How much does Medicare pay for CPT 64628?

Medicare allowed an average of $4693.89 per service and paid $3735.52 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $19,738, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 64628?

Heat destruction of intraosseous basivertebral nerve in bones of spine in lower back, first two bones. It was billed 7,767 times to 7,261 Medicare beneficiaries by 331 providers in 2024.

Does 64628 pay differently in an office than a hospital?

Yes. The allowed amount averaged $431.61 in an office setting and $4756.81 in a facility. The office rate is generally higher because the practice supplies the room, staff and equipment out of that single payment; in a hospital those are billed separately by the facility.

Which specialty bills 64628 most?

Ambulatory Surgical Center, with 3,791 services from 142 clinicians. Next are Pain Management, Interventional Pain Management, Anesthesiology.

CPT 64628

Heat destruction of intraosseous basivertebral nerve in bones of spine in lower back, first two bones

$4693.89Medicare-allowed amount per service, averaged across 7,767 services

Providers submitted

$19,738

Asking price, not received

Medicare allowed

$4693.89

The fee schedule figure

Medicare paid

$3735.52

Balance is patient coinsurance

Providers submitted an average of $19,738 for this code and Medicare allowed $4693.89 — 4.2× less. That gap is normal and means nothing on its own: Medicare pays its fee schedule regardless of what is billed, so the submitted figure describes a hospital chargemaster, not a price anyone paid. Of the allowed amount Medicare paid $3735.52 (80%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $431.61
Hospital / facility: $4756.81

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 113 services were billed in an office setting and 7,654 in a facility.

Services: 7,767
Beneficiaries: 7,261
Providers billing it: 331
Total allowed: $36,457,444

What Medicare pays for CPT 64628

Across 7,767 services billed by 331 providers to 7,261 beneficiaries, Medicare allowed an average of $4693.89 per service. The allowed amount is the figure that matters: it is what Medicare and the patient together owe, set by the fee schedule and adjusted for local practice costs. What a provider chose to submit has no bearing on it.

Who bills 64628

Specialty	Services	Beneficiaries	Avg allowed	Providers
Ambulatory Surgical Center	3,791	3,544	$9195.76	142
Pain Management	1,198	1,113	$404.38	61
Interventional Pain Management	934	898	$404.40	40
Anesthesiology	785	717	$396.73	34
Physical Medicine and Rehabilitation	747	691	$402.24	39
Orthopedic Surgery	133	126	$396.58	7
Diagnostic Radiology	66	63	$384.79	3
Neurosurgery	62	61	$385.75	3
Family Practice	27	27	$394.54	1
Osteopathic Manipulative Medicine	24	21	$396.53	1

64628 reimbursement by state

Two different numbers. Allowed is what Medicare actually allowed in that state, which includes the local practice-cost adjustment. Standardized strips that geographic adjustment out of the payment, so it is the column to use when comparing states — a difference there reflects how the code was billed, not what it costs to run a practice locally.

State	Services	Allowed	Standardized pmt	Providers
Florida	1,274	$4713.59	$3990.86	47
Arizona	768	$5584.59	$4483.76	27
California	674	$6040.93	$4054.30	35
Texas	583	$3808.57	$3168.94	26
Utah	438	$4981.95	$4169.54	17
Pennsylvania	352	$4591.14	$3721.20	13
Delaware	308	$5334.49	$4138.24	8
New York	302	$4491.51	$3185.24	14
Oregon	270	$5564.31	$4188.61	9
Mississippi	214	$3889.38	$3606.33	5
Colorado	201	$4940.68	$3999.57	9
Nebraska	200	$5563.47	$4545.14	11
Georgia	172	$5525.58	$4464.55	9
Oklahoma	164	$2146.51	$1861.06	5
Massachusetts	153	$1921.21	$1366.00	5
Nevada	152	$5603.22	$4349.85	8
South Carolina	120	$2575.30	$2186.56	6
Maryland	119	$5003.92	$3986.24	6
Louisiana	110	$3094.53	$2754.70	6
South Dakota	102	$1922.80	$1625.57	5
Illinois	100	$3440.06	$2715.61	7
Arkansas	84	$4587.04	$4139.21	2
Missouri	78	$3918.65	$3209.89	5
New Jersey	75	$6159.07	$4454.45	5
Washington	74	$2616.08	$1940.50	3
Ohio	74	$5459.99	$4598.61	5
North Dakota	59	$3305.33	$2819.19	3
Kansas	58	$377.66	$305.87	1
Minnesota	56	$7079.50	$5480.03	4
Tennessee	54	$6286.45	$5408.47	3
Indiana	52	$4709.37	$3844.00	3
Idaho	49	$8869.07	$7362.66	1
Kentucky	46	$8701.87	$7359.95	3
Virginia	41	$2659.08	$2206.62	3
North Carolina	40	$385.82	$314.04	3
Iowa	34	$376.94	$316.82	2
Wyoming	31	$396.90	$309.75	1
Michigan	26	$4936.92	$4114.79	2
Alaska	23	$9981.37	$7364.37	1
Connecticut	13	$430.37	$322.82	1
Wisconsin	12	$378.34	$321.94	1
Alabama	12	$8282.78	$7366.93	1

Related codes

64635Destruction of lower or sacral spinal facet joint nerves$498.61
64636Destruction of lower or sacral spinal facet joint nerves$170.99
64615Injection of chemical for paralysis of facial and neck nerve muscles o$139.05
64633Destruction of upper or middle spinal facet joint nerves$505.48
64640Destruction of peripheral nerve or branch$128.51
64616Injection of chemical for paralysis of nerve muscles on side of neck e$175.81
64634Destruction of upper or middle spinal facet joint nerves$174.09
64612Injection of chemical for paralysis of nerve muscles on side of face$170.37
64642Injection of chemical for paralysis of nerve muscles on arm or leg$120.67
64643Injection of chemical for paralysis of nerve muscles on arm or leg$81.52
64644Injection of chemical for paralysis of nerve muscles on arm or leg$147.30
64624Destruction of nerve branches of knee$425.22

Billing this code is not the same as earning it

An allowed amount is revenue to a practice, not income to a clinician. It funds staff, premises, equipment and supplies before anyone is paid. What clinicians actually earn is published separately by the Department of Labor, and what industry pays them is published separately again by CMS — this site carries both.

What doctors are paid →·Look up a clinician →·All procedure codes →

Where this comes from. CMS Medicare Physician & Other Practitioners, by Provider and Service, 2024. It covers fee-for-service Original Medicare Part B only — not Medicare Advantage, not Medicaid, and not commercial insurance, which typically pays more for the same code.

How it is averaged. CMS publishes one average per provider per code. Every figure here is re-weighted by the number of services, so a clinician who billed the code 4,000 times counts 4,000 times more than one who billed it twice. CMS also suppresses any provider-code pair with fewer than 11 beneficiaries, so low-volume practice is missing from these totals by design.