CPT code 64405: Occipital nerve block, greater occipital nerve2026 Medicare rate & RVUs in North Dakota
Report this injection for a greater occipital nerve block, commonly performed for occipital neuralgia or headache involving the occipital nerve distribution.
In North Dakota, Medicare pays $74.66 for 64405 in the office and $41.93 when it’s performed in a hospital or facility.
Check a contract rate as a % of Medicare · 64405 nationwide
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 11 sections
What 64405 covers
This service injects anesthetic, steroid, or both around the greater occipital nerve to interrupt pain signals. Pain medicine physicians, anesthesiologists, neurologists, and other qualified clinicians commonly perform the block in an office or outpatient facility for occipital neuralgia or headache symptoms involving the back of the head. Documentation should identify the nerve and side treated, the clinical indication, and the injection performed.
Select this code for the greater occipital nerve rather than another named nerve or an unspecified peripheral nerve branch. CMS assigns a 0-day global period, so same-day preoperative and postoperative care is included. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and the others at 50%. For bilateral treatment, modifier 50 is paid at 150%. Assistant-at-surgery payment is restricted; 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 North Dakota compares for 64405
Across 109 of 109 payment localities, the office rate for 64405 runs from $69.63 in Arkansas to $97.11 in San Benito County, CA. North Dakota pays $74.66. The RVUs are the same everywhere; the geographic indexes change the dollars.
- North Dakota · this page$74.66
- Los Angeles, CA · California$85.25+$10.59
- Washington, DC area · District of Columbia$88.59+$13.93
- Miami, FL · Florida$91.24+$16.58
- Chicago, IL · Illinois$88.33+$13.67
- Manhattan, NY · New York$91.56+$16.90
- Alaska · Alaska$93.71+$19.05
Other areas in North Dakota first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| AlabamaAlabama | $70.65 | $42.01 |
| ArkansasArkansas | $69.63 | $41.51 |
| ArizonaArizona | $76.54 | $44.82 |
| Bakersfield, CACalifornia | $80.61 | $44.74 |
| Chico, CACalifornia | $80.04 | $44.16 |
| El Centro, CACalifornia | $80.07 | $44.20 |
| Fresno, CACalifornia | $80.04 | $44.16 |
| Hanford, CACalifornia | $80.04 | $44.16 |
| Madera, CACalifornia | $80.04 | $44.16 |
| Merced, CACalifornia | $80.04 | $44.16 |
| Modesto, CACalifornia | $80.04 | $44.16 |
| Napa, CACalifornia | $90.38 | $47.23 |
| Oxnard, CACalifornia | $84.52 | $45.83 |
| Redding, CACalifornia | $80.04 | $44.16 |
| Rest of CaliforniaCalifornia | $80.04 | $44.16 |
| Riverside, CACalifornia | $82.29 | $46.42 |
| Sacramento, CACalifornia | $83.37 | $45.31 |
| Salinas, CACalifornia | $83.06 | $45.12 |
| San Diego, CACalifornia | $84.59 | $45.44 |
| Marin County, CACalifornia | $94.79 | $48.64 |
| San Francisco, CACalifornia | $94.56 | $48.40 |
| San Benito County, CACalifornia | $97.11 | $49.91 |
| Santa Clara County, CACalifornia | $96.14 | $48.93 |
| San Luis Obispo, CACalifornia | $81.80 | $44.52 |
| Santa Cruz, CACalifornia | $85.05 | $45.28 |
| Santa Maria, CACalifornia | $83.25 | $45.09 |
| Santa Rosa, CACalifornia | $85.86 | $45.66 |
| Stockton, CACalifornia | $80.04 | $44.16 |
| Vallejo, CACalifornia | $90.03 | $46.89 |
| Visalia, CACalifornia | $80.04 | $44.16 |
| Yuba City, CACalifornia | $80.04 | $44.16 |
| ColoradoColorado | $80.29 | $45.46 |
| ConnecticutConnecticut | $84.08 | $48.82 |
| DelawareDelaware | $77.78 | $45.44 |
| Fort Lauderdale, FLFlorida | $85.03 | $51.87 |
| Rest of FloridaFlorida | $80.55 | $49.25 |
| Atlanta, GAGeorgia | $80.99 | $47.73 |
| Rest of GeorgiaGeorgia | $75.74 | $46.54 |
| Hawaii, Guam, HIHawaii | $81.50 | $44.28 |
| IowaIowa | $71.10 | $41.15 |
| IdahoIdaho | $71.84 | $41.73 |
| East St. Louis, ILIllinois | $82.65 | $52.54 |
| Rest of IllinoisIllinois | $79.20 | $49.32 |
| Suburban Chicago, ILIllinois | $85.57 | $51.95 |
| IndianaIndiana | $72.22 | $41.88 |
| KansasKansas | $71.40 | $41.81 |
| KentuckyKentucky | $73.67 | $44.57 |
| New Orleans, LALouisiana | $77.36 | $46.55 |
| Rest of LouisianaLouisiana | $73.81 | $44.84 |
| Metropolitan Boston, MAMassachusetts | $87.28 | $48.20 |
| Rest of MassachusettsMassachusetts | $80.07 | $45.60 |
| Baltimore area, MDMaryland | $83.98 | $48.86 |
| Rest of MarylandMaryland | $79.05 | $45.93 |
| Rest of MaineMaine | $72.89 | $42.77 |
| Southern Maine, MEMaine | $75.87 | $43.43 |
| Detroit, MIMichigan | $82.20 | $50.61 |
| Rest of MichiganMichigan | $76.16 | $46.27 |
| MinnesotaMinnesota | $75.08 | $41.40 |
| Metropolitan Kansas City, MOMissouri | $76.16 | $45.42 |
| Metropolitan St. Louis, MOMissouri | $76.87 | $45.71 |
| Rest of MissouriMissouri | $72.97 | $44.76 |
| MississippiMississippi | $71.28 | $43.10 |
| MontanaMontana | $78.81 | $46.08 |
| North CarolinaNorth Carolina | $73.54 | $43.00 |
| NebraskaNebraska | $71.30 | $41.09 |
| New HampshireNew Hampshire | $79.63 | $45.56 |
| Northern New JerseyNew Jersey | $87.81 | $49.84 |
| Rest of New JerseyNew Jersey | $84.52 | $48.77 |
| New MexicoNew Mexico | $76.83 | $46.81 |
| NevadaNevada | $77.70 | $44.93 |
| NYC suburbs and Long Island, NYNew York | $94.57 | $55.65 |
| Poughkeepsie and northern NYC suburbs, NYNew York | $85.58 | $49.74 |
| Queens, NYNew York | $91.37 | $52.68 |
| Rest of New YorkNew York | $74.69 | $43.59 |
| OhioOhio | $75.31 | $45.42 |
| OklahomaOklahoma | $72.87 | $43.64 |
| Portland, OROregon | $82.08 | $45.72 |
| Rest of OregonOregon | $76.58 | $43.98 |
| Metropolitan Philadelphia, PAPennsylvania | $82.42 | $48.34 |
| Rest of PennsylvaniaPennsylvania | $75.07 | $45.02 |
| Puerto RicoPuerto Rico | $79.17 | $46.08 |
| Rhode IslandRhode Island | $80.01 | $46.20 |
| South CarolinaSouth Carolina | $74.65 | $44.41 |
| South DakotaSouth Dakota | $74.17 | $41.44 |
| TennesseeTennessee | $71.84 | $42.09 |
| Austin, TXTexas | $80.47 | $45.84 |
| Beaumont, TXTexas | $74.63 | $44.84 |
| Brazoria, TXTexas | $77.16 | $44.72 |
| Dallas, TXTexas | $77.94 | $45.34 |
| Fort Worth, TXTexas | $77.62 | $45.35 |
| Galveston, TXTexas | $77.58 | $45.07 |
| Houston, TXTexas | $81.42 | $48.92 |
| Rest of TexasTexas | $76.05 | $44.99 |
| UtahUtah | $75.65 | $44.88 |
| VirginiaVirginia | $76.07 | $43.89 |
| Virgin Islands, VIUnited States Virgin Islands | $79.17 | $46.08 |
| VermontVermont | $74.95 | $42.54 |
| Rest of WashingtonWashington | $79.73 | $45.26 |
| King County, WAWashington | $88.40 | $48.24 |
| WisconsinWisconsin | $72.25 | $40.89 |
| West VirginiaWest Virginia | $76.47 | $48.02 |
| WyomingWyoming | $77.00 | $44.27 |
64405 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.
$69.63
$93.71
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 | $93.71 | 1 |
| AL | $70.65 | 1 |
| AR | $69.63 | 1 |
| AZ | $76.54 | 1 |
| CA | $80.04–$97.11 | 29 |
| CO | $80.29 | 1 |
| CT | $84.08 | 1 |
| DC | $88.59 | 1 |
| DE | $77.78 | 1 |
| FL | $80.55–$91.24 | 3 |
| GA | $75.74–$80.99 | 2 |
| GU | $81.50 | 1 |
| HI | $81.50 | 1 |
| IA | $71.10 | 1 |
| ID | $71.84 | 1 |
| IL | $79.20–$88.33 | 4 |
| IN | $72.22 | 1 |
| KS | $71.40 | 1 |
| KY | $73.67 | 1 |
| LA | $73.81–$77.36 | 2 |
| MA | $80.07–$87.28 | 2 |
| MD | $79.05–$88.59 | 3 |
| ME | $72.89–$75.87 | 2 |
| MI | $76.16–$82.20 | 2 |
| MN | $75.08 | 1 |
| MO | $72.97–$76.87 | 3 |
| MS | $71.28 | 1 |
| MT | $78.81 | 1 |
| NC | $73.54 | 1 |
| ND | $74.66 | 1 |
| NE | $71.30 | 1 |
| NH | $79.63 | 1 |
| NJ | $84.52–$87.81 | 2 |
| NM | $76.83 | 1 |
| NV | $77.70 | 1 |
| NY | $74.69–$94.57 | 5 |
| OH | $75.31 | 1 |
| OK | $72.87 | 1 |
| OR | $76.58–$82.08 | 2 |
| PA | $75.07–$82.42 | 2 |
| PR | $79.17 | 1 |
| RI | $80.01 | 1 |
| SC | $74.65 | 1 |
| SD | $74.17 | 1 |
| TN | $71.84 | 1 |
| TX | $74.63–$81.42 | 8 |
| UT | $75.65 | 1 |
| VA | $76.07–$88.59 | 2 |
| VI | $79.17 | 1 |
| VT | $74.95 | 1 |
| WA | $79.73–$88.40 | 2 |
| WI | $72.25 | 1 |
| WV | $76.47 | 1 |
| WY | $77.00 | 1 |
How the 64405 rate is calculated
Each of 64405’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 · 64405
RVUs × geographic indexes × conversion factor
Work0.92
0.92 RVUs× 1.000 GPCI
Practice expense1.23
1.23 RVUs× 1.000 GPCI
Malpractice0.21
0.21 RVUs× 1.000 GPCI
Adjusted RVUs
2.3600
Conversion factor
$33.4009
Medicare rate
$78.83
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
The exact North Dakota inputs and CMS source lines
PPRRVU2026_Oct_nonQPP.csv
7,097
- Code
- 64405
- Physician work
- 0.92
- Practice expense
- 1.23
- Malpractice
- 0.21
GPCI2026.csv
84
- Locality
- North Dakota
- Physician work
- 1.000
- Practice expense
- 1.000
- Malpractice
- 0.406
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 0.92 | × 1.000 | 0.9200 |
| Practice expense | 1.23 | × 1.000 | 1.2300 |
| Malpractice | 0.21 | × 0.406 | 0.0853 |
| Total RVUs | 2.2353 | ||
| Conversion factor | × 33.4009 | ||
Office rate, North Dakota$74.66
Office: (0.92 × 1 + 1.23 × 1 + 0.21 × 0.406) × $33.4009 = $74.66
Facility: (0.92 × 1 + 0.25 × 1 + 0.21 × 0.406) × $33.4009 = $41.93
Payment rules and modifiers for 64405
The CMS indicators that decide how 64405 is paid alongside other services.
CMS payment indicators · 64405
Occipital nerve block, greater occipital nerve
| 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
64405 without 50 · national office
$78.83
Occipital nerve block, greater occipital nerve
64405-50 · Bilateral: 150%
$118.25
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).
How 64405 has changed in North Dakota
64405 · Office / nonfacility
$74.66
Effective 2026-10-01
The base rate is $4.67 higher than on 2025-10-01, moving from $69.99 to $74.66 (6.7%).
It is unchanged from the immediately preceding available release, effective 2026-07-01.
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
January 1, 2026
RVU26A
$69.99changed to$74.66
- Conversion factor 32.3465 changed to 33.4009
- Work RVU 0.94 changed to 0.92
- Practice expense RVU 1.11 changed to 1.23
- Malpractice RVU 0.22 changed to 0.21
- Malpractice GPCI 0.517 changed to 0.406
Held through RVU26B, RVU26C, RVU26D.
January 1, 2025
RVU25A
$72.03changed to$69.99
- Conversion factor 33.2875 changed to 32.3465
Held through RVU25B, RVU25C, RVU25D.
March 9, 2024
RVU24AR
$70.85changed to$72.03
- Conversion factor 32.7442 changed to 33.2875
Held through RVU24B, RVU24C, RVU24D.
January 1, 2024
RVU24A
$71.99changed to$70.85
- Conversion factor 33.8872 changed to 32.7442
- Practice expense RVU 1.08 changed to 1.11
- Malpractice GPCI 0.474 changed to 0.517
January 1, 2023
RVU23A
$73.38changed to$71.99
- Conversion factor 34.6062 changed to 33.8872
- Practice expense RVU 1.09 changed to 1.08
- Malpractice RVU 0.21 changed to 0.22
- Malpractice GPCI 0.431 changed to 0.474
Held through RVU23B, RVU23C, RVU23D.
January 1, 2022
RVU22A
$72.25changed to$73.38
- Conversion factor 34.8931 changed to 34.6062
- Practice expense RVU 1.04 changed to 1.09
Held through RVU22B, RVU22C, RVU22D.
January 1, 2021
RVU21A
$70.80changed to$72.25
- Conversion factor 36.0896 changed to 34.8931
- Practice expense RVU 0.92 changed to 1.04
- Malpractice GPCI 0.485 changed to 0.431
Held through RVU21B, RVU21C, RVU21D.
January 1, 2020
RVU20A
$82.10changed to$70.80
- Conversion factor 36.0391 changed to 36.0896
- Practice expense RVU 1.23 changed to 0.92
- Malpractice RVU 0.20 changed to 0.21
- Malpractice GPCI 0.540 changed to 0.485
Held through RVU20B, RVU20C, RVU20D.
January 1, 2019
RVU19A
$102.17changed to$82.10
- Conversion factor 35.9996 changed to 36.0391
- Practice expense RVU 1.79 changed to 1.23
Held through RVU19B, RVU19C, RVU19D.
January 1, 2018
RVU18AR1
$99.55changed to$102.17
- Conversion factor 35.8887 changed to 35.9996
- Practice expense RVU 1.73 changed to 1.79
- Malpractice RVU 0.19 changed to 0.20
- Malpractice GPCI 0.547 changed to 0.540
Held through RVU18B, RVU18C, RVU18D.
January 1, 2017
RVU17A
$100.08changed to$99.55
- Conversion factor 35.8043 changed to 35.8887
- Practice expense RVU 1.75 changed to 1.73
- Malpractice GPCI 0.554 changed to 0.547
Held through RVU17B, RVU17C, RVU17D.
January 1, 2016
RVU16A
$100.44changed to$100.08
- Conversion factor 35.9335 changed to 35.8043
Held through RVU16B, RVU16C, RVU16D.
July 1, 2015
RVU15C
$99.94changed to$100.44
- Conversion factor 35.7547 changed to 35.9335
Held through RVU15D.
January 1, 2015
RVU15A
$99.10changed to$99.94
- Conversion factor 35.8228 changed to 35.7547
- Practice expense RVU 1.73 changed to 1.75
- Malpractice RVU 0.18 changed to 0.19
- Malpractice GPCI 0.536 changed to 0.554
Held through RVU15B.
January 1, 2014
RVU14A
$100.65changed to$99.10
- Conversion factor 34.0230 changed to 35.8228
- Practice expense RVU 1.92 changed to 1.73
- Malpractice RVU 0.19 changed to 0.18
- Malpractice GPCI 0.517 changed to 0.536
Held through RVU14B, RVU14C, RVU14D.
January 1, 2013
RVU13AR
Earliest loaded release: $100.65
Held through RVU13B, RVU13C, RVU13D.
| Effective from | Office | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | $74.66 | $41.93 | RVU26D |
| 2026-07-01 | $74.66 | $41.93 | RVU26C |
| 2026-04-01 | $74.66 | $41.93 | RVU26B |
| 2026-01-01 | $74.66 | $41.93 | RVU26A |
| 2025-10-01 | $69.99 | $47.99 | RVU25D |
| 2025-07-01 | $69.99 | $47.99 | RVU25C |
| 2025-04-01 | $69.99 | $47.99 | RVU25B |
| 2025-01-01 | $69.99 | $47.99 | RVU25A |
| 2024-10-01 | $72.03 | $49.06 | RVU24D |
| 2024-07-01 | $72.03 | $49.06 | RVU24C |
| 2024-04-01 | $72.03 | $49.06 | RVU24B |
| 2024-03-09 | $72.03 | $49.06 | RVU24AR |
| 2024-01-01 | $70.85 | $48.26 | RVU24A |
| 2023-10-01 | $71.99 | $49.28 | RVU23D |
| 2023-07-01 | $71.99 | $49.28 | RVU23C |
| 2023-04-01 | $71.99 | $49.28 | RVU23B |
| 2023-01-01 | $71.99 | $49.28 | RVU23A |
| 2022-10-01 | $73.38 | $49.85 | RVU22D |
| 2022-07-01 | $73.38 | $49.85 | RVU22C |
| 2022-04-01 | $73.38 | $49.85 | RVU22B |
| 2022-01-01 | $73.38 | $49.85 | RVU22A |
| 2021-10-01 | $72.25 | $50.61 | RVU21D |
| 2021-07-01 | $72.25 | $50.61 | RVU21C |
| 2021-04-01 | $72.25 | $50.61 | RVU21B |
| 2021-01-01 | $72.25 | $50.61 | RVU21A |
| 2020-10-01 | $70.80 | $52.04 | RVU20D |
| 2020-07-01 | $70.80 | $52.04 | RVU20C |
| 2020-04-01 | $70.80 | $52.04 | RVU20B |
| 2020-01-01 | $70.80 | $52.04 | RVU20A |
| 2019-10-01 | $82.10 | $52.18 | RVU19D |
| 2019-07-01 | $82.10 | $52.18 | RVU19C |
| 2019-04-01 | $82.10 | $52.18 | RVU19B |
| 2019-01-01 | $82.10 | $52.18 | RVU19A |
| 2018-10-01 | $102.17 | $62.57 | RVU18D |
| 2018-07-01 | $102.17 | $62.57 | RVU18C |
| 2018-04-01 | $102.17 | $62.57 | RVU18B |
| 2018-01-01 | $102.17 | $62.57 | RVU18AR1 |
| 2017-10-01 | $99.55 | $61.87 | RVU17D |
| 2017-07-01 | $99.55 | $61.87 | RVU17C |
| 2017-04-01 | $99.55 | $61.87 | RVU17B |
| 2017-01-01 | $99.55 | $61.87 | RVU17A |
| 2016-10-01 | $100.08 | $62.13 | RVU16D |
| 2016-07-01 | $100.08 | $62.13 | RVU16C |
| 2016-04-01 | $100.08 | $62.13 | RVU16B |
| 2016-01-01 | $100.08 | $62.13 | RVU16A |
| 2015-10-01 | $100.44 | $62.35 | RVU15D |
| 2015-07-01 | $100.44 | $62.35 | RVU15C |
| 2015-04-01 | $99.94 | $62.04 | RVU15B |
| 2015-01-01 | $99.94 | $62.04 | RVU15A |
| 2014-10-01 | $99.10 | $61.49 | RVU14D |
| 2014-07-01 | $99.10 | $61.49 | RVU14C |
| 2014-04-01 | $99.10 | $61.49 | RVU14B |
| 2014-01-01 | $99.10 | $61.49 | RVU14A |
| 2013-10-01 | $100.65 | $60.84 | RVU13D |
| 2013-07-01 | $100.65 | $60.84 | RVU13C |
| 2013-04-01 | $100.65 | $60.84 | RVU13B |
| 2013-01-01 | $100.65 | $60.84 | RVU13AR |
Where the North Dakota rate applies
North Dakota is a Medicare payment area, not a city. Our Census mapping connects it to 406 cities and communities in North Dakota. Some span more than one payment area; confirm with the service ZIP.
- Abercrombie
- Adams
- Alamo
- Alexander
- Alice
- Almont
- Alsen
- Ambrose
64405 billing questions
When should this code be chosen instead of 64400?
Use 64405 for the greater occipital nerve. Code 64400 describes an injection targeting the trigeminal nerve, a different nerve and distribution.
How is bilateral treatment reported?
CMS identifies this as a bilateral procedure; modifier 50 is paid at 150%. Document treatment of both greater occipital nerves.
Is same-day evaluation and postoperative care separately included?
CMS assigns a 0-day global period, with same-day preoperative and postoperative care included in the procedure.
What happens when another procedure is performed in the same session?
Under the standard multiple procedure reduction, the highest-valued procedure is paid in full and the other procedures are paid at 50%.
What documentation supports reporting this code?
Record the greater occipital nerve treated, laterality, clinical indication, and details of the injection. The documentation should distinguish this nerve from other named nerves treated.
Can an assistant or surgical team be reported for this procedure?
CMS does not pay an assistant at surgery for this code, and co-surgeons and team surgery are not permitted.
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
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