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CPT code 64420: Intercostal block, single nerve2026 Medicare rate & RVUs in West Virginia

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 West Virginia, Medicare pays $98.29 for 64420 in the office and $51.85 when it’s performed in a hospital or facility.

$98.29Office (non-facility)
$51.85Hospital or facility
−7.2%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 West Virginia
  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 West Virginia 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. West Virginia pays $98.29. The RVUs are the same everywhere; the geographic indexes change the dollars.

64420 in West Virginia vs other payment areas
  1. West Virginia · this page$98.29
  2. Los Angeles, CA · California$118.72+$20.43
  3. Washington, DC area · District of Columbia$120.18+$21.89
  4. Miami, FL · Florida$113.26+$14.97
  5. Chicago, IL · Illinois$110.36+$12.07
  6. Manhattan, NY · New York$120.87+$22.58
  7. Alaska · Alaska$126.47+$28.18

Other areas in West Virginia 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 West Virginia 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

110

Locality
West Virginia
Physician work
1.000
Practice expense
0.869
Malpractice
1.431
Office calculation for 64420 in West Virginia
ComponentRVULocality factorAdjusted
Physician work1.05× 1.0001.0500
Practice expense2.03× 0.8691.7641
Malpractice0.09× 1.4310.1288
Total RVUs2.9429
Conversion factor× 33.4009

Office rate, West Virginia$98.29

Office: (1.05 × 1 + 2.03 × 0.869 + 0.09 × 1.431) × $33.4009 = $98.29

Facility: (1.05 × 1 + 0.43 × 0.869 + 0.09 × 1.431) × $33.4009 = $51.85

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, West Virginia
Add-on codes
64421Intercostal nerve block, each additional nerveAdd-on for each additional intercostal nerve blocked after the first.$33.56
Used instead
64461Paravertebral block, thoracic, single siteThoracic paravertebral block at a single injection site, rather than a targeted intercostal nerve block.$140.52
64466Thoracic block, unilateral injectionThoracic fascial plane block uses a different target and injection approach.$132.37

How 64420 has changed in West Virginia

64420 · Office / nonfacility

$98.29

Effective 2026-10-01

The base rate is $9.39 higher than on 2025-10-01, moving from $88.90 to $98.29 (10.6%).

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

    $88.90changed to$98.29

    • 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 0.862 changed to 0.869
    • Malpractice GPCI 1.333 changed to 1.431

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $90.89changed to$88.90

    • 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

    $89.41changed to$90.89

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $91.31changed to$89.41

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 1.73 changed to 1.76
    • Practice expense GPCI 0.860 changed to 0.862
    • Malpractice GPCI 1.266 changed to 1.333

  5. January 1, 2023

    RVU23A

    $92.71changed to$91.31

    • 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 0.858 changed to 0.860
    • Malpractice GPCI 1.198 changed to 1.266

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $94.67changed to$92.71

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

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $95.27changed to$94.67

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 1.66 changed to 1.75
    • Practice expense GPCI 0.857 changed to 0.858
    • Malpractice GPCI 1.247 changed to 1.198

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $105.11changed to$95.27

    • 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
    • Malpractice GPCI 1.296 changed to 1.247

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $105.92changed to$105.11

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

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $103.98changed to$105.92

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 1.86 changed to 1.89
    • Practice expense GPCI 0.847 changed to 0.857
    • Malpractice GPCI 1.289 changed to 1.296

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $104.47changed to$103.98

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 1.91 changed to 1.86
    • Practice expense GPCI 0.836 changed to 0.847
    • Malpractice GPCI 1.282 changed to 1.289

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $104.85changed to$104.47

    • Conversion factor 35.9335 changed to 35.8043

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $104.32changed to$104.85

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $104.15changed to$104.32

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense GPCI 0.832 changed to 0.836
    • Malpractice GPCI 1.256 changed to 1.282

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $105.73changed to$104.15

    • 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 0.828 changed to 0.832
    • Malpractice GPCI 1.229 changed to 1.256

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $105.73

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$98.29$51.85RVU26D
2026-07-01$98.29$51.85RVU26C
2026-04-01$98.29$51.85RVU26B
2026-01-01$98.29$51.85RVU26A
2025-10-01$88.90$55.72RVU25D
2025-07-01$88.90$55.72RVU25C
2025-04-01$88.90$55.72RVU25B
2025-01-01$88.90$55.72RVU25A
2024-10-01$90.89$56.17RVU24D
2024-07-01$90.89$56.17RVU24C
2024-04-01$90.89$56.17RVU24B
2024-03-09$90.89$56.17RVU24AR
2024-01-01$89.41$55.25RVU24A
2023-10-01$91.31$56.92RVU23D
2023-07-01$91.31$56.92RVU23C
2023-04-01$91.31$56.92RVU23B
2023-01-01$91.31$56.92RVU23A
2022-10-01$92.71$57.97RVU22D
2022-07-01$92.71$57.97RVU22C
2022-04-01$92.71$57.97RVU22B
2022-01-01$92.71$57.97RVU22A
2021-10-01$94.67$58.45RVU21D
2021-07-01$94.67$58.45RVU21C
2021-04-01$94.67$58.45RVU21B
2021-01-01$94.67$58.45RVU21A
2020-10-01$95.27$60.32RVU20D
2020-07-01$95.27$60.32RVU20C
2020-04-01$95.27$60.32RVU20B
2020-01-01$95.27$60.32RVU20A
2019-10-01$105.11$67.12RVU19D
2019-07-01$105.11$67.12RVU19C
2019-04-01$105.11$67.12RVU19B
2019-01-01$105.11$67.12RVU19A
2018-10-01$105.92$67.36RVU18D
2018-07-01$105.92$67.36RVU18C
2018-04-01$105.92$67.36RVU18B
2018-01-01$105.92$67.36RVU18AR1
2017-10-01$103.98$67.20RVU17D
2017-07-01$103.98$67.20RVU17C
2017-04-01$103.98$67.20RVU17B
2017-01-01$103.98$67.20RVU17A
2016-10-01$104.47$67.35RVU16D
2016-07-01$104.47$67.35RVU16C
2016-04-01$104.47$67.35RVU16B
2016-01-01$104.47$67.35RVU16A
2015-10-01$104.85$67.30RVU15D
2015-07-01$104.85$67.30RVU15C
2015-04-01$104.32$66.96RVU15B
2015-01-01$104.32$66.96RVU15A
2014-10-01$104.15$67.49RVU14D
2014-07-01$104.15$67.49RVU14C
2014-04-01$104.15$67.49RVU14B
2014-01-01$104.15$67.49RVU14A
2013-10-01$105.73$66.57RVU13D
2013-07-01$105.73$66.57RVU13C
2013-04-01$105.73$66.57RVU13B
2013-01-01$105.73$66.57RVU13AR

Price 64420 for an earlier date of service

Where the West Virginia rate applies

West Virginia is a Medicare payment area, not a city. Our Census mapping connects it to 439 cities and communities in West Virginia. Some span more than one payment area; confirm with the service ZIP.

  • Accoville
  • Addison (Webster Springs)
  • Adrian
  • Albright
  • Alderson
  • Alum Creek
  • Amherstdale
  • Anawalt

Browse all communities in West Virginia

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 West VirginiaGPCI2026.csv, line 110 (RVU26D)

Open CMS sourceHow we calculate rates

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