Radiofrequency Ablation Cost: $465 in an Office, $2,168 in a Hospital
Lumbar facet radiofrequency ablation, CPT 64635, is the widest site-of-care gap in spine care. Medicare allows $464.94 for it in a doctor's office and $2,168.04 for the same procedure in a hospital outpatient department, a difference of $1,703.10. Your 20% share goes from $92.99 to $433.61. In 2024, hospitals billed an average of $11,192.10 for the facility side alone.
- A hospital costs 4.7x an office for this. A surgery center sits in between at $1,121.68. The procedure, the needles and the doctor are identical.
- The hospital is paid one flat $1,995.02 for the whole encounter no matter how many levels are burned, because this code is assigned to a comprehensive payment bundle. In an office, each extra level adds a real $251.51.
- Medicare covers two ablation sessions per spinal region per rolling twelve months, and only after two separate diagnostic blocks each produced at least 80% relief. Ablation without those blocks in the chart is a denial waiting to happen.
What Medicare Allows, by Code and by Place
National rates for October 1 through December 31, 2026. Facility totals combine the doctor's professional fee with the facility's own payment, because a facility procedure produces two separate bills.
| Procedure (CPT) | Office | Surgery center | Hospital outpatient |
|---|---|---|---|
| Facet nerve ablation, lumbar or sacral, 1 level (64635) | $464.94 | $1,121.68 | $2,168.04 |
| Facet nerve ablation, cervical or thoracic, 1 level (64633) | $458.93 | $1,121.34 | $2,167.70 |
| Each additional level, lumbar (64636) | +$251.51 | +$50.77 | +$50.77 |
| Each additional level, cervical or thoracic (64634) | +$266.54 | +$57.78 | +$57.78 |
Your 20% Share
| What you are having done | Office | Surgery center | Hospital |
|---|---|---|---|
| One-level lumbar ablation | $92.99 | $224.34 | $433.61 |
| Two-level lumbar ablation, the usual procedure | $143.29 | $234.49 | $443.76 |
| The yearly maximum: two two-level sessions | $286.58 | $468.98 | $887.52 |
Add the $283 Part B deductible if you have not met it. And remember the two diagnostic blocks Medicare requires first, which are billed separately. What those blocks cost.
Want to know what your radiofrequency ablation should cost you?
Costs vary substantially by procedure, location, facility, and insurance. Get a personalized estimate based on your situation.
Already have a bill? Send it to CareRoute and we will work to reduce it. 64% of cases reduced.
The Hospital Gets One Payment for Everything
Spinal ablation is assigned to a comprehensive payment bundle in Medicare's hospital outpatient system. That single $1,995.02 payment is meant to cover the entire encounter: the procedure, the imaging, the supplies, the recovery bay, the drugs, the extra levels, all of it. Nothing else billed that day for that encounter generates a separate hospital payment.
That matters when you read the bill. A hospital statement for an ablation can easily run to a dozen line items with separate charges for fluoroscopy, the radiofrequency probes, the recovery room and the second and third levels. Medicare pays one amount for all of it. Your coinsurance is 20% of the one payment, not 20% of the charge list.
The number to compare against
Get the remittance advice or the Medicare Summary Notice, not just the hospital's itemized statement. The statement shows charges, which on these procedures averaged $11,192.10 in 2024. The remittance shows what was actually allowed. If the hospital is billing you a percentage of the charge column, that is the error to catch.
If You Are Uninsured or Out of Network
Then the charge column is your bill. In 2024, for a hospital outpatient radiofrequency ablation, the two sides of the bill looked like this:
| Who bills it | Average charge | Average allowed | Multiple |
|---|---|---|---|
| The hospital, for the facility | $11,192.10 | $1,773.86 | 6.3x |
| The doctor, for the procedure | $3,563.12 | $480.20 | 7.4x |
| Together | $14,755.22 | $2,254.06 | 6.5x |
Nearly $15,000 in charges for a procedure the same providers accept about $2,254 for from Medicare, and about $465 for in total if it is done in an office instead. Knowing both numbers is most of the leverage in a negotiation. We handle that negotiation on a success fee, and here is where else to look for help.
What Has to Happen Before Medicare Pays
From LCD L38773, Facet Joint Interventions for Pain Management, revised July 23, 2026. Ablation has the strictest prerequisites of any spinal injection procedure.
Two diagnostic blocks, each with at least 80% relief
Initial ablation is covered only after two medically necessary diagnostic medial branch blocks, each producing a consistent minimum of 80% sustained relief of the primary pain. One block is not enough. A block that gave partial relief is not enough. This is the single most common reason an ablation claim is denied, and it is entirely about what is written in the chart before the procedure.
Two sessions per spinal region per rolling twelve months
That is the ceiling, and it is half what facet injections get. One spinal region per session.
A repeat needs six months of proven benefit
Repeat ablation at the same site requires documented 50% improvement in pain for at least six months, or the same improvement in the ability to do previously painful activities, measured on the same scale as baseline. And if two or more years have passed since the last ablation and the pain source is in question, the diagnostic blocks have to be repeated from scratch.
Two levels per session
One to two levels per session per spinal region, unilateral or bilateral. Three and four-level procedures are called not medically necessary and are non-covered.
Sedation is case by case, and anxiety is not the case
Routine moderate sedation or monitored anesthesia care, and any use of general anesthesia or deep sedation for ablation, are not reasonable and necessary. Moderate sedation may be considered with documentation of a long-standing inability to cooperate or remain motionless. The policy says in so many words that patient anxiety or preference alone is not sufficient justification. What to do about a surprise anesthesia bill.
Imaging is required and already included
CT or fluoroscopic guidance only. Ultrasound and MRI guidance are not covered. The guidance is part of the ablation codes, so a separate fluoroscopy line on the same date is a duplicate.
How to Pay Less
Ask for an office or a surgery center
This is a $1,703.10 question, and $340.62 of it is yours. Many interventional pain practices do ablation in their own procedure suite and bill as an office. If your doctor only does it at the hospital, it is worth asking whether a colleague does it in an office, especially if you are going to need it again in six to twelve months.
Confirm both diagnostic blocks are documented before you schedule
Ask the office to confirm two blocks are in the record with at least 80% relief each. If they are not, the ablation can be denied after it is done, and then the entire allowed amount is yours. This is a five-minute phone call that protects up to $2,168.
Get the remittance, not just the statement
Because the hospital is paid one bundled amount, an itemized charge list for an ablation bears almost no relationship to what is owed. Compare against the allowed amount on the Medicare Summary Notice or the explanation of benefits.
Decline sedation unless there is a documented reason
It adds a separate anesthesia bill that Medicare's own policy says is usually not covered for this procedure.
How Common This Is
In 2024, Medicare paid for 381,119 lumbar facet ablations, plus 111,118 cervical and thoracic ablations and 251,269 additional-level procedures. 259,254 of the lumbar ablations, 68%, were done in a facility rather than an office, and 53,041 specifically in hospital outpatient departments, which is where the $11,192.10 average charge comes from. Traditional Medicare only, so Medicare Advantage and commercial insurance are on top of this.
Related Guides
Common Questions
How much does radiofrequency ablation of the spine cost?
Medicare allows $464.94 for a one-level lumbar facet ablation in a doctor's office, $1,121.68 in an ambulatory surgery center and $2,168.04 in a hospital outpatient department, at national rates for October through December 2026. Your 20% is $92.99, $224.34 or $433.61 plus the $283 Part B deductible. If you are uninsured, the 2024 average charge was $11,192.10 from the hospital plus $3,563.12 from the doctor.
Does Medicare cover radiofrequency ablation for back pain?
Yes, for facet joint pain, after two diagnostic medial branch blocks that each produced at least 80% sustained relief of the primary pain. It is limited to two sessions per spinal region per rolling twelve months, one region and a maximum of two levels per session, and it must be done under CT or fluoroscopic guidance. A repeat requires documented 50% improvement lasting at least six months.
How many radiofrequency ablations can you have in a year?
Two per spinal region per rolling twelve months. That is half the limit for facet injections. Because the benefit typically lasts six to twelve months as the nerves regenerate, most people who respond are back for a repeat within that window, and the limit is designed around that.
Why is my hospital ablation bill so large compared with what Medicare paid?
Because the procedure is paid through a comprehensive bundle. The hospital receives one payment of $1,995.02 covering the entire encounter, including the imaging, supplies, recovery and any additional levels, while its itemized statement may list all of those separately at charge rates. In 2024 the average hospital charge for this procedure was $11,192.10 against an average allowed amount of $1,773.86. Compare against the remittance advice, not the statement.
Why was my ablation denied?
By far the most common reason is the diagnostic blocks: Medicare requires two, each documented as producing at least 80% relief. Other frequent reasons are exceeding two sessions in twelve months, more than two levels, more than one spinal region in a session, a repeat without six months of documented benefit, or guidance other than CT or fluoroscopy. Get the denial reason in writing and the chart notes, and answer the specific criterion.
Do I need to be put to sleep for ablation?
Medicare's policy says routine moderate sedation or monitored anesthesia care, and any use of general anesthesia or deep sedation for ablation, are not reasonable and necessary. Moderate sedation may be considered in individual cases with documentation of a long-standing inability to cooperate or remain motionless, and the policy states that patient anxiety or preference alone is not sufficient justification. Sedation also means a second professional bill.
Sources
- CMS, CY2026 Physician Fee Schedule Relative Value File, October release. Non-facility and facility total RVUs for CPT 64633, 64634, 64635 and 64636. Conversion factor $33.4009.
- CMS, Hospital Outpatient Prospective Payment System Addendum B, October 2026 quarterly update. CPT 64633 and 64635 assigned to APC 5431 with status indicator J1, comprehensive APC, payment rate $1,995.02; CPT 64634 and 64636 status indicator N, packaged.
- CMS, Ambulatory Surgical Center Payment Addendum AA, October 2026 quarterly update.
- CMS Medicare Coverage Database, LCD L38773, Facet Joint Interventions for Pain Management (CGS Administrators), original effective May 2, 2021, revision effective July 23, 2026. Facet joint denervation criteria and frequency limits.
- CMS, Medicare Physician and Other Practitioners by Geography and Service, 2024 data year, and Medicare Outpatient Hospitals by Geography and Service, 2024 data year. National service counts, average submitted charges and average allowed amounts.