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CPT code 64408: Vagus nerve block, anesthetic injection2026 Medicare rate & RVUs in Houston, TX

Injection of anesthetic around the vagus nerve for a diagnostic or therapeutic block, including selected vagal sensory blocks for neurogenic cough.

CMS RVU26DEffective Oct 1, 2026One payment locality2.3K Medicare services in 2024

In Houston, TX, Medicare pays $81.04 for 64408 in the office and $40.25 when it’s performed in a hospital or facility.

$81.04Office (non-facility)
$40.25Hospital or facility
+1.5%vs the national office rate ($79.83)

Check a contract rate as a % of Medicare · 64408 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 64408 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Houston, TX
  2. What 64408 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 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.

How Houston, TX compares for 64408

Across 109 of 109 payment localities, the office rate for 64408 runs from $70.75 in Arkansas to $103.69 in San Benito County, CA. Houston, TX pays $81.04. The RVUs are the same everywhere; the geographic indexes change the dollars.

64408 in Houston, TX vs other payment areas
  1. Houston, TX · this page$81.04
  2. Austin, TX · Texas$82.46+$1.42
  3. Beaumont, TX · Texas$74.91−$6.13
  4. Brazoria, TX · Texas$78.75−$2.29
  5. Dallas, TX · Texas$79.32−$1.72
  6. Fort Worth, TX · Texas$78.85−$2.19
  7. Galveston, TX · Texas$79.03−$2.01

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

Every other payment area

64408 in every other Medicare payment locality
Payment localityOfficeFacility
Rest of TexasTexas$76.83$37.84
Los Angeles, CACalifornia$89.07$40.47
Washington, DC areaDistrict of Columbia$90.78$42.38
Miami, FLFlorida$87.57$44.80
Chicago, ILIllinois$85.02$43.73
Manhattan, NYNew York$91.93$44.19
AlaskaAlaska$93.73$49.98
AlabamaAlabama$71.76$35.81

64408 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.

$70.75

$93.73

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

View every state and territory as a table
64408 office rate range by state
State / territoryOffice rate rangeLocalities
AK$93.731
AL$71.761
AR$70.751
AZ$77.691
CA$83.51–$103.6929
CO$82.631
CT$85.071
DC$90.781
DE$78.961
FL$79.40–$87.573
GA$74.94–$81.472
GU$85.371
HI$85.371
IA$73.211
ID$73.751
IL$77.39–$85.024
IN$74.161
KS$73.041
KY$73.771
LA$73.72–$77.272
MA$82.22–$90.472
MD$80.39–$90.783
ME$74.30–$78.012
MI$75.80–$80.542
MN$78.741
MO$72.59–$77.353
MS$71.671
MT$79.821
NC$75.031
ND$77.651
NE$73.561
NH$81.491
NJ$85.92–$89.902
NM$76.271
NV$79.271
NY$76.15–$94.325
OH$75.351
OK$73.471
OR$78.53–$85.022
PA$75.38–$83.102
PR$80.341
RI$81.601
SC$75.341
SD$77.391
TN$73.421
TX$74.91–$82.468
UT$76.351
VA$77.87–$90.782
VI$80.341
VT$77.501
WA$82.01–$92.132
WI$75.111
WV$74.631
WY$78.871

See 64408 in every payment locality

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

Office or facility?

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.

The exact Houston, TX inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

7,098

Code
64408
Physician work
0.73
Practice expense
1.55
Malpractice
0.11

GPCI2026.csv

102

Locality
Houston, TX
Physician work
1.008
Practice expense
0.993
Malpractice
1.376
Office calculation for 64408 in Houston, TX
ComponentRVULocality factorAdjusted
Physician work0.73× 1.0080.7358
Practice expense1.55× 0.9931.5392
Malpractice0.11× 1.3760.1514
Total RVUs2.4263
Conversion factor× 33.4009

Office rate, Houston, TX$81.04

Office: (0.73 × 1.008 + 1.55 × 0.993 + 0.11 × 1.376) × $33.4009 = $81.04

Facility: (0.73 × 1.008 + 0.32 × 0.993 + 0.11 × 1.376) × $33.4009 = $40.25

Open 64408 in the RVU calculator

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

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)0Not paid without supporting documentation.
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

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).

When to use modifier 50

Codes related to 64408

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

Codes related to 64408
CodeHow it relatesOffice range, Houston, TX
Used instead
64400Nerve block, trigeminal nerve or branchFor an injection targeting the trigeminal nerve rather than the vagus nerve.$124.11
64405Occipital nerve block, greater occipital nerveFor an injection targeting the greater occipital nerve.$81.42
64450Nerve block, other peripheral nerve or branchFor an other peripheral nerve or branch without a more specific nerve code.$81.53
64415Brachial plexus block, single injectionFor an injection targeting the brachial plexus rather than the vagus nerve.$156.16

How 64408 has changed in Houston, TX

64408 · Office / nonfacility

$81.04

Effective 2026-10-01

The base rate is $0.36 higher than on 2025-10-01, moving from $80.68 to $81.04 (0.4%).

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

    $80.68changed to$81.04

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 0.75 changed to 0.73
    • Practice expense RVU 1.56 changed to 1.55
    • Malpractice RVU 0.12 changed to 0.11
    • 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

    $83.56changed to$80.68

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 1.59 changed to 1.56
    • Malpractice RVU 0.11 changed to 0.12

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $82.20changed to$83.56

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $85.39changed to$82.20

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 1.60 changed to 1.59
    • 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

    $86.47changed to$85.39

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 1.58 changed to 1.60
    • 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

    $81.85changed to$86.47

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 1.44 changed to 1.58
    • Malpractice RVU 0.10 changed to 0.11

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $72.35changed to$81.85

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 1.13 changed to 1.44
    • Malpractice RVU 0.09 changed to 0.10
    • 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

    $122.28changed to$72.35

    • Conversion factor 36.0391 changed to 36.0896
    • Work RVU 1.41 changed to 0.75
    • Practice expense RVU 1.83 changed to 1.13
    • Malpractice RVU 0.11 changed to 0.09
    • 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

    $120.69changed to$122.28

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 1.79 changed to 1.83

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $122.52changed to$120.69

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 1.78 changed to 1.79
    • Malpractice RVU 0.19 changed to 0.11
    • 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

    $105.25changed to$122.52

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 1.38 changed to 1.78
    • Malpractice RVU 0.12 changed to 0.19
    • 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

    $120.42changed to$105.25

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 1.77 changed to 1.38
    • Malpractice RVU 0.14 changed to 0.12

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $119.82changed to$120.42

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $101.58changed to$119.82

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 1.26 changed to 1.77
    • Malpractice RVU 0.15 changed to 0.14
    • 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

    $101.50changed to$101.58

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 1.41 changed to 1.26
    • Malpractice RVU 0.16 changed to 0.15
    • 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: $101.50

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$81.04$40.25RVU26D
2026-07-01$81.04$40.25RVU26C
2026-04-01$81.04$40.25RVU26B
2026-01-01$81.04$40.25RVU26A
2025-10-01$80.68$45.97RVU25D
2025-07-01$80.68$45.97RVU25C
2025-04-01$80.68$45.97RVU25B
2025-01-01$80.68$45.97RVU25A
2024-10-01$83.56$46.50RVU24D
2024-07-01$83.56$46.50RVU24C
2024-04-01$83.56$46.50RVU24B
2024-03-09$83.56$46.50RVU24AR
2024-01-01$82.20$45.74RVU24A
2023-10-01$85.39$46.83RVU23D
2023-07-01$85.39$46.83RVU23C
2023-04-01$85.39$46.83RVU23B
2023-01-01$85.39$46.83RVU23A
2022-10-01$86.47$46.59RVU22D
2022-07-01$86.47$46.59RVU22C
2022-04-01$86.47$46.59RVU22B
2022-01-01$86.47$46.59RVU22A
2021-10-01$81.85$45.59RVU21D
2021-07-01$81.85$45.59RVU21C
2021-04-01$81.85$45.59RVU21B
2021-01-01$81.85$45.59RVU21A
2020-10-01$72.35$45.85RVU20D
2020-07-01$72.35$45.85RVU20C
2020-04-01$72.35$45.85RVU20B
2020-01-01$72.35$45.85RVU20A
2019-10-01$122.28$89.10RVU19D
2019-07-01$122.28$89.10RVU19C
2019-04-01$122.28$89.10RVU19B
2019-01-01$122.28$89.10RVU19A
2018-10-01$120.69$90.09RVU18D
2018-07-01$120.69$90.09RVU18C
2018-04-01$120.69$90.09RVU18B
2018-01-01$120.69$90.09RVU18AR1
2017-10-01$122.52$90.29RVU17D
2017-07-01$122.52$90.29RVU17C
2017-04-01$122.52$90.29RVU17B
2017-01-01$122.52$90.29RVU17A
2016-10-01$105.25$77.52RVU16D
2016-07-01$105.25$77.52RVU16C
2016-04-01$105.25$77.52RVU16B
2016-01-01$105.25$77.52RVU16A
2015-10-01$120.42$89.69RVU15D
2015-07-01$120.42$89.69RVU15C
2015-04-01$119.82$89.24RVU15B
2015-01-01$119.82$89.24RVU15A
2014-10-01$101.58$76.04RVU14D
2014-07-01$101.58$76.04RVU14C
2014-04-01$101.58$76.04RVU14B
2014-01-01$101.58$76.04RVU14A
2013-10-01$101.50$74.22RVU13D
2013-07-01$101.50$74.22RVU13C
2013-04-01$101.50$74.22RVU13B
2013-01-01$101.50$74.22RVU13AR

Price 64408 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

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

Show the CMS file lines behind this rate
RVUs for 64408PPRRVU2026_Oct_nonQPP.csv, line 7,098 (RVU26D)
Geographic factors for Houston, TXGPCI2026.csv, line 102 (RVU26D)

Open CMS sourceHow we calculate rates

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