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CPT code 64421: Intercostal nerve block, each additional nerve2026 Medicare rate & RVUs in Baltimore area, MD

Reports anesthetic blockade of each intercostal nerve beyond the first, such as for chest wall pain managed with a regional block.

CMS RVU26DEffective Oct 1, 2026One payment locality20.3K Medicare services in 2024

In Baltimore area, MD, Medicare pays $36.97 for 64421 in the office and $22.64 when it’s performed in a hospital or facility.

$36.97Office (non-facility)
$22.64Hospital or facility
+5.4%vs the national office rate ($35.07)

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.

We’ll open 64421 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Baltimore area, MD
  2. What 64421 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 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 Baltimore area, MD 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. Baltimore area, MD pays $36.97. The RVUs are the same everywhere; the geographic indexes change the dollars.

64421 in Baltimore area, MD vs other payment areas
  1. Baltimore area, MD · this page$36.97
  2. Rest of Maryland · Maryland$35.30−$1.67
  3. Los Angeles, CA · California$38.30+$1.33
  4. Washington, DC area · District of Columbia$39.18+$2.21
  5. Miami, FL · Florida$38.32+$1.35
  6. Chicago, IL · Illinois$37.43+$0.46
  7. Manhattan, NY · New York$39.86+$2.89

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

Every other payment area

64421 in every other Medicare payment locality
Payment localityOfficeFacility
AlaskaAlaska$43.61$29.38
AlabamaAlabama$32.22$20.53
ArkansasArkansas$31.86$20.38
ArizonaArizona$34.30$21.36
Bakersfield, CACalifornia$36.36$21.72
Chico, CACalifornia$36.21$21.57
El Centro, CACalifornia$36.22$21.57
Fresno, CACalifornia$36.21$21.57

64421 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.

$31.86

$43.61

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

View every state and territory as a table
64421 office rate range by state
State / territoryOffice rate rangeLocalities
AK$43.611
AL$32.221
AR$31.861
AZ$34.301
CA$36.21–$43.6329
CO$35.991
CT$37.061
DC$39.181
DE$34.781
FL$35.16–$38.323
GA$33.55–$35.732
GU$36.701
HI$36.701
IA$32.621
ID$32.831
IL$34.53–$37.434
IN$32.971
KS$32.611
KY$33.041
LA$33.04–$34.292
MA$35.90–$38.862
MD$35.30–$39.183
ME$33.08–$34.302
MI$33.80–$35.622
MN$34.391
MO$32.68–$34.263
MS$32.271
MT$35.071
NC$33.331
ND$34.081
NE$32.721
NH$35.561
NJ$37.45–$38.942
NM$33.991
NV$34.811
NY$33.72–$40.775
OH$33.601
OK$32.881
OR$34.51–$36.802
PA$33.58–$36.392
PR$35.231
RI$35.761
SC$33.531
SD$33.961
TN$32.751
TX$33.42–$35.908
UT$33.881
VA$34.29–$39.182
VI$35.231
VT$34.081
WA$35.79–$39.452
WI$33.201
WV$33.561
WY$34.641

See 64421 in every payment locality

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

Office or facility?

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 Baltimore area, MD 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

60

Locality
Baltimore area, MD
Physician work
1.016
Practice expense
1.073
Malpractice
1.237
Office calculation for 64421 in Baltimore area, MD
ComponentRVULocality factorAdjusted
Physician work0.49× 1.0160.4978
Practice expense0.51× 1.0730.5472
Malpractice0.05× 1.2370.0619
Total RVUs1.1069
Conversion factor× 33.4009

Office rate, Baltimore area, MD$36.97

Office: (0.49 × 1.016 + 0.51 × 1.073 + 0.05 × 1.237) × $33.4009 = $36.97

Facility: (0.49 × 1.016 + 0.11 × 1.073 + 0.05 × 1.237) × $33.4009 = $22.64

Open 64421 in the RVU calculator

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

RuleCMS valueWhat it means
Global periodZZZAdd-on code: falls within the primary procedure’s global period.
Multiple procedures0No multiple-procedure reduction.
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

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).

When to use modifier 50

Codes related to 64421

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

Codes related to 64421
CodeHow it relatesOffice range, Baltimore area, MD
Primary code
64420Intercostal block, single nervePrimary code for the first intercostal nerve block; report 64421 for additional nerves.$112.10
Used instead
64461Paravertebral block, thoracic, single siteThoracic paravertebral block by a different regional approach.$158.18
64466Thoracic block, unilateral injectionThoracic fascial plane block, a different approach to regional chest wall analgesia.$150.30

How 64421 has changed in Baltimore area, MD

64421 · Office / nonfacility

$36.97

Effective 2026-10-01

The base rate is $2.74 higher than on 2025-10-01, moving from $34.23 to $36.97 (8.0%).

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

    $34.23changed to$36.97

    • 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 1.020 changed to 1.016
    • Practice expense GPCI 1.078 changed to 1.073
    • Malpractice GPCI 1.309 changed to 1.237

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $35.30changed to$34.23

    • 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.

  3. March 9, 2024

    RVU24AR

    $34.73changed to$35.30

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $35.33changed to$34.73

    • 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 1.024 changed to 1.020
    • Practice expense GPCI 1.087 changed to 1.078
    • Malpractice GPCI 1.311 changed to 1.309

  5. January 1, 2023

    RVU23A

    $36.37changed to$35.33

    • 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 1.028 changed to 1.024
    • Practice expense GPCI 1.096 changed to 1.087
    • Malpractice GPCI 1.313 changed to 1.311

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $37.05changed to$36.37

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 0.44 changed to 0.43

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $37.46changed to$37.05

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 0.42 changed to 0.44
    • Work GPCI 1.026 changed to 1.028
    • Practice expense GPCI 1.095 changed to 1.096
    • Malpractice GPCI 1.304 changed to 1.313

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $172.65changed to$37.46

    • 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 1.023 changed to 1.026
    • Malpractice GPCI 1.295 changed to 1.304

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $166.16changed to$172.65

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 2.48 changed to 2.64

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $163.48changed to$166.16

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 2.43 changed to 2.48
    • Practice expense GPCI 1.096 changed to 1.095
    • Malpractice GPCI 1.238 changed to 1.295

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $164.47changed to$163.48

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 2.47 changed to 2.43
    • Practice expense GPCI 1.097 changed to 1.096
    • Malpractice GPCI 1.181 changed to 1.238

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $163.91changed to$164.47

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 2.43 changed to 2.47
    • Malpractice RVU 0.15 changed to 0.14

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $163.10changed to$163.91

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $166.88changed to$163.10

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 2.47 changed to 2.43
    • Malpractice RVU 0.19 changed to 0.15
    • Work GPCI 1.025 changed to 1.023
    • Malpractice GPCI 1.194 changed to 1.181

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $171.41changed to$166.88

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 2.80 changed to 2.47
    • Malpractice RVU 0.20 changed to 0.19
    • Work GPCI 1.027 changed to 1.025
    • Malpractice GPCI 1.206 changed to 1.194

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $171.41

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$36.97$22.64RVU26D
2026-07-01$36.97$22.64RVU26C
2026-04-01$36.97$22.64RVU26B
2026-01-01$36.97$22.64RVU26A
2025-10-01$34.23$24.82RVU25D
2025-07-01$34.23$24.82RVU25C
2025-04-01$34.23$24.82RVU25B
2025-01-01$34.23$24.82RVU25A
2024-10-01$35.30$25.97RVU24D
2024-07-01$35.30$25.97RVU24C
2024-04-01$35.30$25.97RVU24B
2024-03-09$35.30$25.97RVU24AR
2024-01-01$34.73$25.55RVU24A
2023-10-01$35.33$25.76RVU23D
2023-07-01$35.33$25.76RVU23C
2023-04-01$35.33$25.76RVU23B
2023-01-01$35.33$25.76RVU23A
2022-10-01$36.37$26.89RVU22D
2022-07-01$36.37$26.89RVU22C
2022-04-01$36.37$26.89RVU22B
2022-01-01$36.37$26.89RVU22A
2021-10-01$37.05$27.11RVU21D
2021-07-01$37.05$27.11RVU21C
2021-04-01$37.05$27.11RVU21B
2021-01-01$37.05$27.11RVU21A
2020-10-01$37.46$27.98RVU20D
2020-07-01$37.46$27.98RVU20C
2020-04-01$37.46$27.98RVU20B
2020-01-01$37.46$27.98RVU20A
2019-10-01$172.65$100.83RVU19D
2019-07-01$172.65$100.83RVU19C
2019-04-01$172.65$100.83RVU19B
2019-01-01$172.65$100.83RVU19A
2018-10-01$166.16$100.72RVU18D
2018-07-01$166.16$100.72RVU18C
2018-04-01$166.16$100.72RVU18B
2018-01-01$166.16$100.72RVU18AR1
2017-10-01$163.48$99.76RVU17D
2017-07-01$163.48$99.76RVU17C
2017-04-01$163.48$99.76RVU17B
2017-01-01$163.48$99.76RVU17A
2016-10-01$164.47$99.66RVU16D
2016-07-01$164.47$99.66RVU16C
2016-04-01$164.47$99.66RVU16B
2016-01-01$164.47$99.66RVU16A
2015-10-01$163.91$99.66RVU15D
2015-07-01$163.91$99.66RVU15C
2015-04-01$163.10$99.16RVU15B
2015-01-01$163.10$99.16RVU15A
2014-10-01$166.88$102.82RVU14D
2014-07-01$166.88$102.82RVU14C
2014-04-01$166.88$102.82RVU14B
2014-01-01$166.88$102.82RVU14A
2013-10-01$171.41$101.99RVU13D
2013-07-01$171.41$101.99RVU13C
2013-04-01$171.41$101.99RVU13B
2013-01-01$171.41$101.99RVU13AR

Price 64421 for an earlier date of service

Where the Baltimore area, MD rate applies

Baltimore area, MD is a Medicare payment area, not a city. Our Census mapping connects it to 100 cities and communities in Maryland. Some span more than one payment area; confirm with the service ZIP.

  • Baltimore
  • Aberdeen
  • Aberdeen Proving Ground
  • Abingdon
  • Annapolis
  • Annapolis Neck
  • Arbutus
  • Arden on the Severn

Browse all communities in Maryland

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
RVUs for 64421PPRRVU2026_Oct_nonQPP.csv, line 7,104 (RVU26D)
Geographic factors for Baltimore area, MDGPCI2026.csv, line 60 (RVU26D)

Open CMS sourceHow we calculate rates

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