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CPT code 64418: Nerve injection, suprascapular nerve2026 Medicare rate & RVUs in Iowa

Report this service for an anesthetic and/or steroid injection targeting the suprascapular nerve to evaluate or relieve shoulder pain.

CMS RVU26DEffective Oct 1, 2026One payment locality24.3K Medicare services in 2024

In Iowa, Medicare pays $83.35 for 64418 in the office and $45.14 when it’s performed in a hospital or facility.

$83.35Office (non-facility)
$45.14Hospital or facility
−7.2%vs the national office rate ($89.85)

Check a contract rate as a % of Medicare · 64418 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 64418 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Iowa
  2. What 64418 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 64418 covers

The clinician places an injection at the suprascapular nerve, which supplies sensation to parts of the shoulder. Pain medicine physicians, anesthesiologists, physiatrists, and other clinicians may use the block diagnostically or therapeutically for shoulder pain, including pain associated with rotator cuff disease or glenohumeral arthritis. The injected medication may be anesthetic, steroid, or both; the service is defined by the nerve targeted, not simply by an injection into the shoulder joint.

Report 64418 when documentation identifies the suprascapular nerve as the injection target and supports the clinical indication, side, approach, and medication administered. The code has a 0-day global period, so same-day preoperative and postoperative care is included. For bilateral treatment, modifier 50 is paid at 150%. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Medicare does not pay an assistant at surgery for this service; 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 Iowa compares for 64418

Across 109 of 109 payment localities, the office rate for 64418 runs from $80.96 in Arkansas to $114.37 in San Benito County, CA. Iowa pays $83.35. The RVUs are the same everywhere; the geographic indexes change the dollars.

64418 in Iowa vs other payment areas
  1. Iowa · this page$83.35
  2. Los Angeles, CA · California$99.31+$15.96
  3. Washington, DC area · District of Columbia$101.17+$17.82
  4. Miami, FL · Florida$97.53+$14.18
  5. Chicago, IL · Illinois$95.11+$11.76
  6. Manhattan, NY · New York$102.46+$19.11
  7. Alaska · Alaska$109.35+$26.00

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

Every other payment area

64418 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$81.95$45.42
ArkansasArkansas$80.96$45.09
ArizonaArizona$87.76$47.30
Bakersfield, CACalifornia$93.93$48.17
Chico, CACalifornia$93.59$47.83
El Centro, CACalifornia$93.61$47.85
Fresno, CACalifornia$93.59$47.83
Hanford, CACalifornia$93.59$47.83

64418 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.

$80.96

$109.35

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

View every state and territory as a table
64418 office rate range by state
State / territoryOffice rate rangeLocalities
AK$109.351
AL$81.951
AR$80.961
AZ$87.761
CA$93.59–$114.3729
CO$92.701
CT$95.221
DC$101.171
DE$89.051
FL$89.48–$97.533
GA$85.11–$91.502
GU$95.211
HI$95.211
IA$83.351
ID$83.881
IL$87.53–$95.114
IN$84.281
KS$83.181
KY$83.941
LA$83.89–$87.372
MA$92.35–$100.692
MD$90.51–$101.173
ME$84.42–$88.042
MI$85.93–$90.602
MN$88.721
MO$82.79–$87.433
MS$81.881
MT$89.841
NC$85.141
ND$87.671
NE$83.681
NH$91.461
NJ$96.27–$100.422
NM$86.401
NV$89.291
NY$86.24–$104.825
OH$85.491
OK$83.631
OR$88.56–$95.082
PA$85.51–$93.272
PR$90.351
RI$91.801
SC$85.461
SD$87.411
TN$83.561
TX$85.05–$92.438
UT$86.451
VA$87.91–$101.172
VI$90.351
VT$87.531
WA$92.11–$102.412
WI$85.191
WV$84.821
WY$88.891

See 64418 in every payment locality

How the 64418 rate is calculated

Each of 64418’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 · 64418

RVUs × geographic indexes × conversion factor

Office or facility?

Work1.07

1.07 RVUs× 1.000 GPCI

Practice expense1.51

1.51 RVUs× 1.000 GPCI

Malpractice0.11

0.11 RVUs× 1.000 GPCI

Adjusted RVUs

2.6900

Conversion factor

$33.4009

Medicare rate

$89.85

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

The exact Iowa inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

7,102

Code
64418
Physician work
1.07
Practice expense
1.51
Malpractice
0.11

GPCI2026.csv

53

Locality
Iowa
Physician work
1.000
Practice expense
0.915
Malpractice
0.397
Office calculation for 64418 in Iowa
ComponentRVULocality factorAdjusted
Physician work1.07× 1.0001.0700
Practice expense1.51× 0.9151.3817
Malpractice0.11× 0.3970.0437
Total RVUs2.4953
Conversion factor× 33.4009

Office rate, Iowa$83.35

Office: (1.07 × 1 + 1.51 × 0.915 + 0.11 × 0.397) × $33.4009 = $83.35

Facility: (1.07 × 1 + 0.26 × 0.915 + 0.11 × 0.397) × $33.4009 = $45.14

Open 64418 in the RVU calculator

Payment rules and modifiers for 64418

The CMS indicators that decide how 64418 is paid alongside other services.

CMS payment indicators · 64418

Nerve injection, suprascapular 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

64418 without 50 · national office

$89.85

Nerve injection, suprascapular nerve

64418-50 · Bilateral: 150%

$134.78

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 64418

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

Codes related to 64418
CodeHow it relatesOffice range, Iowa
Used instead
64417Axillary nerve block, image guidance includedTargets the axillary nerve, a distinct shoulder nerve target.$171.61
64415Brachial plexus block, single injectionTargets the brachial plexus rather than the suprascapular nerve.$143.88
64450Nerve block, other peripheral nerve or branchFor a peripheral nerve or branch without a more specific injection code.$74.82
Often billed with
76942Ultrasound needle guidance, biopsy, aspiration, injection, or localizationMay report ultrasound needle guidance when performed and separately documented.$59.83

How 64418 has changed in Iowa

64418 · Office / nonfacility

$83.35

Effective 2026-10-01

The base rate is $5.98 higher than on 2025-10-01, moving from $77.37 to $83.35 (7.7%).

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

    $77.37changed to$83.35

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 1.10 changed to 1.07
    • Practice expense RVU 1.35 changed to 1.51
    • Malpractice RVU 0.13 changed to 0.11
    • Practice expense GPCI 0.913 changed to 0.915
    • Malpractice GPCI 0.457 changed to 0.397

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $80.08changed to$77.37

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 1.37 changed to 1.35
    • Malpractice RVU 0.12 changed to 0.13

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $78.77changed to$80.08

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $81.62changed to$78.77

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 1.38 changed to 1.37
    • Practice expense GPCI 0.910 changed to 0.913
    • Malpractice GPCI 0.441 changed to 0.457

  5. January 1, 2023

    RVU23A

    $83.77changed to$81.62

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 1.40 changed to 1.38
    • Practice expense GPCI 0.907 changed to 0.910
    • Malpractice GPCI 0.425 changed to 0.441

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $84.13changed to$83.77

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 1.38 changed to 1.40
    • Malpractice RVU 0.14 changed to 0.12

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $80.81changed to$84.13

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 1.20 changed to 1.38
    • Malpractice RVU 0.12 changed to 0.14
    • Malpractice GPCI 0.424 changed to 0.425

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $90.18changed to$80.81

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 1.49 changed to 1.20
    • Malpractice GPCI 0.423 changed to 0.424

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $110.65changed to$90.18

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 2.12 changed to 1.49

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $135.78changed to$110.65

    • Conversion factor 35.8887 changed to 35.9996
    • Work RVU 1.32 changed to 1.10
    • Practice expense RVU 2.66 changed to 2.12
    • Malpractice RVU 0.14 changed to 0.12
    • Practice expense GPCI 0.902 changed to 0.907
    • Malpractice GPCI 0.458 changed to 0.423

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $135.71changed to$135.78

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 2.68 changed to 2.66
    • Practice expense GPCI 0.896 changed to 0.902
    • Malpractice GPCI 0.493 changed to 0.458

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $137.02changed to$135.71

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 2.70 changed to 2.68
    • Malpractice RVU 0.15 changed to 0.14

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $136.34changed to$137.02

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $132.24changed to$136.34

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 2.60 changed to 2.70
    • Malpractice RVU 0.11 changed to 0.15
    • Practice expense GPCI 0.892 changed to 0.896
    • Malpractice GPCI 0.475 changed to 0.493

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $132.18changed to$132.24

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 2.83 changed to 2.60
    • Malpractice RVU 0.12 changed to 0.11
    • Practice expense GPCI 0.887 changed to 0.892
    • Malpractice GPCI 0.456 changed to 0.475

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $132.18

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$83.35$45.14RVU26D
2026-07-01$83.35$45.14RVU26C
2026-04-01$83.35$45.14RVU26B
2026-01-01$83.35$45.14RVU26A
2025-10-01$77.37$50.20RVU25D
2025-07-01$77.37$50.20RVU25C
2025-04-01$77.37$50.20RVU25B
2025-01-01$77.37$50.20RVU25A
2024-10-01$80.08$51.51RVU24D
2024-07-01$80.08$51.51RVU24C
2024-04-01$80.08$51.51RVU24B
2024-03-09$80.08$51.51RVU24AR
2024-01-01$78.77$50.67RVU24A
2023-10-01$81.62$52.33RVU23D
2023-07-01$81.62$52.33RVU23C
2023-04-01$81.62$52.33RVU23B
2023-01-01$81.62$52.33RVU23A
2022-10-01$83.77$53.33RVU22D
2022-07-01$83.77$53.33RVU22C
2022-04-01$83.77$53.33RVU22B
2022-01-01$83.77$53.33RVU22A
2021-10-01$84.13$54.38RVU21D
2021-07-01$84.13$54.38RVU21C
2021-04-01$84.13$54.38RVU21B
2021-01-01$84.13$54.38RVU21A
2020-10-01$80.81$55.28RVU20D
2020-07-01$80.81$55.28RVU20C
2020-04-01$80.81$55.28RVU20B
2020-01-01$80.81$55.28RVU20A
2019-10-01$90.18$55.20RVU19D
2019-07-01$90.18$55.20RVU19C
2019-04-01$90.18$55.20RVU19B
2019-01-01$90.18$55.20RVU19A
2018-10-01$110.65$59.71RVU18D
2018-07-01$110.65$59.71RVU18C
2018-04-01$110.65$59.71RVU18B
2018-01-01$110.65$59.71RVU18AR1
2017-10-01$135.78$73.31RVU17D
2017-07-01$135.78$73.31RVU17C
2017-04-01$135.78$73.31RVU17B
2017-01-01$135.78$73.31RVU17A
2016-10-01$135.71$73.15RVU16D
2016-07-01$135.71$73.15RVU16C
2016-04-01$135.71$73.15RVU16B
2016-01-01$135.71$73.15RVU16A
2015-10-01$137.02$73.91RVU15D
2015-07-01$137.02$73.91RVU15C
2015-04-01$136.34$73.55RVU15B
2015-01-01$136.34$73.55RVU15A
2014-10-01$132.24$72.48RVU14D
2014-07-01$132.24$72.48RVU14C
2014-04-01$132.24$72.48RVU14B
2014-01-01$132.24$72.48RVU14A
2013-10-01$132.18$70.61RVU13D
2013-07-01$132.18$70.61RVU13C
2013-04-01$132.18$70.61RVU13B
2013-01-01$132.18$70.61RVU13AR

Price 64418 for an earlier date of service

Where the Iowa rate applies

Iowa is a Medicare payment area, not a city. Our Census mapping connects it to 1026 cities and communities in Iowa. Some span more than one payment area; confirm with the service ZIP.

  • Ackley
  • Ackworth
  • Adair
  • Adel
  • Afton
  • Agency
  • Ainsworth
  • Akron

Browse all communities in Iowa

64418 billing questions

How is 64418 different from a shoulder joint injection?

64418 targets the suprascapular nerve. An injection placed into the shoulder joint itself is a different service and should not be selected based only on the shared shoulder-pain indication.

When should 64450 be considered instead?

Use 64418 when the suprascapular nerve is the target. Code 64450 is for an injection targeting a peripheral nerve or branch without a more specific code for that nerve.

What documentation supports reporting 64418?

Document the shoulder-pain indication, the suprascapular nerve as the target, laterality, injection approach, and medication administered.

Can ultrasound guidance be reported separately?

When ultrasound needle guidance is performed and documented, 76942 may be separately reportable. The record should support the guidance service as well as the nerve injection.

How does Medicare pay when both sides are treated?

For bilateral treatment, Medicare pays 150% when the service is reported with modifier 50.

What happens when another procedure is performed in the same session?

The highest-valued procedure is paid in full, and other procedures in that session are subject to the standard multiple-procedure reduction.

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 64418PPRRVU2026_Oct_nonQPP.csv, line 7,102 (RVU26D)
Geographic factors for IowaGPCI2026.csv, line 53 (RVU26D)

Open CMS sourceHow we calculate rates

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