.67 |
HOPD (APC 5431) Hospital outpatient department | $1,995.02 |
ASC (PI G2) Ambulatory surgical center (freestanding) | $948.66 |
Common denial reasons
The recurring reasons claims for CPT 64625 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Payer policy treats SI joint RFA as not medically necessary
- No ABN on file for a Medicare patient
- Diagnostic blocks not documented
- Billed as 64635 instead of the SI joint code
- Imaging guidance billed separately
- No prior authorization from the commercial payer
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 3 cited references ↓
01What CPT code is used for SI joint radiofrequency ablation?
02Does Medicare cover SI joint RFA?
03Is fluoroscopy included in 64625?
04Can 64635 be used for SI joint RFA?
Sources & references
Editorial content was developed using the following public sources.
Mira Scribe
Mira Scribe notes capture the SI provocation tests and the diagnostic block response, so the practice has the clinical case written down before it asks a payer for authorization.
See how Mira captures CPT 64625 documentation