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CPT code 64405: Occipital nerve block, greater occipital nerve2026 Medicare rate & RVUs in King County, WA

Report this injection for a greater occipital nerve block, commonly performed for occipital neuralgia or headache involving the occipital nerve distribution.

CMS RVU26DEffective Oct 1, 2026One payment locality76.8K Medicare services in 2024

In King County, WA, Medicare pays $88.40 for 64405 in the office and $48.24 when it’s performed in a hospital or facility.

$88.40Office (non-facility)
$48.24Hospital or facility
+12.1%vs the national office rate ($78.83)

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.

We’ll open 64405 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in King County, WA
  2. What 64405 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 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 King County, WA 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. King County, WA pays $88.40. The RVUs are the same everywhere; the geographic indexes change the dollars.

64405 in King County, WA vs other payment areas
  1. King County, WA · this page$88.40
  2. Rest of Washington · Washington$79.73−$8.67
  3. Los Angeles, CA · California$85.25−$3.15
  4. Washington, DC area · District of Columbia$88.59+$0.19
  5. Miami, FL · Florida$91.24+$2.84
  6. Chicago, IL · Illinois$88.33−$0.07
  7. Manhattan, NY · New York$91.56+$3.16

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

Every other payment area

64405 in every other Medicare payment locality
Payment localityOfficeFacility
AlaskaAlaska$93.71$58.85
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

64405 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.

$69.63

$93.71

Color shows the midpoint of each state’s locality range.

View every state and territory as a table
64405 office rate range by state
State / territoryOffice rate rangeLocalities
AK$93.711
AL$70.651
AR$69.631
AZ$76.541
CA$80.04–$97.1129
CO$80.291
CT$84.081
DC$88.591
DE$77.781
FL$80.55–$91.243
GA$75.74–$80.992
GU$81.501
HI$81.501
IA$71.101
ID$71.841
IL$79.20–$88.334
IN$72.221
KS$71.401
KY$73.671
LA$73.81–$77.362
MA$80.07–$87.282
MD$79.05–$88.593
ME$72.89–$75.872
MI$76.16–$82.202
MN$75.081
MO$72.97–$76.873
MS$71.281
MT$78.811
NC$73.541
ND$74.661
NE$71.301
NH$79.631
NJ$84.52–$87.812
NM$76.831
NV$77.701
NY$74.69–$94.575
OH$75.311
OK$72.871
OR$76.58–$82.082
PA$75.07–$82.422
PR$79.171
RI$80.011
SC$74.651
SD$74.171
TN$71.841
TX$74.63–$81.428
UT$75.651
VA$76.07–$88.592
VI$79.171
VT$74.951
WA$79.73–$88.402
WI$72.251
WV$76.471
WY$77.001

See 64405 in every payment locality

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

Office or facility?

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 King County, WA 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

108

Locality
King County, WA
Physician work
1.050
Practice expense
1.227
Malpractice
0.817
Office calculation for 64405 in King County, WA
ComponentRVULocality factorAdjusted
Physician work0.92× 1.0500.9660
Practice expense1.23× 1.2271.5092
Malpractice0.21× 0.8170.1716
Total RVUs2.6468
Conversion factor× 33.4009

Office rate, King County, WA$88.40

Office: (0.92 × 1.05 + 1.23 × 1.227 + 0.21 × 0.817) × $33.4009 = $88.40

Facility: (0.92 × 1.05 + 0.25 × 1.227 + 0.21 × 0.817) × $33.4009 = $48.24

Open 64405 in the RVU calculator

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

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

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).

When to use modifier 50

Codes related to 64405

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

Codes related to 64405
CodeHow it relatesOffice range, King County, WA
Same family
64400Nerve block, trigeminal nerve or branchInjection targeting the trigeminal nerve rather than the greater occipital nerve.$142.40
64418Nerve injection, suprascapular nerveNamed-nerve injection for the suprascapular nerve, a different anatomic target.$102.41
Used instead
64450Nerve block, other peripheral nerve or branchFor an injection of another peripheral nerve or branch without a more specific code.$93.90

How 64405 has changed in King County, WA

64405 · Office / nonfacility

$88.40

Effective 2026-10-01

The base rate is $6.81 higher than on 2025-10-01, moving from $81.59 to $88.40 (8.3%).

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

    $81.59changed to$88.40

    • 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
    • Work GPCI 1.043 changed to 1.050
    • Practice expense GPCI 1.220 changed to 1.227
    • Malpractice GPCI 0.853 changed to 0.817

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $83.96changed to$81.59

    • Conversion factor 33.2875 changed to 32.3465

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $82.59changed to$83.96

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $83.35changed to$82.59

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 1.08 changed to 1.11
    • Work GPCI 1.039 changed to 1.043
    • Practice expense GPCI 1.207 changed to 1.220
    • Malpractice GPCI 0.815 changed to 0.853

  5. January 1, 2023

    RVU23A

    $84.38changed to$83.35

    • 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
    • Work GPCI 1.036 changed to 1.039
    • Practice expense GPCI 1.194 changed to 1.207
    • Malpractice GPCI 0.776 changed to 0.815

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $83.00changed to$84.38

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 1.04 changed to 1.09

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $80.30changed to$83.00

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 0.92 changed to 1.04
    • Work GPCI 1.031 changed to 1.036
    • Practice expense GPCI 1.170 changed to 1.194
    • Malpractice GPCI 0.854 changed to 0.776

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $92.30changed to$80.30

    • 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
    • Work GPCI 1.027 changed to 1.031
    • Practice expense GPCI 1.146 changed to 1.170
    • Malpractice GPCI 0.931 changed to 0.854

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $115.30changed to$92.30

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 1.79 changed to 1.23

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $110.94changed to$115.30

    • 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
    • Work GPCI 1.026 changed to 1.027
    • Practice expense GPCI 1.151 changed to 1.146
    • Malpractice GPCI 0.713 changed to 0.931

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $110.23changed to$110.94

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 1.75 changed to 1.73
    • Work GPCI 1.025 changed to 1.026
    • Practice expense GPCI 1.155 changed to 1.151
    • Malpractice GPCI 0.495 changed to 0.713

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $110.63changed to$110.23

    • Conversion factor 35.9335 changed to 35.8043

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $110.08changed to$110.63

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $110.22changed to$110.08

    • 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
    • Practice expense GPCI 1.150 changed to 1.155
    • Malpractice GPCI 0.688 changed to 0.495

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $113.21changed to$110.22

    • 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
    • Practice expense GPCI 1.144 changed to 1.150
    • Malpractice GPCI 0.881 changed to 0.688

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $113.21

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$88.40$48.24RVU26D
2026-07-01$88.40$48.24RVU26C
2026-04-01$88.40$48.24RVU26B
2026-01-01$88.40$48.24RVU26A
2025-10-01$81.59$54.75RVU25D
2025-07-01$81.59$54.75RVU25C
2025-04-01$81.59$54.75RVU25B
2025-01-01$81.59$54.75RVU25A
2024-10-01$83.96$55.94RVU24D
2024-07-01$83.96$55.94RVU24C
2024-04-01$83.96$55.94RVU24B
2024-03-09$83.96$55.94RVU24AR
2024-01-01$82.59$55.03RVU24A
2023-10-01$83.35$55.94RVU23D
2023-07-01$83.35$55.94RVU23C
2023-04-01$83.35$55.94RVU23B
2023-01-01$83.35$55.94RVU23A
2022-10-01$84.38$56.28RVU22D
2022-07-01$84.38$56.28RVU22C
2022-04-01$84.38$56.28RVU22B
2022-01-01$84.38$56.28RVU22A
2021-10-01$83.00$57.16RVU21D
2021-07-01$83.00$57.16RVU21C
2021-04-01$83.00$57.16RVU21B
2021-01-01$83.00$57.16RVU21A
2020-10-01$80.30$58.34RVU20D
2020-07-01$80.30$58.34RVU20C
2020-04-01$80.30$58.34RVU20B
2020-01-01$80.30$58.34RVU20A
2019-10-01$92.30$58.02RVU19D
2019-07-01$92.30$58.02RVU19C
2019-04-01$92.30$58.02RVU19B
2019-01-01$92.30$58.02RVU19A
2018-10-01$115.30$69.92RVU18D
2018-07-01$115.30$69.92RVU18C
2018-04-01$115.30$69.92RVU18B
2018-01-01$115.30$69.92RVU18AR1
2017-10-01$110.94$67.56RVU17D
2017-07-01$110.94$67.56RVU17C
2017-04-01$110.94$67.56RVU17B
2017-01-01$110.94$67.56RVU17A
2016-10-01$110.23$66.40RVU16D
2016-07-01$110.23$66.40RVU16C
2016-04-01$110.23$66.40RVU16B
2016-01-01$110.23$66.40RVU16A
2015-10-01$110.63$66.64RVU15D
2015-07-01$110.63$66.64RVU15C
2015-04-01$110.08$66.31RVU15B
2015-01-01$110.08$66.31RVU15A
2014-10-01$110.22$66.96RVU14D
2014-07-01$110.22$66.96RVU14C
2014-04-01$110.22$66.96RVU14B
2014-01-01$110.22$66.96RVU14A
2013-10-01$113.21$67.67RVU13D
2013-07-01$113.21$67.67RVU13C
2013-04-01$113.21$67.67RVU13B
2013-01-01$113.21$67.67RVU13AR

Price 64405 for an earlier date of service

Where the King County, WA rate applies

King County, WA is a Medicare payment area, not a city. Our Census mapping connects it to 63 cities and communities in Washington. Some span more than one payment area; confirm with the service ZIP.

  • Seattle
  • Algona
  • Ames Lake
  • 64405 in Auburn · multiple payment areas
  • Baring
  • Beaux Arts Village
  • Bellevue
  • Black Diamond

Browse all communities in Washington

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
RVUs for 64405PPRRVU2026_Oct_nonQPP.csv, line 7,097 (RVU26D)
Geographic factors for King County, WAGPCI2026.csv, line 108 (RVU26D)

Open CMS sourceHow we calculate rates

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