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CPT code 64400: Nerve block, trigeminal nerve or branch2026 Medicare rate & RVUs in Houston, TX

Reports an injection around a trigeminal nerve division or branch, commonly for facial pain or trigeminal neuralgia treatment or diagnostic evaluation.

CMS RVU26DEffective Oct 1, 2026One payment locality25.4K Medicare services in 2024

In Houston, TX, Medicare pays $124.11 for 64400 in the office and $50.15 when it’s performed in a hospital or facility.

$124.11Office (non-facility)
$50.15Hospital or facility
+1.8%vs the national office rate ($121.91)

Check a contract rate as a % of Medicare · 64400 nationwide

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

We’ll open 64400 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Houston, TX
  2. What 64400 covers
  3. Compared with other areas
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Related codes
  8. Rate history
  9. Where it applies
  10. Billing questions
  11. Sources

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.

How Houston, TX compares for 64400

Across 109 of 109 payment localities, the office rate for 64400 runs from $105.75 in Arkansas to $161.35 in San Benito County, CA. Houston, TX pays $124.11. The RVUs are the same everywhere; the geographic indexes change the dollars.

64400 in Houston, TX vs other payment areas
  1. Houston, TX · this page$124.11
  2. Austin, TX · Texas$126.41+$2.30
  3. Beaumont, TX · Texas$113.27−$10.84
  4. Brazoria, TX · Texas$119.75−$4.36
  5. Dallas, TX · Texas$120.77−$3.34
  6. Fort Worth, TX · Texas$119.96−$4.15
  7. Galveston, TX · Texas$120.27−$3.84

Other areas in Texas first, then benchmark localities. Bars start at $0.

Every other payment area

64400 in every other Medicare payment locality
Payment localityOfficeFacility
Rest of TexasTexas$116.62$45.93
Los Angeles, CACalifornia$137.12$49.01
Washington, DC areaDistrict of Columbia$140.13$52.39
Miami, FLFlorida$136.35$58.81
Chicago, ILIllinois$131.62$56.76
Manhattan, NYNew York$142.25$55.70
AlaskaAlaska$136.84$57.51
AlabamaAlabama$107.55$42.38

64400 rates by state

Office rate range in each state. Select a state to see its payment localities.

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

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
64400 office rate range by state
State / territoryOffice rate rangeLocalities
AK$136.841
AL$107.551
AR$105.751
AZ$118.101
CA$127.76–$161.3529
CO$126.461
CT$130.841
DC$140.131
DE$120.241
FL$121.46–$136.353
GA$113.48–$124.842
GU$131.361
HI$131.361
IA$109.991
ID$110.981
IL$117.99–$131.624
IN$111.701
KS$109.741
KY$111.271
LA$111.21–$117.532
MA$125.68–$139.702
MD$122.67–$140.133
ME$112.02–$118.512
MI$114.94–$123.562
MN$119.601
MO$109.24–$117.583
MS$107.501
MT$121.901
NC$113.321
ND$117.751
NE$110.581
NH$124.751
NJ$131.90–$138.412
NM$115.811
NV$120.831
NY$115.30–$146.595
OH$114.091
OK$110.661
OR$119.47–$130.562
PA$114.11–$127.422
PR$122.801
RI$124.611
SC$113.981
SD$117.261
TN$110.431
TX$113.27–$126.418
UT$115.771
VA$118.31–$140.132
VI$122.801
VT$117.541
WA$125.35–$142.402
WI$113.261
WV$113.081
WY$120.091

See 64400 in every payment locality

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

Office or facility?

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.

The exact Houston, TX inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

7,096

Code
64400
Physician work
0.73
Practice expense
2.71
Malpractice
0.21

GPCI2026.csv

102

Locality
Houston, TX
Physician work
1.008
Practice expense
0.993
Malpractice
1.376
Office calculation for 64400 in Houston, TX
ComponentRVULocality factorAdjusted
Physician work0.73× 1.0080.7358
Practice expense2.71× 0.9932.6910
Malpractice0.21× 1.3760.2890
Total RVUs3.7158
Conversion factor× 33.4009

Office rate, Houston, TX$124.11

Office: (0.73 × 1.008 + 2.71 × 0.993 + 0.21 × 1.376) × $33.4009 = $124.11

Facility: (0.73 × 1.008 + 0.48 × 0.993 + 0.21 × 1.376) × $33.4009 = $50.15

Open 64400 in the RVU calculator

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

RuleCMS valueWhat it means
Global period000Same-day global: pre- and post-op care on the day of the procedure is included.
Multiple procedures2Standard reduction: highest-valued procedure at 100%, others at 50%.
Bilateral (modifier 50)1Bilateral with modifier 50 pays 150% of the fee schedule amount.
Assistant at surgery (80/81/82/AS)1Not paid (statutory restriction).
Co-surgeons (62)0Not permitted.
Team surgery (66)0Not permitted.
Professional/technical0Physician 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).

When to use modifier 50

Codes related to 64400

Related codes aren’t interchangeable: bill the code that matches the service performed.

Codes related to 64400
CodeHow it relatesOffice range, Houston, TX
Same family
64405Occipital nerve block, greater occipital nerveA named-nerve injection in the same general code series, directed to the greater occipital nerve.$81.42
64408Vagus nerve block, anesthetic injectionA named-nerve injection in the same general code series, directed to the vagus nerve.$81.04
64450Nerve block, other peripheral nerve or branchFor an injection of another peripheral nerve or branch without a more specific code.$81.53

How 64400 has changed in Houston, TX

64400 · Office / nonfacility

$124.11

Effective 2026-10-01

The base rate is $11.75 higher than on 2025-10-01, moving from $112.36 to $124.11 (10.5%).

It is unchanged from the immediately preceding available release, effective 2026-07-01.

Base rate by release · bars start at $0 · select a bar to compare

One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.

What changed, release by release

  1. January 1, 2026

    RVU26A

    $112.36changed to$124.11

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 0.75 changed to 0.73
    • Practice expense RVU 2.41 changed to 2.71
    • Work GPCI 1.014 changed to 1.008
    • Practice expense GPCI 1.003 changed to 0.993
    • Malpractice GPCI 1.409 changed to 1.376

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $117.30changed to$112.36

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 2.46 changed to 2.41

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $115.38changed to$117.30

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $116.75changed to$115.38

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 2.42 changed to 2.46
    • Malpractice RVU 0.19 changed to 0.21
    • Work GPCI 1.023 changed to 1.014
    • Practice expense GPCI 1.016 changed to 1.003
    • Malpractice GPCI 1.154 changed to 1.409

  5. January 1, 2023

    RVU23A

    $119.90changed to$116.75

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 2.44 changed to 2.42
    • Malpractice RVU 0.20 changed to 0.19
    • Work GPCI 1.032 changed to 1.023
    • Practice expense GPCI 1.029 changed to 1.016
    • Malpractice GPCI 0.900 changed to 1.154

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $119.15changed to$119.90

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 2.40 changed to 2.44
    • Malpractice RVU 0.19 changed to 0.20

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $111.77changed to$119.15

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 2.12 changed to 2.40
    • Malpractice RVU 0.18 changed to 0.19
    • Work GPCI 1.026 changed to 1.032
    • Practice expense GPCI 1.020 changed to 1.029
    • Malpractice GPCI 0.918 changed to 0.900

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $141.14changed to$111.77

    • Conversion factor 36.0391 changed to 36.0896
    • Work RVU 1.11 changed to 0.75
    • Practice expense RVU 2.52 changed to 2.12
    • Malpractice RVU 0.25 changed to 0.18
    • Work GPCI 1.020 changed to 1.026
    • Practice expense GPCI 1.012 changed to 1.020
    • Malpractice GPCI 0.936 changed to 0.918

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $135.92changed to$141.14

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 2.39 changed to 2.52
    • Malpractice RVU 0.24 changed to 0.25

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $131.37changed to$135.92

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 2.29 changed to 2.39
    • Malpractice RVU 0.23 changed to 0.24
    • Practice expense GPCI 1.009 changed to 1.012
    • Malpractice GPCI 0.946 changed to 0.936

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $130.86changed to$131.37

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 2.30 changed to 2.29
    • Malpractice RVU 0.22 changed to 0.23
    • Work GPCI 1.019 changed to 1.020
    • Practice expense GPCI 1.006 changed to 1.009
    • Malpractice GPCI 0.955 changed to 0.946

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $131.34changed to$130.86

    • Conversion factor 35.9335 changed to 35.8043

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $130.68changed to$131.34

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $126.60changed to$130.68

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 2.24 changed to 2.30
    • Malpractice RVU 0.17 changed to 0.22
    • Work GPCI 1.014 changed to 1.019
    • Practice expense GPCI 1.004 changed to 1.006
    • Malpractice GPCI 0.939 changed to 0.955

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $126.26changed to$126.60

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 2.42 changed to 2.24
    • Malpractice RVU 0.18 changed to 0.17
    • Work GPCI 1.009 changed to 1.014
    • Practice expense GPCI 1.002 changed to 1.004
    • Malpractice GPCI 0.923 changed to 0.939

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $126.26

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$124.11$50.15RVU26D
2026-07-01$124.11$50.15RVU26C
2026-04-01$124.11$50.15RVU26B
2026-01-01$124.11$50.15RVU26A
2025-10-01$112.36$53.96RVU25D
2025-07-01$112.36$53.96RVU25C
2025-04-01$112.36$53.96RVU25B
2025-01-01$112.36$53.96RVU25A
2024-10-01$117.30$54.86RVU24D
2024-07-01$117.30$54.86RVU24C
2024-04-01$117.30$54.86RVU24B
2024-03-09$117.30$54.86RVU24AR
2024-01-01$115.38$53.97RVU24A
2023-10-01$116.75$52.71RVU23D
2023-07-01$116.75$52.71RVU23C
2023-04-01$116.75$52.71RVU23B
2023-01-01$116.75$52.71RVU23A
2022-10-01$119.90$52.24RVU22D
2022-07-01$119.90$52.24RVU22C
2022-04-01$119.90$52.24RVU22B
2022-01-01$119.90$52.24RVU22A
2021-10-01$119.15$52.00RVU21D
2021-07-01$119.15$52.00RVU21C
2021-04-01$119.15$52.00RVU21B
2021-01-01$119.15$52.00RVU21A
2020-10-01$111.77$52.51RVU20D
2020-07-01$111.77$52.51RVU20C
2020-04-01$111.77$52.51RVU20B
2020-01-01$111.77$52.51RVU20A
2019-10-01$141.14$75.50RVU19D
2019-07-01$141.14$75.50RVU19C
2019-04-01$141.14$75.50RVU19B
2019-01-01$141.14$75.50RVU19A
2018-10-01$135.92$75.08RVU18D
2018-07-01$135.92$75.08RVU18C
2018-04-01$135.92$75.08RVU18B
2018-01-01$135.92$75.08RVU18AR1
2017-10-01$131.37$74.15RVU17D
2017-07-01$131.37$74.15RVU17C
2017-04-01$131.37$74.15RVU17B
2017-01-01$131.37$74.15RVU17A
2016-10-01$130.86$73.59RVU16D
2016-07-01$130.86$73.59RVU16C
2016-04-01$130.86$73.59RVU16B
2016-01-01$130.86$73.59RVU16A
2015-10-01$131.34$73.86RVU15D
2015-07-01$131.34$73.86RVU15C
2015-04-01$130.68$73.49RVU15B
2015-01-01$130.68$73.49RVU15A
2014-10-01$126.60$71.21RVU14D
2014-07-01$126.60$71.21RVU14C
2014-04-01$126.60$71.21RVU14B
2014-01-01$126.60$71.21RVU14A
2013-10-01$126.26$70.01RVU13D
2013-07-01$126.26$70.01RVU13C
2013-04-01$126.26$70.01RVU13B
2013-01-01$126.26$70.01RVU13AR

Price 64400 for an earlier date of service

Where the Houston, TX rate applies

Houston, TX is a Medicare payment area, not a city. Our Census mapping connects it to 46 cities and communities in Texas. Some span more than one payment area; confirm with the service ZIP.

Browse all communities in Texas

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
RVUs for 64400PPRRVU2026_Oct_nonQPP.csv, line 7,096 (RVU26D)
Geographic factors for Houston, TXGPCI2026.csv, line 102 (RVU26D)

Open CMS sourceHow we calculate rates

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