CPT code 64421: Intercostal nerve block, each additional nerve2026 Medicare rate & RVUs in Redding, CA
Reports anesthetic blockade of each intercostal nerve beyond the first, such as for chest wall pain managed with a regional block.
In Redding, CA, Medicare pays $36.21 for 64421 in the office and $21.57 when it’s performed in a hospital or facility.
Check a contract rate as a % of Medicare · 64421 nationwide
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 11 sections
What 64421 covers
This add-on represents anesthetic blockade of additional intercostal nerves after the first nerve is blocked. Physicians, anesthesiologists, and pain specialists may use multiple intercostal blocks for chest wall analgesia, including pain related to rib injuries or thoracic procedures. The service targets individual nerves supplying the chest wall rather than a broader thoracic regional approach.
Report 64421 with 64420 for the first intercostal nerve; use 64421 for each additional nerve treated. The procedure note should identify the nerves and side treated, the anesthetic administered, and the clinical reason for blocking multiple nerves. CMS classifies 64421 as an add-on code: it is billed only with a primary procedure and paid within that procedure’s global period. For a bilateral procedure reported with modifier 50, CMS pays 150%.
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 Redding, CA compares for 64421
Across 109 of 109 payment localities, the office rate for 64421 runs from $31.86 in Arkansas to $43.63 in San Benito County, CA. Redding, CA pays $36.21. The RVUs are the same everywhere; the geographic indexes change the dollars.
- Redding, CA · this page$36.21
- Bakersfield, CA · California$36.36+$0.15
- Chico, CA · California$36.21
- El Centro, CA · California$36.22+$0.01
- Fresno, CA · California$36.21
- Hanford, CA · California$36.21
- Los Angeles, CA · California$38.30+$2.09
Other areas in California first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| Madera, CACalifornia | $36.21 | $21.57 |
| Merced, CACalifornia | $36.21 | $21.57 |
| Modesto, CACalifornia | $36.21 | $21.57 |
| Napa, CACalifornia | $40.70 | $23.09 |
| Oxnard, CACalifornia | $38.00 | $22.21 |
| Rest of CaliforniaCalifornia | $36.21 | $21.57 |
| Riverside, CACalifornia | $36.76 | $22.11 |
| Sacramento, CACalifornia | $37.66 | $22.12 |
| Salinas, CACalifornia | $37.51 | $22.03 |
| San Diego, CACalifornia | $38.14 | $22.16 |
| Marin County, CACalifornia | $42.71 | $23.87 |
| San Francisco, CACalifornia | $42.65 | $23.81 |
| San Benito County, CACalifornia | $43.63 | $24.36 |
| Santa Clara County, CACalifornia | $43.39 | $24.13 |
| San Luis Obispo, CACalifornia | $36.94 | $21.72 |
| Santa Cruz, CACalifornia | $38.30 | $22.07 |
| Santa Maria, CACalifornia | $37.58 | $22.00 |
| Santa Rosa, CACalifornia | $38.67 | $22.26 |
| Stockton, CACalifornia | $36.21 | $21.57 |
| Vallejo, CACalifornia | $40.62 | $23.01 |
| Visalia, CACalifornia | $36.21 | $21.57 |
| Yuba City, CACalifornia | $36.21 | $21.57 |
| Washington, DC areaDistrict of Columbia | $39.18 | $23.44 |
| Miami, FLFlorida | $38.32 | $24.41 |
| Chicago, ILIllinois | $37.43 | $24.01 |
| Manhattan, NYNew York | $39.86 | $24.33 |
| AlaskaAlaska | $43.61 | $29.38 |
| AlabamaAlabama | $32.22 | $20.53 |
| ArkansasArkansas | $31.86 | $20.38 |
| ArizonaArizona | $34.30 | $21.36 |
| ColoradoColorado | $35.99 | $21.78 |
| ConnecticutConnecticut | $37.06 | $22.67 |
| DelawareDelaware | $34.78 | $21.58 |
| Fort Lauderdale, FLFlorida | $36.64 | $23.11 |
| Rest of FloridaFlorida | $35.16 | $22.39 |
| Atlanta, GAGeorgia | $35.73 | $22.15 |
| Rest of GeorgiaGeorgia | $33.55 | $21.63 |
| Hawaii, Guam, HIHawaii | $36.70 | $21.51 |
| IowaIowa | $32.62 | $20.39 |
| IdahoIdaho | $32.83 | $20.54 |
| East St. Louis, ILIllinois | $35.40 | $23.11 |
| Rest of IllinoisIllinois | $34.53 | $22.33 |
| Suburban Chicago, ILIllinois | $36.93 | $23.21 |
| IndianaIndiana | $32.97 | $20.58 |
| KansasKansas | $32.61 | $20.53 |
| KentuckyKentucky | $33.04 | $21.16 |
| New Orleans, LALouisiana | $34.29 | $21.72 |
| Rest of LouisianaLouisiana | $33.04 | $21.22 |
| Metropolitan Boston, MAMassachusetts | $38.86 | $22.91 |
| Rest of MassachusettsMassachusetts | $35.90 | $21.83 |
| Baltimore area, MDMaryland | $36.97 | $22.64 |
| Rest of MarylandMaryland | $35.30 | $21.78 |
| Rest of MaineMaine | $33.08 | $20.79 |
| Southern Maine, MEMaine | $34.30 | $21.06 |
| Detroit, MIMichigan | $35.62 | $22.73 |
| Rest of MichiganMichigan | $33.80 | $21.61 |
| MinnesotaMinnesota | $34.39 | $20.64 |
| Metropolitan Kansas City, MOMissouri | $33.99 | $21.45 |
| Metropolitan St. Louis, MOMissouri | $34.26 | $21.54 |
| Rest of MissouriMissouri | $32.68 | $21.16 |
| MississippiMississippi | $32.27 | $20.76 |
| MontanaMontana | $35.07 | $21.71 |
| North CarolinaNorth Carolina | $33.33 | $20.86 |
| North DakotaNorth Dakota | $34.08 | $20.72 |
| NebraskaNebraska | $32.72 | $20.39 |
| New HampshireNew Hampshire | $35.56 | $21.65 |
| Northern New JerseyNew Jersey | $38.94 | $23.44 |
| Rest of New JerseyNew Jersey | $37.45 | $22.87 |
| New MexicoNew Mexico | $33.99 | $21.74 |
| NevadaNevada | $34.81 | $21.44 |
| NYC suburbs and Long Island, NYNew York | $40.77 | $24.88 |
| Poughkeepsie and northern NYC suburbs, NYNew York | $37.78 | $23.15 |
| Queens, NYNew York | $39.96 | $24.16 |
| Rest of New YorkNew York | $33.72 | $21.03 |
| OhioOhio | $33.60 | $21.40 |
| OklahomaOklahoma | $32.88 | $20.95 |
| Portland, OROregon | $36.80 | $21.95 |
| Rest of OregonOregon | $34.51 | $21.20 |
| Metropolitan Philadelphia, PAPennsylvania | $36.39 | $22.48 |
| Rest of PennsylvaniaPennsylvania | $33.58 | $21.32 |
| Puerto RicoPuerto Rico | $35.23 | $21.73 |
| Rhode IslandRhode Island | $35.76 | $21.96 |
| South CarolinaSouth Carolina | $33.53 | $21.18 |
| South DakotaSouth Dakota | $33.96 | $20.60 |
| TennesseeTennessee | $32.75 | $20.60 |
| Austin, TXTexas | $35.90 | $21.77 |
| Beaumont, TXTexas | $33.42 | $21.26 |
| Brazoria, TXTexas | $34.68 | $21.44 |
| Dallas, TXTexas | $34.91 | $21.61 |
| Fort Worth, TXTexas | $34.76 | $21.59 |
| Galveston, TXTexas | $34.80 | $21.53 |
| Houston, TXTexas | $35.71 | $22.44 |
| Rest of TexasTexas | $34.04 | $21.36 |
| UtahUtah | $33.88 | $21.32 |
| VirginiaVirginia | $34.29 | $21.16 |
| Virgin Islands, VIUnited States Virgin Islands | $35.23 | $21.73 |
| VermontVermont | $34.08 | $20.85 |
| Rest of WashingtonWashington | $35.79 | $21.72 |
| King County, WAWashington | $39.45 | $23.06 |
| WisconsinWisconsin | $33.20 | $20.40 |
| West VirginiaWest Virginia | $33.56 | $21.95 |
| WyomingWyoming | $34.64 | $21.28 |
64421 rates by state
Office rate range in each state. Select a state to see its payment localities.
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.
$31.86
$43.61
Color shows the midpoint of each state’s locality range.
View every state and territory as a table
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | $43.61 | 1 |
| AL | $32.22 | 1 |
| AR | $31.86 | 1 |
| AZ | $34.30 | 1 |
| CA | $36.21–$43.63 | 29 |
| CO | $35.99 | 1 |
| CT | $37.06 | 1 |
| DC | $39.18 | 1 |
| DE | $34.78 | 1 |
| FL | $35.16–$38.32 | 3 |
| GA | $33.55–$35.73 | 2 |
| GU | $36.70 | 1 |
| HI | $36.70 | 1 |
| IA | $32.62 | 1 |
| ID | $32.83 | 1 |
| IL | $34.53–$37.43 | 4 |
| IN | $32.97 | 1 |
| KS | $32.61 | 1 |
| KY | $33.04 | 1 |
| LA | $33.04–$34.29 | 2 |
| MA | $35.90–$38.86 | 2 |
| MD | $35.30–$39.18 | 3 |
| ME | $33.08–$34.30 | 2 |
| MI | $33.80–$35.62 | 2 |
| MN | $34.39 | 1 |
| MO | $32.68–$34.26 | 3 |
| MS | $32.27 | 1 |
| MT | $35.07 | 1 |
| NC | $33.33 | 1 |
| ND | $34.08 | 1 |
| NE | $32.72 | 1 |
| NH | $35.56 | 1 |
| NJ | $37.45–$38.94 | 2 |
| NM | $33.99 | 1 |
| NV | $34.81 | 1 |
| NY | $33.72–$40.77 | 5 |
| OH | $33.60 | 1 |
| OK | $32.88 | 1 |
| OR | $34.51–$36.80 | 2 |
| PA | $33.58–$36.39 | 2 |
| PR | $35.23 | 1 |
| RI | $35.76 | 1 |
| SC | $33.53 | 1 |
| SD | $33.96 | 1 |
| TN | $32.75 | 1 |
| TX | $33.42–$35.90 | 8 |
| UT | $33.88 | 1 |
| VA | $34.29–$39.18 | 2 |
| VI | $35.23 | 1 |
| VT | $34.08 | 1 |
| WA | $35.79–$39.45 | 2 |
| WI | $33.20 | 1 |
| WV | $33.56 | 1 |
| WY | $34.64 | 1 |
How the 64421 rate is calculated
Each of 64421’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 · 64421
RVUs × geographic indexes × conversion factor
Work0.49
0.49 RVUs× 1.000 GPCI
Practice expense0.51
0.51 RVUs× 1.000 GPCI
Malpractice0.05
0.05 RVUs× 1.000 GPCI
Adjusted RVUs
1.0500
Conversion factor
$33.4009
Medicare rate
$35.07
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
The exact Redding, CA inputs and CMS source lines
PPRRVU2026_Oct_nonQPP.csv
7,104
- Code
- 64421
- Physician work
- 0.49
- Practice expense
- 0.51
- Malpractice
- 0.05
GPCI2026.csv
19
- Locality
- Redding, CA
- Physician work
- 1.017
- Practice expense
- 1.096
- Malpractice
- 0.536
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 0.49 | × 1.017 | 0.4983 |
| Practice expense | 0.51 | × 1.096 | 0.5590 |
| Malpractice | 0.05 | × 0.536 | 0.0268 |
| Total RVUs | 1.0841 | ||
| Conversion factor | × 33.4009 | ||
Office rate, Redding, CA$36.21
Office: (0.49 × 1.017 + 0.51 × 1.096 + 0.05 × 0.536) × $33.4009 = $36.21
Facility: (0.49 × 1.017 + 0.11 × 1.096 + 0.05 × 0.536) × $33.4009 = $21.57
Payment rules and modifiers for 64421
The CMS indicators that decide how 64421 is paid alongside other services.
CMS payment indicators · 64421
Intercostal nerve block, each additional nerve
| Rule | CMS value | What it means |
|---|---|---|
| Global period | ZZZ | Add-on code: falls within the primary procedure’s global period. |
| Multiple procedures | 0 | No multiple-procedure reduction. |
| 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
64421 without 50 · national office
$35.07
Intercostal nerve block, each additional nerve
64421-50 · Bilateral: 150%
$52.61
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).
How 64421 has changed in Redding, CA
64421 · Office / nonfacility
$36.21
Effective 2026-10-01
The base rate is $2.82 higher than on 2025-10-01, moving from $33.39 to $36.21 (8.4%).
It is unchanged from the immediately preceding available release, effective 2026-07-01.
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
January 1, 2026
RVU26A
$33.39changed to$36.21
- Conversion factor 32.3465 changed to 33.4009
- Work RVU 0.50 changed to 0.49
- Practice expense RVU 0.46 changed to 0.51
- Malpractice RVU 0.04 changed to 0.05
- Work GPCI 1.014 changed to 1.017
- Practice expense GPCI 1.093 changed to 1.096
- Malpractice GPCI 0.560 changed to 0.536
Held through RVU26B, RVU26C, RVU26D.
January 1, 2025
RVU25A
$34.18changed to$33.39
- Conversion factor 33.2875 changed to 32.3465
- Practice expense RVU 0.45 changed to 0.46
- Malpractice RVU 0.05 changed to 0.04
Held through RVU25B, RVU25C, RVU25D.
March 9, 2024
RVU24AR
$33.62changed to$34.18
- Conversion factor 32.7442 changed to 33.2875
Held through RVU24B, RVU24C, RVU24D.
January 1, 2024
RVU24A
$34.17changed to$33.62
- Conversion factor 33.8872 changed to 32.7442
- Practice expense RVU 0.44 changed to 0.45
- Malpractice RVU 0.04 changed to 0.05
- Work GPCI 1.021 changed to 1.014
- Practice expense GPCI 1.079 changed to 1.093
- Malpractice GPCI 0.579 changed to 0.560
January 1, 2023
RVU23A
$34.65changed to$34.17
- Conversion factor 34.6062 changed to 33.8872
- Practice expense RVU 0.43 changed to 0.44
- Malpractice RVU 0.05 changed to 0.04
- Work GPCI 1.027 changed to 1.021
- Practice expense GPCI 1.065 changed to 1.079
- Malpractice GPCI 0.597 changed to 0.579
Held through RVU23B, RVU23C, RVU23D.
January 1, 2022
RVU22A
$35.31changed to$34.65
- Conversion factor 34.8931 changed to 34.6062
- Practice expense RVU 0.44 changed to 0.43
Held through RVU22B, RVU22C, RVU22D.
January 1, 2021
RVU21A
$35.74changed to$35.31
- Conversion factor 36.0896 changed to 34.8931
- Practice expense RVU 0.42 changed to 0.44
- Work GPCI 1.024 changed to 1.027
- Practice expense GPCI 1.070 changed to 1.065
- Malpractice GPCI 0.580 changed to 0.597
Held through RVU21B, RVU21C, RVU21D.
January 1, 2020
RVU20A
$166.78changed to$35.74
- Conversion factor 36.0391 changed to 36.0896
- Work RVU 1.68 changed to 0.50
- Practice expense RVU 2.64 changed to 0.42
- Malpractice RVU 0.14 changed to 0.05
- Work GPCI 1.020 changed to 1.024
- Practice expense GPCI 1.074 changed to 1.070
- Malpractice GPCI 0.562 changed to 0.580
Held through RVU20B, RVU20C, RVU20D.
January 1, 2019
RVU19A
$160.41changed to$166.78
- Conversion factor 35.9996 changed to 36.0391
- Practice expense RVU 2.48 changed to 2.64
Held through RVU19B, RVU19C, RVU19D.
January 1, 2018
RVU18AR1
$158.90changed to$160.41
- Conversion factor 35.8887 changed to 35.9996
- Practice expense RVU 2.43 changed to 2.48
- Work GPCI 1.024 changed to 1.020
- Practice expense GPCI 1.079 changed to 1.074
- Malpractice GPCI 0.610 changed to 0.562
Held through RVU18B, RVU18C, RVU18D.
January 1, 2017
RVU17A
No ratechanged to$158.90
Held through RVU17B, RVU17C, RVU17D.
January 1, 2013
RVU13AR
Earliest loaded release: No rate
Held through RVU13B, RVU13C, RVU13D, RVU14A, RVU14B, RVU14C, RVU14D, RVU15A, RVU15B, RVU15C, RVU15D, RVU16A, RVU16B, RVU16C, RVU16D.
| Effective from | Office | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | $36.21 | $21.57 | RVU26D |
| 2026-07-01 | $36.21 | $21.57 | RVU26C |
| 2026-04-01 | $36.21 | $21.57 | RVU26B |
| 2026-01-01 | $36.21 | $21.57 | RVU26A |
| 2025-10-01 | $33.39 | $23.84 | RVU25D |
| 2025-07-01 | $33.39 | $23.84 | RVU25C |
| 2025-04-01 | $33.39 | $23.84 | RVU25B |
| 2025-01-01 | $33.39 | $23.84 | RVU25A |
| 2024-10-01 | $34.18 | $24.72 | RVU24D |
| 2024-07-01 | $34.18 | $24.72 | RVU24C |
| 2024-04-01 | $34.18 | $24.72 | RVU24B |
| 2024-03-09 | $34.18 | $24.72 | RVU24AR |
| 2024-01-01 | $33.62 | $24.32 | RVU24A |
| 2023-10-01 | $34.17 | $24.67 | RVU23D |
| 2023-07-01 | $34.17 | $24.67 | RVU23C |
| 2023-04-01 | $34.17 | $24.67 | RVU23B |
| 2023-01-01 | $34.17 | $24.67 | RVU23A |
| 2022-10-01 | $34.65 | $25.44 | RVU22D |
| 2022-07-01 | $34.65 | $25.44 | RVU22C |
| 2022-04-01 | $34.65 | $25.44 | RVU22B |
| 2022-01-01 | $34.65 | $25.44 | RVU22A |
| 2021-10-01 | $35.31 | $25.65 | RVU21D |
| 2021-07-01 | $35.31 | $25.65 | RVU21C |
| 2021-04-01 | $35.31 | $25.65 | RVU21B |
| 2021-01-01 | $35.31 | $25.65 | RVU21A |
| 2020-10-01 | $35.74 | $26.48 | RVU20D |
| 2020-07-01 | $35.74 | $26.48 | RVU20C |
| 2020-04-01 | $35.74 | $26.48 | RVU20B |
| 2020-01-01 | $35.74 | $26.48 | RVU20A |
| 2019-10-01 | $166.78 | $96.33 | RVU19D |
| 2019-07-01 | $166.78 | $96.33 | RVU19C |
| 2019-04-01 | $166.78 | $96.33 | RVU19B |
| 2019-01-01 | $166.78 | $96.33 | RVU19A |
| 2018-10-01 | $160.41 | $96.23 | RVU18D |
| 2018-07-01 | $160.41 | $96.23 | RVU18C |
| 2018-04-01 | $160.41 | $96.23 | RVU18B |
| 2018-01-01 | $160.41 | $96.23 | RVU18AR1 |
| 2017-10-01 | $158.90 | $96.17 | RVU17D |
| 2017-07-01 | $158.90 | $96.17 | RVU17C |
| 2017-04-01 | $158.90 | $96.17 | RVU17B |
| 2017-01-01 | $158.90 | $96.17 | RVU17A |
| 2016-10-01 | Rate data unavailable | Rate data unavailable | RVU16D |
| 2016-07-01 | Rate data unavailable | Rate data unavailable | RVU16C |
| 2016-04-01 | Rate data unavailable | Rate data unavailable | RVU16B |
| 2016-01-01 | Rate data unavailable | Rate data unavailable | RVU16A |
| 2015-10-01 | Rate data unavailable | Rate data unavailable | RVU15D |
| 2015-07-01 | Rate data unavailable | Rate data unavailable | RVU15C |
| 2015-04-01 | Rate data unavailable | Rate data unavailable | RVU15B |
| 2015-01-01 | Rate data unavailable | Rate data unavailable | RVU15A |
| 2014-10-01 | Rate data unavailable | Rate data unavailable | RVU14D |
| 2014-07-01 | Rate data unavailable | Rate data unavailable | RVU14C |
| 2014-04-01 | Rate data unavailable | Rate data unavailable | RVU14B |
| 2014-01-01 | Rate data unavailable | Rate data unavailable | RVU14A |
| 2013-10-01 | Rate data unavailable | Rate data unavailable | RVU13D |
| 2013-07-01 | Rate data unavailable | Rate data unavailable | RVU13C |
| 2013-04-01 | Rate data unavailable | Rate data unavailable | RVU13B |
| 2013-01-01 | Rate data unavailable | Rate data unavailable | RVU13AR |
Where the Redding, CA rate applies
Redding, CA is a Medicare payment area, not a city. Our Census mapping connects it to 32 cities and communities in California. Some span more than one payment area; confirm with the service ZIP.
- Redding
- Anderson
- Bella Vista
- Big Bend
- Burney
- Cassel
- Castella
- Centerville
64421 billing questions
When is 64421 reported instead of 64420?
64420 represents the initial intercostal nerve block. Report 64421 for each additional intercostal nerve blocked in the same service.
Which primary code must accompany 64421?
Report 64421 with 64420 for the initial intercostal nerve block. CMS treats 64421 as an add-on code and pays it within the primary procedure’s global period.
What should the procedure note identify?
Document the clinical reason for the blocks, the intercostal nerves and side treated, and the anesthetic administered. The record should support that additional nerves beyond the first were blocked.
How is a bilateral procedure handled?
CMS pays a bilateral procedure reported with modifier 50 at 150%. The documentation should support treatment on both sides.
Is 64421 reported for every nerve injected?
Use 64420 for the first intercostal nerve and 64421 for each additional nerve. The documented nerve count should support the reported additional services.
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
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