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CPT code 64421: Intercostal nerve block, each additional nerve2026 Medicare rate & RVUs in North Carolina

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 North Carolina, Medicare pays $33.33 for 64421 in the office and $20.86 when it’s performed in a hospital or facility.

$33.33Office (non-facility)
$20.86Hospital or facility
−5.0%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 North Carolina
  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 North Carolina 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. North Carolina pays $33.33. The RVUs are the same everywhere; the geographic indexes change the dollars.

64421 in North Carolina vs other payment areas
  1. North Carolina · this page$33.33
  2. Los Angeles, CA · California$38.30+$4.97
  3. Washington, DC area · District of Columbia$39.18+$5.85
  4. Miami, FL · Florida$38.32+$4.99
  5. Chicago, IL · Illinois$37.43+$4.10
  6. Manhattan, NY · New York$39.86+$6.53
  7. Alaska · Alaska$43.61+$10.28

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

Every other payment area

64421 in every other Medicare payment locality
Payment localityOfficeFacility
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
Hanford, 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 North Carolina 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

83

Locality
North Carolina
Physician work
1.000
Practice expense
0.933
Malpractice
0.639
Office calculation for 64421 in North Carolina
ComponentRVULocality factorAdjusted
Physician work0.49× 1.0000.4900
Practice expense0.51× 0.9330.4758
Malpractice0.05× 0.6390.0319
Total RVUs0.9978
Conversion factor× 33.4009

Office rate, North Carolina$33.33

Office: (0.49 × 1 + 0.51 × 0.933 + 0.05 × 0.639) × $33.4009 = $33.33

Facility: (0.49 × 1 + 0.11 × 0.933 + 0.05 × 0.639) × $33.4009 = $20.86

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, North Carolina
Primary code
64420Intercostal block, single nervePrimary code for the first intercostal nerve block; report 64421 for additional nerves.$100.25
Used instead
64461Paravertebral block, thoracic, single siteThoracic paravertebral block by a different regional approach.$141.87
64466Thoracic block, unilateral injectionThoracic fascial plane block, a different approach to regional chest wall analgesia.$134.34

How 64421 has changed in North Carolina

64421 · Office / nonfacility

$33.33

Effective 2026-10-01

The base rate is $2.52 higher than on 2025-10-01, moving from $30.81 to $33.33 (8.2%).

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

    $30.81changed to$33.33

    • 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
    • Practice expense GPCI 0.926 changed to 0.933
    • Malpractice GPCI 0.665 changed to 0.639

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $31.62changed to$30.81

    • 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

    $31.11changed to$31.62

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $31.77changed to$31.11

    • 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
    • Practice expense GPCI 0.927 changed to 0.926
    • Malpractice GPCI 0.742 changed to 0.665

  5. January 1, 2023

    RVU23A

    $32.53changed to$31.77

    • 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
    • Practice expense GPCI 0.928 changed to 0.927
    • Malpractice GPCI 0.819 changed to 0.742

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $33.12changed to$32.53

    • 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

    $33.51changed to$33.12

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 0.42 changed to 0.44
    • Practice expense GPCI 0.930 changed to 0.928
    • Malpractice GPCI 0.757 changed to 0.819

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $152.63changed to$33.51

    • 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
    • Practice expense GPCI 0.931 changed to 0.930
    • Malpractice GPCI 0.695 changed to 0.757

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $147.10changed to$152.63

    • 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

    $145.16changed to$147.10

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 2.43 changed to 2.48
    • Malpractice GPCI 0.732 changed to 0.695

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $146.25changed to$145.16

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 2.47 changed to 2.43
    • Practice expense GPCI 0.930 changed to 0.931
    • Malpractice GPCI 0.768 changed to 0.732

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $145.71changed to$146.25

    • 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

    $144.99changed to$145.71

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $147.36changed to$144.99

    • 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
    • Practice expense GPCI 0.929 changed to 0.930
    • Malpractice GPCI 0.732 changed to 0.768

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $150.20changed to$147.36

    • 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
    • Practice expense GPCI 0.927 changed to 0.929
    • Malpractice GPCI 0.695 changed to 0.732

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $150.20

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$33.33$20.86RVU26D
2026-07-01$33.33$20.86RVU26C
2026-04-01$33.33$20.86RVU26B
2026-01-01$33.33$20.86RVU26A
2025-10-01$30.81$22.72RVU25D
2025-07-01$30.81$22.72RVU25C
2025-04-01$30.81$22.72RVU25B
2025-01-01$30.81$22.72RVU25A
2024-10-01$31.62$23.61RVU24D
2024-07-01$31.62$23.61RVU24C
2024-04-01$31.62$23.61RVU24B
2024-03-09$31.62$23.61RVU24AR
2024-01-01$31.11$23.22RVU24A
2023-10-01$31.77$23.60RVU23D
2023-07-01$31.77$23.60RVU23C
2023-04-01$31.77$23.60RVU23B
2023-01-01$31.77$23.60RVU23A
2022-10-01$32.53$24.50RVU22D
2022-07-01$32.53$24.50RVU22C
2022-04-01$32.53$24.50RVU22B
2022-01-01$32.53$24.50RVU22A
2021-10-01$33.12$24.70RVU21D
2021-07-01$33.12$24.70RVU21C
2021-04-01$33.12$24.70RVU21B
2021-01-01$33.12$24.70RVU21A
2020-10-01$33.51$25.45RVU20D
2020-07-01$33.51$25.45RVU20C
2020-04-01$33.51$25.45RVU20B
2020-01-01$33.51$25.45RVU20A
2019-10-01$152.63$91.57RVU19D
2019-07-01$152.63$91.57RVU19C
2019-04-01$152.63$91.57RVU19B
2019-01-01$152.63$91.57RVU19A
2018-10-01$147.10$91.46RVU18D
2018-07-01$147.10$91.46RVU18C
2018-04-01$147.10$91.46RVU18B
2018-01-01$147.10$91.46RVU18AR1
2017-10-01$145.16$91.03RVU17D
2017-07-01$145.16$91.03RVU17C
2017-04-01$145.16$91.03RVU17B
2017-01-01$145.16$91.03RVU17A
2016-10-01$146.25$91.31RVU16D
2016-07-01$146.25$91.31RVU16C
2016-04-01$146.25$91.31RVU16B
2016-01-01$146.25$91.31RVU16A
2015-10-01$145.71$91.24RVU15D
2015-07-01$145.71$91.24RVU15C
2015-04-01$144.99$90.79RVU15B
2015-01-01$144.99$90.79RVU15A
2014-10-01$147.36$93.12RVU14D
2014-07-01$147.36$93.12RVU14C
2014-04-01$147.36$93.12RVU14B
2014-01-01$147.36$93.12RVU14A
2013-10-01$150.20$91.53RVU13D
2013-07-01$150.20$91.53RVU13C
2013-04-01$150.20$91.53RVU13B
2013-01-01$150.20$91.53RVU13AR

Price 64421 for an earlier date of service

Where the North Carolina rate applies

North Carolina is a Medicare payment area, not a city. Our Census mapping connects it to 785 cities and communities in North Carolina. Some span more than one payment area; confirm with the service ZIP.

  • Aberdeen
  • Advance
  • Ahoskie
  • Alamance
  • Albemarle
  • Alexis
  • Alliance
  • Altamahaw

Browse all communities in North Carolina

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 North CarolinaGPCI2026.csv, line 83 (RVU26D)

Open CMS sourceHow we calculate rates

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