CPT code 64417: Axillary nerve block, image guidance included2026 Medicare rate & RVUs in Maryland
Reports an anesthetic injection targeting the axillary nerve, commonly for shoulder pain control or perioperative analgesia when that specific nerve is blocked.
Medicare pays $187.78–$213.58 for 64417 in the office in Maryland, from Rest of Maryland to Washington, DC area. 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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On this page 9 sections
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.
Where 64417 pays more and less in Maryland
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
3 payment localities
$187.78 to $213.58
| Payment locality | Office | Facility |
|---|---|---|
| Baltimore area, MD | $197.90 | $64.22 |
| Rest of Maryland | $187.78 | $61.70 |
| Washington, DC area | $213.58 | $66.81 |
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
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.
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
| 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
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).
64417 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 64415Brachial plexus blockSingle injection
- 64415 is for a brachial plexus block. Choose 64417 when the documented injection targets the axillary nerve itself.
- 64418Nerve injectionSuprascapular nerve
- 64418 targets the suprascapular nerve, not the axillary nerve. The documented nerve target distinguishes the codes.
- 64416Nerve blockBrachial plexus catheter infusion
- 64416 describes continuous infusion through a brachial plexus catheter; 64417 is an injection targeting the axillary nerve.
- 64450Nerve blockOther peripheral nerve or branch
- 64450 is a general code for a peripheral nerve or branch when no more specific code applies. Use 64417 for an axillary nerve injection.
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
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