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CPT 64625 Fee Schedule

Last Verified: December 2025

Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.

Radiofrequency Ablation Nerves Innervating The Sacroiliac Joint With Image Guidance (Ie Fluoroscopy Or Computed Tomography)
Key FactDetail
Service Type

Surgery

Surgical Procedures on the Nervous System

Common Place of Service

24 - Ambulatory Surgical Center

11 - Office

Common Modifiers

None

RT - Right side of body

LT - Left side of body

Complexity LevelModerate

National average reimbursement for CPT 64625 by major payers:

bcbs

$618.66

uhc

$681.27

aetna

$668.52

cigna

$828.24

Preview provider-level rates for...
For billing codeCPT 64625
PayerCodeRateNPITax IDStateSpecialty

Select a payer to view fee schedule data

Choose a payer from the options above to see rates for CPT 64625

United
64625$2353.001740260926 - STARK AMBULATORY SURGERY CENTER, LLC611448511 - (OH) STARK AMBULATORY SURGERY CENTER LLCOHAmbulatory Surgical Clinic/Center (261QA1903X)
United
64625$2388.001184671760 - CHANDLER ENDOSCOPY CENTER, L.L.C.454307241AZAmbulatory Surgical Clinic/Center (261QA1903X)
United
64625$1155.001679570774 - NOVAMED SURGERY CENTER OF MADISON, LIMITED PARTNERSHIP201915800 - (WI) NOVAMED SURGERY CENTER OF MADISON LIMITED PARTNERSHIPWIAmbulatory Surgical Clinic/Center (261QA1903X)
United
64625$1000.001962466847 - GULF COAST ENDOSCOPY CENTER OF VENICE LLC650954372 - (FL) GULF COAST ENDOSCOPY CENTER OFFLAmbulatory Surgical Clinic/Center (261QA1903X)
United
64625$4181.001871033878 - REDMOND AMBULATORY SURGERY CENTER, LLC813558711 - (WA) REDMOND AMBULATORY SURGERY CENTER LLCWAAmbulatory Surgical Clinic/Center (261QA1903X)
United
64625$1847.001730401571 - CHILDRENS SURGERY CENTER LLC, ADVENTHEALTH SURGERY CENTER MAITLAND262389638 - (FL) CHILDRENS SURGERY CENTER LLCFLAmbulatory Surgical Clinic/Center (261QA1903X)
United
64625$6245.001396901542 - TEXAS HEALTH ARLINGTON MEMORIAL HOSPITAL750972805 - (TX) TEXAS HEALTH ARLINGTON MEMORIAL HOSPITALTXAmbulatory Surgical Clinic/Center (261QA1903X)
United
64625$2388.001740260926 - STARK AMBULATORY SURGERY CENTER, LLC611448511 - (OH) STARK AMBULATORY SURGERY CENTER LLCOHAmbulatory Surgical Clinic/Center (261QA1903X)
United
64625$1036.001073757480 - ENDOSCOPY CENTER OF WESTERN COLORADO INC262645683COAmbulatory Surgical Clinic/Center (261QA1903X)
United
64625$1819.001588619811 - LAWRENCEVILLE SURGERY CENTER, LLC582591488 - (GA) LAWRENCEVILLE SURGERY CENTER LLCGAAmbulatory Surgical Clinic/Center (261QA1903X)
United
64625$390.001861596967 - G.I.ENDOSCOPY CENTER581862189 - (GA) GIENDOSCOPY CENTERGAAmbulatory Surgical Clinic/Center (261QA1903X)
United
64625$1200.001790237501 - AMERICAN ACCESS CARE OF SP ASC LLC814086575 - (PA) AMERICAN ACCESS CARE OF SP ASC LLCPAAmbulatory Surgical Clinic/Center (261QA1903X)
United
64625$1062.001114980166 - NEW PORT RICHEY SURGERY CENTER LTD592907068 - (FL) NEW PORT RICHEY SURGERY CENTER LTDFLAmbulatory Surgical Clinic/Center (261QA1903X)
United
64625$1477.001437191731 - EL DORADO SURGERY CENTER LP, TUCSON SURGERY CENTER850474225AZAmbulatory Surgical Clinic/Center (261QA1903X)
United
64625$1350.001306993464 - PACIFIC HILLS SURGERY CENTER LLC800180491CAAmbulatory Surgical Clinic/Center (261QA1903X)
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist

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CPT 64625 vs. Other Surgical Procedures on the Nervous System Codes

The CPT 64625 code is part of the Surgery services used for Surgical Procedures on the Nervous System. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.

The CPT 64625 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.

CodeComplexityDescription
64620-CPTModerateDestruction By Neurolytic Agent; Intercostal Nerve
64624-CPTModerateDestruction By Neurolytic Agent, Genicular Nerve Branches Including Imaging Guidance, When Performed - Deny Inv/N10>=4/29/2023
64625-CPTModerateRadiofrequency Ablation Nerves Innervating The Sacroiliac Joint With Image Guidance (Ie Fluoroscopy Or Computed Tomography)
64630-CPTModerateDestruct Neurolytic Pudendal

What is a fee schedule?

A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 64625. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.

Understanding the 64625 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.

Factors that affect fee schedules


Medicare & Medicaid Rates

Government-set reimbursement amounts


Private Insurance Rates

Negotiated rates between providers and insurance companies


Geographic Location

Costs may be higher in urban areas.


Provider Type

Hospital providers may have different rates than private practice.

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