CPT® Code 64628

Thermal destruction of intraosseous basivertebral nerve, including all imaging guidance; first 2 vertebral bodies, lumbar or sacral

Thermal destruction of the intraosseous basivertebral nerve is a specialized procedure aimed at alleviating chronic low back pain. This technique specifically targets the basivertebral nerves, which are sensory nerves located within the center of the vertebral body and at the vertebral end plates. These nerves exit the vertebral body through the basivertebral foramen, and their activation is believed to contribute to "vertebrogenic" pain, a type of pain associated with degeneration of the intervertebral disc and the vertebral endplates. The procedure is performed using a transpedicular approach, which involves accessing the vertebral body through a small incision. Under fluoroscopic guidance, a trocar is introduced to facilitate access to the vertebral body. A curved cannula assembly is then utilized to create a tunnel through the vertebral body, allowing for precise targeting of the basivertebral nerve. To effectively destroy the nerve, a bipolar radiofrequency probe is employed, which applies energy to heat and ablate the nerve tissue, thereby interrupting the transmission of pain signals. This procedure is specifically coded as CPT® Code 64628 when performed on the first two vertebral bodies in the lumbar or sacral region, with additional vertebral bodies treated under CPT® Code 64629.