64634 is not limited to 1 unit (it actually has an MUE of 4) but does have an instruction regarding the use of modifier 50. Copy/paste from Codify:
CPT® Code 64634
Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT); cervical or thoracic, each additional facet joint (List separately in addition to code for primary procedure)
Notes:
(Use 64634 in conjunction with 64633)
(For bilateral procedure, report 64634 twice. Do not report modifier 50 in conjunction with 64634) bolding is mine for emphasis
Yes, I meant one unit "Per CPT" billed. Not that only one 64634 could be billed. My apologies for miscommunicating.
As of 4/25/21 it looks like Medicare wants this billed out as 64633-50, 64634-RT, 64634-LT for second bilateral level.. (unless I'm reading that wrong) but doc wants additional bilateral added for third level burned. 3 total Bilateral units. I think I'm just super exhausted today and not seeing the simple answer in front of me..
Here are his notes for this particular claim. Thanks for your patience and help on this.
Prior to the procedure proper consent was obtained, risks were discussed and all questions were answered. The patient was taken into the procedure room and positioned in a prone position. After proper prep and drape with Hibiclens solution and sterile draping using towels, the superior portion of the transverse process of the vertebral body of T7, T8, T9, and T10, was identified with fluoroscopy. 1 mL of 1% Xylocaine was injected above each of the described levels. An SMK 10 Radio Frequency needle with a 10mm exposed tip was placed to the superior portion of the transverse process at each level. Motor testing at 2 hertz, 2 volts was done showing no motor involvement. 1 mL of 1% Xylocaine was injected and the patient was given an 80 degree, 80 second radiofrequency lesion.
This same procedure, with the same parameters, injectates, and radiofrequency lesioning was done at the other levels as stated above.