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CPT code 64417: Axillary nerve block, image guidance included2026 Medicare rate & RVUs in San Francisco, CA

Reports an anesthetic injection targeting the axillary nerve, commonly for shoulder pain control or perioperative analgesia when that specific nerve is blocked.

CMS RVU26DEffective Oct 1, 2026One payment locality15.9K Medicare services in 2024

In San Francisco, CA, Medicare pays $244.58 for 64417 in the office and $68.91 when it’s performed in a hospital or facility.

$244.58Office (non-facility)
$68.91Hospital or facility
+31.5%vs the national office rate ($186.04)

Check a contract rate as a % of Medicare · 64417 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 64417 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in San Francisco, CA
  2. What 64417 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 64417 covers

This service places anesthetic, sometimes with steroid, around the axillary nerve to interrupt shoulder-region sensation. Pain specialists and anesthesiologists may perform it for diagnostic or therapeutic shoulder pain care, or for analgesia around shoulder surgery. The nerve’s relationship to the humerus and deltoid makes ultrasound or other imaging useful for locating the target; imaging guidance is included in the procedure when performed.

Choose this code when the documented target is the axillary nerve, rather than the brachial plexus or another shoulder nerve. The record should identify the side, clinical indication, nerve target, injectate, and any guidance used. CMS assigns a 0-day global period, so same-day preoperative and postoperative care is included. For bilateral treatment, modifier 50 is paid at 150%. In a same-session multiple-procedure claim, the highest-valued procedure is paid in full and others at 50%. Assistant-at-surgery payment is restricted, and 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 San Francisco, CA compares for 64417

Across 109 of 109 payment localities, the office rate for 64417 runs from $164.35 in Arkansas to $250.15 in San Benito County, CA. San Francisco, CA pays $244.58. The RVUs are the same everywhere; the geographic indexes change the dollars.

64417 in San Francisco, CA vs other payment areas
  1. San Francisco, CA · this page$244.58
  2. Bakersfield, CA · California$198.50−$46.08
  3. Chico, CA · California$198.09−$46.49
  4. El Centro, CA · California$198.12−$46.46
  5. Fresno, CA · California$198.09−$46.49
  6. Hanford, CA · California$198.09−$46.49
  7. Los Angeles, CA · California$211.76−$32.82

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

Every other payment area

64417 in every other Medicare payment locality
Payment localityOfficeFacility
Madera, CACalifornia$198.09$61.55
Merced, CACalifornia$198.09$61.55
Modesto, CACalifornia$198.09$61.55
Napa, CACalifornia$230.79$66.58
Oxnard, CACalifornia$210.89$63.63
Redding, CACalifornia$198.09$61.55
Rest of CaliforniaCalifornia$198.09$61.55
Riverside, CACalifornia$199.51$62.97

64417 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.

$164.35

$224.12

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

View every state and territory as a table
64417 office rate range by state
State / territoryOffice rate rangeLocalities
AK$214.501
AL$166.791
AR$164.351
AZ$181.111
CA$198.09–$250.1529
CO$194.501
CT$198.511
DC$213.581
DE$184.151
FL$182.11–$198.383
GA$171.87–$189.272
GU$203.251
HI$203.251
IA$171.611
ID$172.641
IL$176.40–$193.454
IN$173.671
KS$170.551
KY$170.251
LA$169.88–$178.442
MA$193.21–$214.272
MD$187.78–$213.583
ME$173.29–$183.192
MI$174.51–$184.162
MN$187.021
MO$166.76–$179.383
MS$165.601
MT$186.031
NC$175.171
ND$183.461
NE$172.641
NH$191.201
NJ$200.96–$211.262
NM$175.381
NV$185.461
NY$177.81–$218.765
OH$173.991
OK$170.211
OR$184.20–$201.042
PA$174.41–$193.352
PR$187.511
RI$190.971
SC$174.831
SD$183.161
TN$171.391
TX$173.23–$193.698
UT$177.261
VA$182.40–$213.582
VI$187.511
VT$182.511
WA$192.93–$218.932
WI$177.201
WV$169.711
WY$184.911

See 64417 in every payment locality

How the 64417 rate is calculated

Each of 64417’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 · 64417

RVUs × geographic indexes × conversion factor

Office or facility?

Work1.28

1.28 RVUs× 1.000 GPCI

Practice expense4.16

4.16 RVUs× 1.000 GPCI

Malpractice0.13

0.13 RVUs× 1.000 GPCI

Adjusted RVUs

5.5700

Conversion factor

$33.4009

Medicare rate

$186.04

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

The exact San Francisco, CA inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

7,101

Code
64417
Physician work
1.28
Practice expense
4.16
Malpractice
0.13

GPCI2026.csv

24

Locality
San Francisco, CA
Physician work
1.095
Practice expense
1.410
Malpractice
0.425
Office calculation for 64417 in San Francisco, CA
ComponentRVULocality factorAdjusted
Physician work1.28× 1.0951.4016
Practice expense4.16× 1.4105.8656
Malpractice0.13× 0.4250.0553
Total RVUs7.3224
Conversion factor× 33.4009

Office rate, San Francisco, CA$244.58

Office: (1.28 × 1.095 + 4.16 × 1.41 + 0.13 × 0.425) × $33.4009 = $244.58

Facility: (1.28 × 1.095 + 0.43 × 1.41 + 0.13 × 0.425) × $33.4009 = $68.91

Open 64417 in the RVU calculator

Payment rules and modifiers for 64417

The CMS indicators that decide how 64417 is paid alongside other services.

CMS payment indicators · 64417

Axillary nerve block, image guidance included

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

64417 without 50 · national office

$186.04

Axillary nerve block, image guidance included

64417-50 · Bilateral: 150%

$279.06

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 64417

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

Codes related to 64417
CodeHow it relatesOffice range, San Francisco, CA
Same family
64418Nerve injection, suprascapular nerveTargets the suprascapular nerve, another named nerve used in shoulder-region blocks.$111.81
Used instead
64415Brachial plexus block, single injectionReports a brachial plexus block rather than a block specifically targeting the axillary nerve.$199.21
64416Nerve block, brachial plexus catheter infusionFor continuous brachial plexus catheter infusion rather than a single axillary nerve injection.No office rate
64450Nerve block, other peripheral nerve or branchFor a peripheral nerve or branch without a more specific applicable code.$103.99

How 64417 has changed in San Francisco, CA

64417 · Office / nonfacility

$244.58

Effective 2026-10-01

The base rate is $42.84 higher than on 2025-10-01, moving from $201.74 to $244.58 (21.2%).

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

    $201.74changed to$244.58

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 1.31 changed to 1.28
    • Practice expense RVU 3.35 changed to 4.16
    • Work GPCI 1.088 changed to 1.095
    • Practice expense GPCI 1.419 changed to 1.410
    • Malpractice GPCI 0.445 changed to 0.425

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $208.55changed to$201.74

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 3.37 changed to 3.35

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $205.15changed to$208.55

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $206.32changed to$205.15

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 3.36 changed to 3.37
    • Malpractice RVU 0.12 changed to 0.13
    • Work GPCI 1.082 changed to 1.088
    • Practice expense GPCI 1.374 changed to 1.419
    • Malpractice GPCI 0.452 changed to 0.445

  5. January 1, 2023

    RVU23A

    $177.85changed to$206.32

    • Conversion factor 34.6062 changed to 33.8872
    • Work RVU 1.27 changed to 1.31
    • Practice expense RVU 2.80 changed to 3.36
    • Malpractice RVU 0.11 changed to 0.12
    • Work GPCI 1.077 changed to 1.082
    • Practice expense GPCI 1.329 changed to 1.374
    • Malpractice GPCI 0.458 changed to 0.452

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $177.47changed to$177.85

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 2.76 changed to 2.80

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $171.27changed to$177.47

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 2.51 changed to 2.76
    • Work GPCI 1.076 changed to 1.077
    • Practice expense GPCI 1.327 changed to 1.329
    • Malpractice GPCI 0.440 changed to 0.458

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $162.66changed to$171.27

    • Conversion factor 36.0391 changed to 36.0896
    • Work RVU 1.44 changed to 1.27
    • Practice expense RVU 2.20 changed to 2.51
    • Malpractice RVU 0.12 changed to 0.11
    • Work GPCI 1.075 changed to 1.076
    • Practice expense GPCI 1.325 changed to 1.327
    • Malpractice GPCI 0.421 changed to 0.440

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $159.15changed to$162.66

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 2.13 changed to 2.20

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $158.36changed to$159.15

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 2.07 changed to 2.13
    • Work GPCI 1.077 changed to 1.075
    • Practice expense GPCI 1.357 changed to 1.325
    • Malpractice GPCI 0.439 changed to 0.421

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $162.62changed to$158.36

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 2.11 changed to 2.07
    • Malpractice RVU 0.13 changed to 0.12
    • Work GPCI 1.079 changed to 1.077
    • Practice expense GPCI 1.388 changed to 1.357
    • Malpractice GPCI 0.457 changed to 0.439

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $163.04changed to$162.62

    • Conversion factor 35.9335 changed to 35.8043
    • Malpractice RVU 0.12 changed to 0.13

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $162.23changed to$163.04

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $161.28changed to$162.23

    • Conversion factor 35.8228 changed to 35.7547
    • Malpractice RVU 0.11 changed to 0.12
    • Work GPCI 1.076 changed to 1.079
    • Practice expense GPCI 1.374 changed to 1.388
    • Malpractice GPCI 0.487 changed to 0.457

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $162.73changed to$161.28

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 2.34 changed to 2.11
    • Work GPCI 1.072 changed to 1.076
    • Practice expense GPCI 1.360 changed to 1.374
    • Malpractice GPCI 0.516 changed to 0.487

    Held through RVU14B, RVU14C, RVU14D.

  16. October 1, 2013

    RVU13D

    No ratechanged to$162.73

  17. January 1, 2013

    RVU13AR

    Earliest loaded release: No rate

    Held through RVU13B, RVU13C.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$244.58$68.91RVU26D
2026-07-01$244.58$68.91RVU26C
2026-04-01$244.58$68.91RVU26B
2026-01-01$244.58$68.91RVU26A
2025-10-01$201.74$70.46RVU25D
2025-07-01$201.74$70.46RVU25C
2025-04-01$201.74$70.46RVU25B
2025-01-01$201.74$70.46RVU25A
2024-10-01$208.55$71.10RVU24D
2024-07-01$208.55$71.10RVU24C
2024-04-01$208.55$71.10RVU24B
2024-03-09$208.55$71.10RVU24AR
2024-01-01$205.15$69.94RVU24A
2023-10-01$206.32$70.36RVU23D
2023-07-01$206.32$70.36RVU23C
2023-04-01$206.32$70.36RVU23B
2023-01-01$206.32$70.36RVU23A
2022-10-01$177.85$67.47RVU22D
2022-07-01$177.85$67.47RVU22C
2022-04-01$177.85$67.47RVU22B
2022-01-01$177.85$67.47RVU22A
2021-10-01$177.47$67.57RVU21D
2021-07-01$177.47$67.57RVU21C
2021-04-01$177.47$67.57RVU21B
2021-01-01$177.47$67.57RVU21A
2020-10-01$171.27$68.78RVU20D
2020-07-01$171.27$68.78RVU20C
2020-04-01$171.27$68.78RVU20B
2020-01-01$171.27$68.78RVU20A
2019-10-01$162.66$79.58RVU19D
2019-07-01$162.66$79.58RVU19C
2019-04-01$162.66$79.58RVU19B
2019-01-01$162.66$79.58RVU19A
2018-10-01$159.15$79.49RVU18D
2018-07-01$159.15$79.49RVU18C
2018-04-01$159.15$79.49RVU18B
2018-01-01$159.15$79.49RVU18AR1
2017-10-01$158.36$79.47RVU17D
2017-07-01$158.36$79.47RVU17C
2017-04-01$158.36$79.47RVU17B
2017-01-01$158.36$79.47RVU17A
2016-10-01$162.62$81.12RVU16D
2016-07-01$162.62$81.12RVU16C
2016-04-01$162.62$81.12RVU16B
2016-01-01$162.62$81.12RVU16A
2015-10-01$163.04$80.75RVU15D
2015-07-01$163.04$80.75RVU15C
2015-04-01$162.23$80.34RVU15B
2015-01-01$162.23$80.34RVU15A
2014-10-01$161.28$80.56RVU14D
2014-07-01$161.28$80.56RVU14C
2014-04-01$161.28$80.56RVU14B
2014-01-01$161.28$80.56RVU14A
2013-10-01$162.73$78.51RVU13D
2013-07-01Rate data unavailableRate data unavailableRVU13C
2013-04-01Rate data unavailableRate data unavailableRVU13B
2013-01-01Rate data unavailableRate data unavailableRVU13AR

Price 64417 for an earlier date of service

Where the San Francisco, CA rate applies

San Francisco, CA is a Medicare payment area, not a city. Our Census mapping connects it to 107 cities and communities in California. Some span more than one payment area; confirm with the service ZIP.

  • Alameda
  • Berkeley
  • Oakland
  • San Francisco
  • San Mateo
  • Acalanes Ridge
  • Alamo
  • Albany

Browse all communities in California

64417 billing questions

When should 64417 be selected instead of a brachial plexus block?

Use 64417 when the documented injection specifically targets the axillary nerve. A block directed at the brachial plexus is reported with the code for that broader target.

Is imaging guidance separately reported?

Imaging guidance is included in 64417 when performed. Do not report a separate guidance service for imaging used to place this block.

Can 64417 be reported for both shoulders?

For bilateral treatment, CMS specifies modifier 50 and payment at 150%. The documentation should establish treatment of both sides.

How does the 0-day global period affect same-day care?

Same-day preoperative and postoperative care is included in the procedure’s 0-day global period.

Can an assistant or co-surgeon be billed for this service?

CMS restricts assistant-at-surgery payment for this code. 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 64417PPRRVU2026_Oct_nonQPP.csv, line 7,101 (RVU26D)
Geographic factors for San Francisco, CAGPCI2026.csv, line 24 (RVU26D)

Open CMS sourceHow we calculate rates

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