CPT code 64400: Nerve block, trigeminal nerve or branch2026 Medicare rate & RVUs
Reports an injection around a trigeminal nerve division or branch, commonly for facial pain or trigeminal neuralgia treatment or diagnostic evaluation.
Medicare pays $121.91 for 64400 nationally in the office and $47.43 in a hospital or facility. Local office rates run $105.75–$161.35.
Medicare rate · 64400
Nerve block, trigeminal nerve or branch
- Work RVUs
- 0.73
- Total RVUs
- 3.65
- Global days
- 000
National rate · 2026
$121.91
Office setting, before claim adjustments.
See every locality for 64400 →Billed by an NP, PA or therapist? →
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
Your location
On this page 10 sections
What 64400 covers
This service places an anesthetic, with or without a steroid, around a trigeminal nerve division or branch to evaluate or relieve facial pain. Pain medicine physicians and anesthesiologists commonly perform it in an office, pain clinic, or outpatient facility. Typical situations include a diagnostic block or treatment directed at trigeminal neuralgia or another facial pain condition. The documented target must be part of the trigeminal nerve, not another cranial or peripheral nerve.
Report the service when the clinician performs the trigeminal injection; document the indication, targeted division or branch, side, and injectate. CMS assigns a 0-day global period, so same-day preoperative and postoperative care is included. For bilateral service, modifier 50 is paid at 150%. When multiple procedures occur in one session, the highest-valued procedure is paid in full and the others at 50%. Assistant-at-surgery services are not paid; co-surgeons and team surgery are not permitted.
This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.
Where 64400 pays more and less
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
109 payment localities
$105.75 to $161.35
109 of 109 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Alabama | $107.55 | $42.38 |
| Alaska | $136.84 | $57.51 |
| Arizona | $118.10 | $45.92 |
| Arkansas | $105.75 | $41.77 |
| Atlanta, GA | $124.84 | $49.17 |
| Austin, TX | $126.41 | $47.61 |
| Bakersfield, CA | $128.32 | $46.69 |
| Baltimore area, MD | $130.57 | $50.65 |
| Beaumont, TX | $113.27 | $45.49 |
| Brazoria, TX | $119.75 | $45.94 |
| Chicago, IL | $131.62 | $56.76 |
| Chico, CA | $127.76 | $46.13 |
| Colorado | $126.46 | $47.21 |
| Connecticut | $130.84 | $50.62 |
| Dallas, TX | $120.77 | $46.59 |
| Delaware | $120.24 | $46.65 |
| Detroit, MI | $123.56 | $51.68 |
| East St. Louis, IL | $121.78 | $53.26 |
| El Centro, CA | $127.80 | $46.16 |
| Fort Lauderdale, FL | $128.76 | $53.31 |
| Fort Worth, TX | $119.96 | $46.52 |
| Fresno, CA | $127.76 | $46.13 |
| Galveston, TX | $120.27 | $46.31 |
| Hanford, CA | $127.76 | $46.13 |
| Hawaii, Guam, HI | $131.36 | $46.67 |
| Houston, TX | $124.11 | $50.15 |
| Idaho | $110.98 | $42.45 |
| Indiana | $111.70 | $42.65 |
| Iowa | $109.99 | $41.84 |
| Kansas | $109.74 | $42.41 |
| Kentucky | $111.27 | $45.05 |
| King County, WA | $142.40 | $51.00 |
| Los Angeles, CA | $137.12 | $49.01 |
| Madera, CA | $127.76 | $46.13 |
| Manhattan, NY | $142.25 | $55.70 |
| Marin County, CA | $157.55 | $52.52 |
| Merced, CA | $127.76 | $46.13 |
| Metropolitan Boston, MA | $139.70 | $50.77 |
| Metropolitan Kansas City, MO | $116.23 | $46.29 |
| Metropolitan Philadelphia, PA | $127.42 | $49.88 |
| Metropolitan St. Louis, MO | $117.58 | $46.67 |
| Miami, FL | $136.35 | $58.81 |
| Minnesota | $119.60 | $42.96 |
| Mississippi | $107.50 | $43.37 |
| Modesto, CA | $127.76 | $46.13 |
| Montana | $121.90 | $47.42 |
| Napa, CA | $148.78 | $50.61 |
| Nebraska | $110.58 | $41.83 |
| Nevada | $120.83 | $46.27 |
| New Hampshire | $124.75 | $47.21 |
| New Mexico | $115.81 | $47.51 |
| New Orleans, LA | $117.53 | $47.44 |
| North Carolina | $113.32 | $43.82 |
| North Dakota | $117.75 | $43.26 |
| Northern New Jersey | $138.41 | $52.01 |
| NYC suburbs and Long Island, NY | $146.59 | $58.03 |
| Ohio | $114.09 | $46.09 |
| Oklahoma | $110.66 | $44.15 |
| Oxnard, CA | $136.43 | $48.39 |
| Portland, OR | $130.56 | $47.80 |
| Poughkeepsie and northern NYC suburbs, NY | $133.08 | $51.52 |
| Puerto Rico | $122.80 | $47.50 |
| Queens, NY | $143.05 | $55.01 |
| Redding, CA | $127.76 | $46.13 |
| Rest of California | $127.76 | $46.13 |
| Rest of Florida | $121.46 | $50.25 |
| Rest of Georgia | $113.48 | $47.04 |
| Rest of Illinois | $117.99 | $49.98 |
| Rest of Louisiana | $111.21 | $45.29 |
| Rest of Maine | $112.02 | $43.50 |
| Rest of Maryland | $122.67 | $47.29 |
| Rest of Massachusetts | $125.68 | $47.25 |
| Rest of Michigan | $114.94 | $46.94 |
| Rest of Missouri | $109.24 | $45.03 |
| Rest of New Jersey | $131.90 | $50.56 |
| Rest of New York | $115.30 | $44.54 |
| Rest of Oregon | $119.47 | $45.28 |
| Rest of Pennsylvania | $114.11 | $45.73 |
| Rest of Texas | $116.62 | $45.93 |
| Rest of Washington | $125.35 | $46.92 |
| Rhode Island | $124.61 | $47.66 |
| Riverside, CA | $130.01 | $48.38 |
| Sacramento, CA | $134.29 | $47.67 |
| Salinas, CA | $133.81 | $47.48 |
| San Benito County, CA | $161.35 | $53.94 |
| San Diego, CA | $137.17 | $48.09 |
| San Francisco, CA | $157.31 | $52.29 |
| San Luis Obispo, CA | $131.65 | $46.82 |
| Santa Clara County, CA | $160.37 | $52.97 |
| Santa Cruz, CA | $138.63 | $48.13 |
| Santa Maria, CA | $134.37 | $47.52 |
| Santa Rosa, CA | $140.03 | $48.56 |
| South Carolina | $113.98 | $45.16 |
| South Dakota | $117.26 | $42.77 |
| Southern Maine, ME | $118.51 | $44.70 |
| Stockton, CA | $127.76 | $46.13 |
| Suburban Chicago, IL | $129.94 | $53.45 |
| Tennessee | $110.43 | $42.72 |
| Utah | $115.77 | $45.75 |
| Vallejo, CA | $148.44 | $50.27 |
| Vermont | $117.54 | $43.80 |
| Virgin Islands, VI | $122.80 | $47.50 |
| Virginia | $118.31 | $45.09 |
| Visalia, CA | $127.76 | $46.13 |
| Washington, DC area | $140.13 | $52.39 |
| West Virginia | $113.08 | $48.35 |
| Wisconsin | $113.26 | $41.90 |
| Wyoming | $120.09 | $45.61 |
| Yuba City, CA | $127.76 | $46.13 |
64400 rates by state
Office rate range in each state. Select a state to see its payment localities.
Explore a state
Local rates. Clear comparisons.
Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.
$105.75
$144.56
Color shows the midpoint of each state’s locality range.
View every state and territory as a table
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | $136.84 | 1 |
| AL | $107.55 | 1 |
| AR | $105.75 | 1 |
| AZ | $118.10 | 1 |
| CA | $127.76–$161.35 | 29 |
| CO | $126.46 | 1 |
| CT | $130.84 | 1 |
| DC | $140.13 | 1 |
| DE | $120.24 | 1 |
| FL | $121.46–$136.35 | 3 |
| GA | $113.48–$124.84 | 2 |
| GU | $131.36 | 1 |
| HI | $131.36 | 1 |
| IA | $109.99 | 1 |
| ID | $110.98 | 1 |
| IL | $117.99–$131.62 | 4 |
| IN | $111.70 | 1 |
| KS | $109.74 | 1 |
| KY | $111.27 | 1 |
| LA | $111.21–$117.53 | 2 |
| MA | $125.68–$139.70 | 2 |
| MD | $122.67–$140.13 | 3 |
| ME | $112.02–$118.51 | 2 |
| MI | $114.94–$123.56 | 2 |
| MN | $119.60 | 1 |
| MO | $109.24–$117.58 | 3 |
| MS | $107.50 | 1 |
| MT | $121.90 | 1 |
| NC | $113.32 | 1 |
| ND | $117.75 | 1 |
| NE | $110.58 | 1 |
| NH | $124.75 | 1 |
| NJ | $131.90–$138.41 | 2 |
| NM | $115.81 | 1 |
| NV | $120.83 | 1 |
| NY | $115.30–$146.59 | 5 |
| OH | $114.09 | 1 |
| OK | $110.66 | 1 |
| OR | $119.47–$130.56 | 2 |
| PA | $114.11–$127.42 | 2 |
| PR | $122.80 | 1 |
| RI | $124.61 | 1 |
| SC | $113.98 | 1 |
| SD | $117.26 | 1 |
| TN | $110.43 | 1 |
| TX | $113.27–$126.41 | 8 |
| UT | $115.77 | 1 |
| VA | $118.31–$140.13 | 2 |
| VI | $122.80 | 1 |
| VT | $117.54 | 1 |
| WA | $125.35–$142.40 | 2 |
| WI | $113.26 | 1 |
| WV | $113.08 | 1 |
| WY | $120.09 | 1 |
How the 64400 rate is calculated
Each of 64400’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 64400
RVUs × geographic indexes × conversion factor
Work0.73
0.73 RVUs× 1.000 GPCI
Practice expense2.71
2.71 RVUs× 1.000 GPCI
Malpractice0.21
0.21 RVUs× 1.000 GPCI
Adjusted RVUs
3.6500
Conversion factor
$33.4009
Medicare rate
$121.91
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 64400
The CMS indicators that decide how 64400 is paid alongside other services.
CMS payment indicators · 64400
Nerve block, trigeminal nerve or branch
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 000 | Same-day global: pre- and post-op care on the day of the procedure is included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 1 | Bilateral with modifier 50 pays 150% of the fee schedule amount. |
| Assistant at surgery (80/81/82/AS) | 1 | Not paid (statutory restriction). |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
What modifiers do to the payment
Modifier 50 · payment effect
With and without the modifier
64400 without 50 · national office
$121.91
Nerve block, trigeminal nerve or branch
64400-50 · Bilateral: 150%
$182.87
Both sides on one line with modifier 50 are paid at 150% of the fee schedule amount (subject to multiple-procedure rules with other procedures).
64400 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 64405Occipital nerve blockGreater occipital nerve
- 64405 targets the greater occipital nerve. Use 64400 for a trigeminal division or branch.
- 64408Vagus nerve blockAnesthetic injection
- 64408 targets the vagus nerve; it is not the code for a trigeminal nerve injection.
- 64450Nerve blockOther peripheral nerve or branch
- 64450 describes an injection of another peripheral nerve or branch. Use 64400 when the documented target is trigeminal.
64400 billing questions
When should 64400 be selected instead of a general peripheral nerve block code?
Use 64400 when the documented target is a trigeminal nerve division or branch. A different peripheral nerve target calls for the code specific to that nerve, when available.
Does the code identify the facial pain diagnosis by itself?
No. The record should support the indication for the injection and identify the trigeminal division or branch treated.
How is a bilateral trigeminal injection reported for Medicare payment?
Use modifier 50 for a bilateral procedure; CMS pays it at 150%.
Is same-day pre- and postoperative care separately included?
The code has a 0-day global period, and same-day preoperative and postoperative care is included.
Can an assistant, co-surgeon, or surgical team be reported for this service?
CMS does not pay an assistant at surgery for this code. Co-surgeons and team surgery are not permitted.
What happens when another procedure is performed in the same session?
CMS pays the highest-valued procedure in full and the other procedures at 50% under the standard multiple procedure reduction.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file lines behind this rate
Fee sheets · Coming soon
Put 64400 and the rest of your codes on one sheet
Your codes at your locality, with payer contracts beside Medicare.
Join the waitlist