CPT code 64408: Vagus nerve block, anesthetic injection2026 Medicare rate & RVUs in Guam
Injection of anesthetic around the vagus nerve for a diagnostic or therapeutic block, including selected vagal sensory blocks for neurogenic cough.
Medicare pays $85.37 for 64408 in the office in Guam (Hawaii, Guam, HI). Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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What 64408 covers
This service places anesthetic at the vagus nerve to interrupt or assess nerve-mediated symptoms. A recognized clinical use is a vagal sensory block, including a superior laryngeal nerve block, for selected patients with neurogenic cough. Pain physicians, anesthesiologists, and otolaryngologists may perform the injection in an office or procedural setting; the record should identify the nerve target, side, indication, and technique.
Select 64408 when the documented target is the vagus nerve, rather than another named nerve or an unspecified peripheral nerve. The code has 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 requires documented medical necessity; 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.
64408 in Hawaii, Guam, HI
| Payment locality | Office | Facility |
|---|---|---|
| Hawaii, Guam, HI | $85.37 | $38.66 |
How the 64408 rate is calculated
Each of 64408’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 · 64408
RVUs × geographic indexes × conversion factor
Work0.73
0.73 RVUs× 1.000 GPCI
Practice expense1.55
1.55 RVUs× 1.000 GPCI
Malpractice0.11
0.11 RVUs× 1.000 GPCI
Adjusted RVUs
2.3900
Conversion factor
$33.4009
Medicare rate
$79.83
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 64408
The CMS indicators that decide how 64408 is paid alongside other services.
CMS payment indicators · 64408
Vagus nerve block, anesthetic injection
| 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) | 0 | Not paid without supporting documentation. |
| 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
64408 without 50 · national office
$79.83
Vagus nerve block, anesthetic injection
64408-50 · Bilateral: 150%
$119.75
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).
64408 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 64400Nerve blockTrigeminal nerve or branch
- 64400 identifies a trigeminal nerve injection, used for a cranial nerve target in the trigeminal distribution. Choose 64408 when the documented target is the vagus nerve.
- 64405Occipital nerve blockGreater occipital nerve
- 64405 is specific to the greater occipital nerve. It is not interchangeable with a block directed at the vagus nerve.
- 64450Nerve blockOther peripheral nerve or branch
- 64450 is for an other peripheral nerve or branch without a more specific code. Use 64408 when the vagus nerve is the documented target.
64408 billing questions
When should 64408 be selected instead of 64450?
Use 64408 when the documented injection target is the vagus nerve. Code 64450 describes an injection of an other peripheral nerve or branch when a more specific code does not identify the target.
Can 64408 be reported for a neurogenic cough block?
It may describe a vagal sensory block, including a superior laryngeal nerve block, when the documentation identifies the vagal target and supports the service performed.
How is bilateral treatment reported?
When the vagus nerve is treated bilaterally, report modifier 50; CMS pays the bilateral procedure at 150%.
What same-day care is included?
The 0-day global period includes same-day preoperative and postoperative care. Services on a different date are not covered by that same-day global period.
How does CMS handle another procedure performed in the same session?
Under the standard multiple procedure reduction, the highest-valued procedure is paid in full and other procedures are paid at 50%.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment is available only with documentation of medical necessity. 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
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