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

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 Virginia, Medicare pays $118.31 for 64400 in the office and $45.09 when it’s performed in a hospital or facility.

$118.31Office (non-facility)
$45.09Hospital or facility
−3.0%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 Virginia
  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 Virginia 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. Virginia pays $118.31. The RVUs are the same everywhere; the geographic indexes change the dollars.

64400 in Virginia vs other payment areas
  1. Virginia · this page$118.31
  2. Los Angeles, CA · California$137.12+$18.81
  3. Washington, DC area · District of Columbia$140.13+$21.82
  4. Miami, FL · Florida$136.35+$18.04
  5. Chicago, IL · Illinois$131.62+$13.31
  6. Manhattan, NY · New York$142.25+$23.94
  7. Alaska · Alaska$136.84+$18.53

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

Every other payment area

64400 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$107.55$42.38
ArkansasArkansas$105.75$41.77
ArizonaArizona$118.10$45.92
Bakersfield, CACalifornia$128.32$46.69
Chico, CACalifornia$127.76$46.13
El Centro, CACalifornia$127.80$46.16
Fresno, CACalifornia$127.76$46.13
Hanford, CACalifornia$127.76$46.13

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 Virginia 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

106

Locality
Virginia
Physician work
1.000
Practice expense
0.983
Malpractice
0.706
Office calculation for 64400 in Virginia
ComponentRVULocality factorAdjusted
Physician work0.73× 1.0000.7300
Practice expense2.71× 0.9832.6639
Malpractice0.21× 0.7060.1483
Total RVUs3.5422
Conversion factor× 33.4009

Office rate, Virginia$118.31

Office: (0.73 × 1 + 2.71 × 0.983 + 0.21 × 0.706) × $33.4009 = $118.31

Facility: (0.73 × 1 + 0.48 × 0.983 + 0.21 × 0.706) × $33.4009 = $45.09

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, Virginia
Same family
64405Occipital nerve block, greater occipital nerveA named-nerve injection in the same general code series, directed to the greater occipital nerve.$76.07
64408Vagus nerve block, anesthetic injectionA named-nerve injection in the same general code series, directed to the vagus nerve.$77.87
64450Nerve block, other peripheral nerve or branchFor an injection of another peripheral nerve or branch without a more specific code.$79.22

How 64400 has changed in Virginia

64400 · Office / nonfacility

$118.31

Effective 2026-10-01

The base rate is $12.17 higher than on 2025-10-01, moving from $106.14 to $118.31 (11.5%).

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

    $106.14changed to$118.31

    • 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 1.002 changed to 1.000
    • Practice expense GPCI 0.984 changed to 0.983
    • Malpractice GPCI 0.755 changed to 0.706

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $110.87changed to$106.14

    • 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

    $109.06changed to$110.87

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $111.92changed to$109.06

    • 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 1.000 changed to 1.002
    • Practice expense GPCI 0.990 changed to 0.984
    • Malpractice GPCI 0.826 changed to 0.755

  5. January 1, 2023

    RVU23A

    $116.18changed to$111.92

    • 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
    • Practice expense GPCI 0.995 changed to 0.990
    • Malpractice GPCI 0.897 changed to 0.826

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $115.44changed to$116.18

    • 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

    $108.75changed to$115.44

    • 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
    • Practice expense GPCI 0.991 changed to 0.995
    • Malpractice GPCI 0.903 changed to 0.897

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $137.73changed to$108.75

    • 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
    • Practice expense GPCI 0.986 changed to 0.991
    • Malpractice GPCI 0.908 changed to 0.903

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $132.64changed to$137.73

    • 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

    $127.94changed to$132.64

    • 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 0.985 changed to 0.986
    • Malpractice GPCI 0.866 changed to 0.908

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $127.18changed to$127.94

    • 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
    • Practice expense GPCI 0.983 changed to 0.985
    • Malpractice GPCI 0.824 changed to 0.866

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $127.64changed to$127.18

    • Conversion factor 35.9335 changed to 35.8043

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $127.01changed to$127.64

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $123.14changed to$127.01

    • 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
    • Practice expense GPCI 0.980 changed to 0.983
    • Malpractice GPCI 0.778 changed to 0.824

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $122.68changed to$123.14

    • 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
    • Practice expense GPCI 0.977 changed to 0.980
    • Malpractice GPCI 0.731 changed to 0.778

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $122.68

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$118.31$45.09RVU26D
2026-07-01$118.31$45.09RVU26C
2026-04-01$118.31$45.09RVU26B
2026-01-01$118.31$45.09RVU26A
2025-10-01$106.14$48.85RVU25D
2025-07-01$106.14$48.85RVU25C
2025-04-01$106.14$48.85RVU25B
2025-01-01$106.14$48.85RVU25A
2024-10-01$110.87$49.62RVU24D
2024-07-01$110.87$49.62RVU24C
2024-04-01$110.87$49.62RVU24B
2024-03-09$110.87$49.62RVU24AR
2024-01-01$109.06$48.81RVU24A
2023-10-01$111.92$49.52RVU23D
2023-07-01$111.92$49.52RVU23C
2023-04-01$111.92$49.52RVU23B
2023-01-01$111.92$49.52RVU23A
2022-10-01$116.18$50.76RVU22D
2022-07-01$116.18$50.76RVU22C
2022-04-01$116.18$50.76RVU22B
2022-01-01$116.18$50.76RVU22A
2021-10-01$115.44$50.52RVU21D
2021-07-01$115.44$50.52RVU21C
2021-04-01$115.44$50.52RVU21B
2021-01-01$115.44$50.52RVU21A
2020-10-01$108.75$51.17RVU20D
2020-07-01$108.75$51.17RVU20C
2020-04-01$108.75$51.17RVU20B
2020-01-01$108.75$51.17RVU20A
2019-10-01$137.73$73.77RVU19D
2019-07-01$137.73$73.77RVU19C
2019-04-01$137.73$73.77RVU19B
2019-01-01$137.73$73.77RVU19A
2018-10-01$132.64$73.36RVU18D
2018-07-01$132.64$73.36RVU18C
2018-04-01$132.64$73.36RVU18B
2018-01-01$132.64$73.36RVU18AR1
2017-10-01$127.94$72.08RVU17D
2017-07-01$127.94$72.08RVU17C
2017-04-01$127.94$72.08RVU17B
2017-01-01$127.94$72.08RVU17A
2016-10-01$127.18$71.22RVU16D
2016-07-01$127.18$71.22RVU16C
2016-04-01$127.18$71.22RVU16B
2016-01-01$127.18$71.22RVU16A
2015-10-01$127.64$71.48RVU15D
2015-07-01$127.64$71.48RVU15C
2015-04-01$127.01$71.12RVU15B
2015-01-01$127.01$71.12RVU15A
2014-10-01$123.14$69.08RVU14D
2014-07-01$123.14$69.08RVU14C
2014-04-01$123.14$69.08RVU14B
2014-01-01$123.14$69.08RVU14A
2013-10-01$122.68$67.84RVU13D
2013-07-01$122.68$67.84RVU13C
2013-04-01$122.68$67.84RVU13B
2013-01-01$122.68$67.84RVU13AR

Price 64400 for an earlier date of service

Where the Virginia rate applies

Virginia is a Medicare payment area, not a city. Our Census mapping connects it to 628 cities and communities in Virginia. Some span more than one payment area; confirm with the service ZIP.

  • Abbs Valley
  • Abingdon
  • Accomac
  • Adwolf
  • Afton
  • Alberta
  • Aldie
  • Allison Gap

Browse all communities in Virginia

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 VirginiaGPCI2026.csv, line 106 (RVU26D)

Open CMS sourceHow we calculate rates

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