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CPT code 64420: Intercostal block, single nerve2026 Medicare rate & RVUs in Puerto Rico

Reports injection of anesthetic, with or without steroid, near one intercostal nerve to relieve localized chest-wall pain or neuralgia.

CMS RVU26DEffective Oct 1, 2026One payment locality22.3K Medicare services in 2024

In Puerto Rico, Medicare pays $106.58 for 64420 in the office and $52.55 when it’s performed in a hospital or facility.

$106.58Office (non-facility)
$52.55Hospital or facility
+0.7%vs the national office rate ($105.88)

Check a contract rate as a % of Medicare · 64420 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 64420 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Puerto Rico
  2. What 64420 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 64420 covers

An intercostal nerve block places local anesthetic, with or without steroid, near one nerve running beneath a rib to interrupt chest-wall pain. Anesthesiologists, pain physicians, and surgeons may perform it for localized pain after rib injury or thoracic surgery, or for intercostal neuralgia, in an office, procedure suite, or hospital.

Report 64420 for one targeted intercostal nerve; when additional intercostal nerves are blocked in the same session, report 64421 for each additional nerve. The record should identify the side and nerve or level treated, clinical indication, medication, technique, and response. 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%. When procedures are performed in the same session, the highest-valued procedure is paid in full and the others receive the standard multiple-procedure reduction. Assistant-at-surgery payment is statutorily restricted; 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 Puerto Rico compares for 64420

Across 109 of 109 payment localities, the office rate for 64420 runs from $94.86 in Arkansas to $138.31 in San Benito County, CA. Puerto Rico pays $106.58. The RVUs are the same everywhere; the geographic indexes change the dollars.

64420 in Puerto Rico vs other payment areas
  1. Puerto Rico · this page$106.58
  2. Los Angeles, CA · California$118.72+$12.14
  3. Washington, DC area · District of Columbia$120.18+$13.60
  4. Miami, FL · Florida$113.26+$6.68
  5. Chicago, IL · Illinois$110.36+$3.78
  6. Manhattan, NY · New York$120.87+$14.29
  7. Alaska · Alaska$126.47+$19.89

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

Every other payment area

64420 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$96.10$49.34
ArkansasArkansas$94.86$48.96
ArizonaArizona$103.35$51.56
Bakersfield, CACalifornia$111.88$53.31
Chico, CACalifornia$111.59$53.02
El Centro, CACalifornia$111.61$53.03
Fresno, CACalifornia$111.59$53.02
Hanford, CACalifornia$111.59$53.02

64420 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.

$94.86

$126.47

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

View every state and territory as a table
64420 office rate range by state
State / territoryOffice rate rangeLocalities
AK$126.471
AL$96.101
AR$94.861
AZ$103.351
CA$111.59–$138.3129
CO$109.981
CT$112.431
DC$120.181
DE$104.941
FL$104.41–$113.263
GA$99.14–$107.682
GU$113.901
HI$113.901
IA$98.301
ID$98.871
IL$101.67–$110.364
IN$99.391
KS$97.881
KY$98.101
LA$97.96–$102.292
MA$109.43–$120.142
MD$106.80–$120.183
ME$99.32–$104.162
MI$100.37–$105.572
MN$105.731
MO$96.45–$102.633
MS$95.671
MT$105.871
NC$100.251
ND$104.101
NE$98.791
NH$108.291
NJ$113.81–$119.142
NM$100.861
NV$105.451
NY$101.60–$123.525
OH$100.011
OK$97.961
OR$104.72–$113.202
PA$100.16–$109.872
PR$106.581
RI$108.461
SC$100.281
SD$103.881
TN$98.321
TX$99.57–$109.548
UT$101.511
VA$103.84–$120.182
VI$106.581
VT$103.721
WA$109.21–$122.482
WI$100.951
WV$98.291
WY$105.101

See 64420 in every payment locality

How the 64420 rate is calculated

Each of 64420’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 · 64420

RVUs × geographic indexes × conversion factor

Office or facility?

Work1.05

1.05 RVUs× 1.000 GPCI

Practice expense2.03

2.03 RVUs× 1.000 GPCI

Malpractice0.09

0.09 RVUs× 1.000 GPCI

Adjusted RVUs

3.1700

Conversion factor

$33.4009

Medicare rate

$105.88

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

The exact Puerto Rico inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

7,103

Code
64420
Physician work
1.05
Practice expense
2.03
Malpractice
0.09

GPCI2026.csv

91

Locality
Puerto Rico
Physician work
1.000
Practice expense
1.011
Malpractice
0.985
Office calculation for 64420 in Puerto Rico
ComponentRVULocality factorAdjusted
Physician work1.05× 1.0001.0500
Practice expense2.03× 1.0112.0523
Malpractice0.09× 0.9850.0886
Total RVUs3.1910
Conversion factor× 33.4009

Office rate, Puerto Rico$106.58

Office: (1.05 × 1 + 2.03 × 1.011 + 0.09 × 0.985) × $33.4009 = $106.58

Facility: (1.05 × 1 + 0.43 × 1.011 + 0.09 × 0.985) × $33.4009 = $52.55

Open 64420 in the RVU calculator

Payment rules and modifiers for 64420

The CMS indicators that decide how 64420 is paid alongside other services.

CMS payment indicators · 64420

Intercostal block, single 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

64420 without 50 · national office

$105.88

Intercostal block, single nerve

64420-50 · Bilateral: 150%

$158.82

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 64420

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

Codes related to 64420
CodeHow it relatesOffice range, Puerto Rico
Add-on codes
64421Intercostal nerve block, each additional nerveAdd-on for each additional intercostal nerve blocked after the first.$35.23
Used instead
64461Paravertebral block, thoracic, single siteThoracic paravertebral block at a single injection site, rather than a targeted intercostal nerve block.$150.51
64466Thoracic block, unilateral injectionThoracic fascial plane block uses a different target and injection approach.$142.86

How 64420 has changed in Puerto Rico

64420 · Office / nonfacility

$106.58

Effective 2026-10-01

The base rate is $10.83 higher than on 2025-10-01, moving from $95.75 to $106.58 (11.3%).

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

    $95.75changed to$106.58

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 1.08 changed to 1.05
    • Practice expense RVU 1.75 changed to 2.03
    • Malpractice RVU 0.12 changed to 0.09
    • Practice expense GPCI 1.007 changed to 1.011
    • Malpractice GPCI 0.982 changed to 0.985

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $98.22changed to$95.75

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 1.76 changed to 1.75
    • Malpractice RVU 0.10 changed to 0.12

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $96.61changed to$98.22

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $99.03changed to$96.61

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 1.73 changed to 1.76
    • Practice expense GPCI 1.008 changed to 1.007
    • Malpractice GPCI 0.984 changed to 0.982

  5. October 1, 2023

    RVU23D

    $98.61changed to$99.03

    • Practice expense GPCI 1.000 changed to 1.008
    • Malpractice GPCI 1.000 changed to 0.984

  6. January 1, 2023

    RVU23A

    $100.78changed to$98.61

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 1.71 changed to 1.73
    • Malpractice RVU 0.11 changed to 0.10
    • Practice expense GPCI 1.008 changed to 1.000
    • Malpractice GPCI 0.986 changed to 1.000

    Held through RVU23B, RVU23C.

  7. January 1, 2022

    RVU22A

    $103.02changed to$100.78

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 1.75 changed to 1.71

    Held through RVU22B, RVU22C, RVU22D.

  8. January 1, 2021

    RVU21A

    $103.29changed to$103.02

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 1.66 changed to 1.75
    • Malpractice GPCI 0.988 changed to 0.986

    Held through RVU21B, RVU21C, RVU21D.

  9. January 1, 2020

    RVU20A

    $113.95changed to$103.29

    • Conversion factor 36.0391 changed to 36.0896
    • Work RVU 1.18 changed to 1.08
    • Practice expense RVU 1.86 changed to 1.66
    • Practice expense GPCI 1.007 changed to 1.008
    • Malpractice GPCI 0.990 changed to 0.988

    Held through RVU20B, RVU20C, RVU20D.

  10. January 1, 2019

    RVU19A

    $114.92changed to$113.95

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 1.89 changed to 1.86

    Held through RVU19B, RVU19C, RVU19D.

  11. January 1, 2018

    RVU18AR1

    $102.02changed to$114.92

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 1.86 changed to 1.89
    • Practice expense GPCI 0.856 changed to 1.007
    • Malpractice GPCI 0.642 changed to 0.990

    Held through RVU18B, RVU18C, RVU18D.

  12. January 1, 2017

    RVU17A

    $91.62changed to$102.02

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 1.91 changed to 1.86
    • Practice expense GPCI 0.705 changed to 0.856
    • Malpractice GPCI 0.293 changed to 0.642

    Held through RVU17B, RVU17C, RVU17D.

  13. January 1, 2016

    RVU16A

    $91.95changed to$91.62

    • Conversion factor 35.9335 changed to 35.8043

    Held through RVU16B, RVU16C, RVU16D.

  14. July 1, 2015

    RVU15C

    $91.49changed to$91.95

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  15. January 1, 2015

    RVU15A

    $90.69changed to$91.49

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense GPCI 0.692 changed to 0.705
    • Malpractice GPCI 0.271 changed to 0.293

    Held through RVU15B.

  16. January 1, 2014

    RVU14A

    $90.76changed to$90.69

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 2.15 changed to 1.91
    • Malpractice RVU 0.12 changed to 0.11
    • Practice expense GPCI 0.678 changed to 0.692
    • Malpractice GPCI 0.249 changed to 0.271

    Held through RVU14B, RVU14C, RVU14D.

  17. January 1, 2013

    RVU13AR

    Earliest loaded release: $90.76

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$106.58$52.55RVU26D
2026-07-01$106.58$52.55RVU26C
2026-04-01$106.58$52.55RVU26B
2026-01-01$106.58$52.55RVU26A
2025-10-01$95.75$56.99RVU25D
2025-07-01$95.75$56.99RVU25C
2025-04-01$95.75$56.99RVU25B
2025-01-01$95.75$56.99RVU25A
2024-10-01$98.22$57.66RVU24D
2024-07-01$98.22$57.66RVU24C
2024-04-01$98.22$57.66RVU24B
2024-03-09$98.22$57.66RVU24AR
2024-01-01$96.61$56.71RVU24A
2023-10-01$99.03$58.72RVU23D
2023-07-01$98.61$58.62RVU23C
2023-04-01$98.61$58.62RVU23B
2023-01-01$98.61$58.62RVU23A
2022-10-01$100.78$59.96RVU22D
2022-07-01$100.78$59.96RVU22C
2022-04-01$100.78$59.96RVU22B
2022-01-01$100.78$59.96RVU22A
2021-10-01$103.02$60.46RVU21D
2021-07-01$103.02$60.46RVU21C
2021-04-01$103.02$60.46RVU21B
2021-01-01$103.02$60.46RVU21A
2020-10-01$103.29$62.18RVU20D
2020-07-01$103.29$62.18RVU20C
2020-04-01$103.29$62.18RVU20B
2020-01-01$103.29$62.18RVU20A
2019-10-01$113.95$69.31RVU19D
2019-07-01$113.95$69.31RVU19C
2019-04-01$113.95$69.31RVU19B
2019-01-01$113.95$69.31RVU19A
2018-10-01$114.92$69.60RVU18D
2018-07-01$114.92$69.60RVU18C
2018-04-01$114.92$69.60RVU18B
2018-01-01$114.92$69.60RVU18AR1
2017-10-01$102.02$64.85RVU17D
2017-07-01$102.02$64.85RVU17C
2017-04-01$102.02$64.85RVU17B
2017-01-01$102.02$64.85RVU17A
2016-10-01$91.62$60.32RVU16D
2016-07-01$91.62$60.32RVU16C
2016-04-01$91.62$60.32RVU16B
2016-01-01$91.62$60.32RVU16A
2015-10-01$91.95$60.28RVU15D
2015-07-01$91.95$60.28RVU15C
2015-04-01$91.49$59.98RVU15B
2015-01-01$91.49$59.98RVU15A
2014-10-01$90.69$60.20RVU14D
2014-07-01$90.69$60.20RVU14C
2014-04-01$90.69$60.20RVU14B
2014-01-01$90.69$60.20RVU14A
2013-10-01$90.76$58.70RVU13D
2013-07-01$90.76$58.70RVU13C
2013-04-01$90.76$58.70RVU13B
2013-01-01$90.76$58.70RVU13AR

Price 64420 for an earlier date of service

Where the Puerto Rico rate applies

Puerto Rico is a Medicare payment area, not a city. Our Census mapping connects it to 292 cities and communities in Puerto Rico. Some span more than one payment area; confirm with the service ZIP.

  • Aceitunas
  • Adjuntas
  • Aguada
  • Aguadilla
  • Aguas Buenas
  • Aguas Claras
  • Aguilita
  • Aibonito

Browse all communities in Puerto Rico

64420 billing questions

When should I use 64420 instead of 64421?

Use 64420 for the first, single intercostal nerve treated. Report 64421 for each additional intercostal nerve blocked in the same session.

How is bilateral treatment reported?

For bilateral treatment, report modifier 50. CMS pays the bilateral procedure at 150%.

What documentation supports 64420?

Document the indication, side and intercostal nerve or level treated, medication and technique, and the patient's response.

Is same-day postoperative care included?

Yes. The 0-day global period includes same-day preoperative and postoperative care.

How does the multiple-procedure reduction affect 64420?

When it is performed with other procedures in the same session, the highest-valued procedure is paid in full and the others receive the standard 50% 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 64420PPRRVU2026_Oct_nonQPP.csv, line 7,103 (RVU26D)
Geographic factors for Puerto RicoGPCI2026.csv, line 91 (RVU26D)

Open CMS sourceHow we calculate rates

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