CPT code 64435: Nerve block, paracervical (uterine)2026 Medicare rate & RVUs in North Dakota
Reports injection around a paracervical uterine nerve to provide regional anesthesia or pain relief during cervical or uterine care.
In North Dakota, Medicare pays $72.57 for 64435 in the office and $36.17 when it’s performed in a hospital or facility.
Check a contract rate as a % of Medicare · 64435 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 64435 covers
This service places anesthetic, with or without steroid, around a paracervical (uterine) nerve to create a regional block. Gynecologists, anesthesiologists, and pain physicians may perform it in an office, procedure room, or hospital. A typical setting is pain control for a cervical or uterine procedure; the code is selected for the paracervical nerve target, not simply because an injection is near the pelvis.
Document the nerve targeted, side, clinical reason, and procedure performed. The code has a 0-day global period, so same-day preoperative and postoperative care is included. For bilateral reporting, modifier 50 is paid at 150%. When multiple procedures occur in one session, the highest-valued procedure is paid in full and other procedures are paid at 50%. An assistant at surgery is not paid; 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 North Dakota compares for 64435
Across 109 of 109 payment localities, the office rate for 64435 runs from $66.50 in Arkansas to $96.34 in San Benito County, CA. North Dakota pays $72.57. The RVUs are the same everywhere; the geographic indexes change the dollars.
- North Dakota · this page$72.57
- Los Angeles, CA · California$83.19+$10.62
- Washington, DC area · District of Columbia$85.22+$12.65
- Miami, FL · Florida$83.69+$11.12
- Chicago, IL · Illinois$81.18+$8.61
- Manhattan, NY · New York$86.78+$14.21
- Alaska · Alaska$88.41+$15.84
Other areas in North Dakota first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| AlabamaAlabama | $67.46 | $35.61 |
| ArkansasArkansas | $66.50 | $35.23 |
| ArizonaArizona | $73.09 | $37.81 |
| Bakersfield, CACalifornia | $78.37 | $38.47 |
| Chico, CACalifornia | $78.01 | $38.11 |
| El Centro, CACalifornia | $78.03 | $38.13 |
| Fresno, CACalifornia | $78.01 | $38.11 |
| Hanford, CACalifornia | $78.01 | $38.11 |
| Madera, CACalifornia | $78.01 | $38.11 |
| Merced, CACalifornia | $78.01 | $38.11 |
| Modesto, CACalifornia | $78.01 | $38.11 |
| Napa, CACalifornia | $89.32 | $41.33 |
| Oxnard, CACalifornia | $82.65 | $39.61 |
| Redding, CACalifornia | $78.01 | $38.11 |
| Rest of CaliforniaCalifornia | $78.01 | $38.11 |
| Riverside, CACalifornia | $79.41 | $39.51 |
| Sacramento, CACalifornia | $81.58 | $39.24 |
| Salinas, CACalifornia | $81.28 | $39.08 |
| San Diego, CACalifornia | $82.99 | $39.45 |
| Marin County, CACalifornia | $94.15 | $42.82 |
| San Francisco, CACalifornia | $94.01 | $42.67 |
| San Benito County, CACalifornia | $96.34 | $43.84 |
| Santa Clara County, CACalifornia | $95.74 | $43.24 |
| San Luis Obispo, CACalifornia | $80.01 | $38.54 |
| Santa Cruz, CACalifornia | $83.63 | $39.40 |
| Santa Maria, CACalifornia | $81.53 | $39.08 |
| Santa Rosa, CACalifornia | $84.45 | $39.75 |
| Stockton, CACalifornia | $78.01 | $38.11 |
| Vallejo, CACalifornia | $89.10 | $41.12 |
| Visalia, CACalifornia | $78.01 | $38.11 |
| Yuba City, CACalifornia | $78.01 | $38.11 |
| ColoradoColorado | $77.47 | $38.73 |
| ConnecticutConnecticut | $80.13 | $40.92 |
| DelawareDelaware | $74.28 | $38.31 |
| Fort Lauderdale, FLFlorida | $79.26 | $42.38 |
| Rest of FloridaFlorida | $75.29 | $40.49 |
| Atlanta, GAGeorgia | $76.84 | $39.85 |
| Rest of GeorgiaGeorgia | $70.97 | $38.50 |
| Hawaii, Guam, HIHawaii | $79.68 | $38.29 |
| IowaIowa | $68.59 | $35.28 |
| IdahoIdaho | $69.15 | $35.66 |
| East St. Louis, ILIllinois | $75.84 | $42.35 |
| Rest of IllinoisIllinois | $73.56 | $40.32 |
| Suburban Chicago, ILIllinois | $79.93 | $42.54 |
| IndianaIndiana | $69.53 | $35.78 |
| KansasKansas | $68.54 | $35.63 |
| KentuckyKentucky | $69.63 | $37.26 |
| New Orleans, LALouisiana | $73.00 | $38.74 |
| Rest of LouisianaLouisiana | $69.63 | $37.41 |
| Metropolitan Boston, MAMassachusetts | $84.68 | $41.21 |
| Rest of MassachusettsMassachusetts | $77.12 | $38.78 |
| Baltimore area, MDMaryland | $79.96 | $40.90 |
| Rest of MarylandMaryland | $75.60 | $38.75 |
| Rest of MaineMaine | $69.80 | $36.30 |
| Southern Maine, MEMaine | $73.13 | $37.05 |
| Detroit, MIMichigan | $76.51 | $41.37 |
| Rest of MichiganMichigan | $71.67 | $38.43 |
| MinnesotaMinnesota | $73.44 | $35.98 |
| Metropolitan Kansas City, MOMissouri | $72.22 | $38.03 |
| Metropolitan St. Louis, MOMissouri | $72.93 | $38.27 |
| Rest of MissouriMissouri | $68.63 | $37.25 |
| MississippiMississippi | $67.57 | $36.22 |
| MontanaMontana | $75.14 | $38.74 |
| North CarolinaNorth Carolina | $70.47 | $36.51 |
| NebraskaNebraska | $68.88 | $35.27 |
| New HampshireNew Hampshire | $76.51 | $38.61 |
| Northern New JerseyNew Jersey | $84.41 | $42.18 |
| Rest of New JerseyNew Jersey | $80.82 | $41.06 |
| New MexicoNew Mexico | $72.17 | $38.79 |
| NevadaNevada | $74.47 | $38.03 |
| NYC suburbs and Long Island, NYNew York | $89.21 | $45.92 |
| Poughkeepsie and northern NYC suburbs, NYNew York | $81.57 | $41.71 |
| Queens, NYNew York | $87.08 | $44.05 |
| Rest of New YorkNew York | $71.54 | $36.95 |
| OhioOhio | $71.15 | $37.91 |
| OklahomaOklahoma | $69.22 | $36.70 |
| Portland, OROregon | $79.58 | $39.14 |
| Rest of OregonOregon | $73.68 | $37.42 |
| Metropolitan Philadelphia, PAPennsylvania | $78.33 | $40.43 |
| Rest of PennsylvaniaPennsylvania | $71.11 | $37.68 |
| Puerto RicoPuerto Rico | $75.60 | $38.79 |
| Rhode IslandRhode Island | $76.68 | $39.07 |
| South CarolinaSouth Carolina | $70.97 | $37.33 |
| South DakotaSouth Dakota | $72.27 | $35.86 |
| TennesseeTennessee | $68.92 | $35.82 |
| Austin, TXTexas | $77.40 | $38.88 |
| Beaumont, TXTexas | $70.67 | $37.53 |
| Brazoria, TXTexas | $73.97 | $37.89 |
| Dallas, TXTexas | $74.57 | $38.31 |
| Fort Worth, TXTexas | $74.16 | $38.26 |
| Galveston, TXTexas | $74.28 | $38.12 |
| Houston, TXTexas | $76.65 | $40.50 |
| Rest of TexasTexas | $72.36 | $37.81 |
| UtahUtah | $71.92 | $37.70 |
| VirginiaVirginia | $73.09 | $37.30 |
| Virgin Islands, VIUnited States Virgin Islands | $75.60 | $38.79 |
| VermontVermont | $72.54 | $36.50 |
| Rest of WashingtonWashington | $76.89 | $38.56 |
| King County, WAWashington | $86.12 | $41.44 |
| WisconsinWisconsin | $70.20 | $35.32 |
| West VirginiaWest Virginia | $70.94 | $39.30 |
| WyomingWyoming | $74.02 | $37.62 |
64435 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.
$66.50
$88.41
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 | $88.41 | 1 |
| AL | $67.46 | 1 |
| AR | $66.50 | 1 |
| AZ | $73.09 | 1 |
| CA | $78.01–$96.34 | 29 |
| CO | $77.47 | 1 |
| CT | $80.13 | 1 |
| DC | $85.22 | 1 |
| DE | $74.28 | 1 |
| FL | $75.29–$83.69 | 3 |
| GA | $70.97–$76.84 | 2 |
| GU | $79.68 | 1 |
| HI | $79.68 | 1 |
| IA | $68.59 | 1 |
| ID | $69.15 | 1 |
| IL | $73.56–$81.18 | 4 |
| IN | $69.53 | 1 |
| KS | $68.54 | 1 |
| KY | $69.63 | 1 |
| LA | $69.63–$73.00 | 2 |
| MA | $77.12–$84.68 | 2 |
| MD | $75.60–$85.22 | 3 |
| ME | $69.80–$73.13 | 2 |
| MI | $71.67–$76.51 | 2 |
| MN | $73.44 | 1 |
| MO | $68.63–$72.93 | 3 |
| MS | $67.57 | 1 |
| MT | $75.14 | 1 |
| NC | $70.47 | 1 |
| ND | $72.57 | 1 |
| NE | $68.88 | 1 |
| NH | $76.51 | 1 |
| NJ | $80.82–$84.41 | 2 |
| NM | $72.17 | 1 |
| NV | $74.47 | 1 |
| NY | $71.54–$89.21 | 5 |
| OH | $71.15 | 1 |
| OK | $69.22 | 1 |
| OR | $73.68–$79.58 | 2 |
| PA | $71.11–$78.33 | 2 |
| PR | $75.60 | 1 |
| RI | $76.68 | 1 |
| SC | $70.97 | 1 |
| SD | $72.27 | 1 |
| TN | $68.92 | 1 |
| TX | $70.67–$77.40 | 8 |
| UT | $71.92 | 1 |
| VA | $73.09–$85.22 | 2 |
| VI | $75.60 | 1 |
| VT | $72.54 | 1 |
| WA | $76.89–$86.12 | 2 |
| WI | $70.20 | 1 |
| WV | $70.94 | 1 |
| WY | $74.02 | 1 |
How the 64435 rate is calculated
Each of 64435’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 · 64435
RVUs × geographic indexes × conversion factor
Work0.73
0.73 RVUs× 1.000 GPCI
Practice expense1.39
1.39 RVUs× 1.000 GPCI
Malpractice0.13
0.13 RVUs× 1.000 GPCI
Adjusted RVUs
2.2500
Conversion factor
$33.4009
Medicare rate
$75.15
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
The exact North Dakota inputs and CMS source lines
PPRRVU2026_Oct_nonQPP.csv
7,107
- Code
- 64435
- Physician work
- 0.73
- Practice expense
- 1.39
- Malpractice
- 0.13
GPCI2026.csv
84
- Locality
- North Dakota
- Physician work
- 1.000
- Practice expense
- 1.000
- Malpractice
- 0.406
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 0.73 | × 1.000 | 0.7300 |
| Practice expense | 1.39 | × 1.000 | 1.3900 |
| Malpractice | 0.13 | × 0.406 | 0.0528 |
| Total RVUs | 2.1728 | ||
| Conversion factor | × 33.4009 | ||
Office rate, North Dakota$72.57
Office: (0.73 × 1 + 1.39 × 1 + 0.13 × 0.406) × $33.4009 = $72.57
Facility: (0.73 × 1 + 0.3 × 1 + 0.13 × 0.406) × $33.4009 = $36.17
Payment rules and modifiers for 64435
The CMS indicators that decide how 64435 is paid alongside other services.
CMS payment indicators · 64435
Nerve block, paracervical (uterine)
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 000 | Same-day global: pre- and post-op care on the day of the procedure is included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| 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
64435 without 50 · national office
$75.15
Nerve block, paracervical (uterine)
64435-50 · Bilateral: 150%
$112.73
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 64435 has changed in North Dakota
64435 · Office / nonfacility
$72.57
Effective 2026-10-01
The base rate is $2.38 lower than on 2025-10-01, moving from $74.95 to $72.57 (3.2%).
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
$74.95changed to$72.57
- Conversion factor 32.3465 changed to 33.4009
- Work RVU 0.75 changed to 0.73
- Practice expense RVU 1.50 changed to 1.39
- Malpractice GPCI 0.517 changed to 0.406
Held through RVU26B, RVU26C, RVU26D.
January 1, 2025
RVU25A
$78.47changed to$74.95
- Conversion factor 33.2875 changed to 32.3465
- Practice expense RVU 1.54 changed to 1.50
Held through RVU25B, RVU25C, RVU25D.
March 9, 2024
RVU24AR
$77.18changed to$78.47
- Conversion factor 32.7442 changed to 33.2875
Held through RVU24B, RVU24C, RVU24D.
January 1, 2024
RVU24A
$80.21changed to$77.18
- Conversion factor 33.8872 changed to 32.7442
- Practice expense RVU 1.56 changed to 1.54
- Malpractice RVU 0.12 changed to 0.13
- Malpractice GPCI 0.474 changed to 0.517
January 1, 2023
RVU23A
$81.58changed to$80.21
- Conversion factor 34.6062 changed to 33.8872
- Malpractice RVU 0.11 changed to 0.12
- Malpractice GPCI 0.431 changed to 0.474
Held through RVU23B, RVU23C, RVU23D.
January 1, 2022
RVU22A
$79.42changed to$81.58
- Conversion factor 34.8931 changed to 34.6062
- Practice expense RVU 1.47 changed to 1.56
- Malpractice RVU 0.13 changed to 0.11
Held through RVU22B, RVU22C, RVU22D.
January 1, 2021
RVU21A
$73.38changed to$79.42
- Conversion factor 36.0896 changed to 34.8931
- Practice expense RVU 1.23 changed to 1.47
- Malpractice RVU 0.11 changed to 0.13
- Malpractice GPCI 0.485 changed to 0.431
Held through RVU21B, RVU21C, RVU21D.
January 1, 2020
RVU20A
$141.34changed to$73.38
- Conversion factor 36.0391 changed to 36.0896
- Work RVU 1.45 changed to 0.75
- Practice expense RVU 2.38 changed to 1.23
- Malpractice RVU 0.17 changed to 0.11
- Malpractice GPCI 0.540 changed to 0.485
Held through RVU20B, RVU20C, RVU20D.
January 1, 2019
RVU19A
$137.22changed to$141.34
- Conversion factor 35.9996 changed to 36.0391
- Practice expense RVU 2.27 changed to 2.38
Held through RVU19B, RVU19C, RVU19D.
January 1, 2018
RVU18AR1
$135.05changed to$137.22
- Conversion factor 35.8887 changed to 35.9996
- Practice expense RVU 2.22 changed to 2.27
- Malpractice GPCI 0.547 changed to 0.540
Held through RVU18B, RVU18C, RVU18D.
January 1, 2017
RVU17A
$135.85changed to$135.05
- Conversion factor 35.8043 changed to 35.8887
- Practice expense RVU 2.25 changed to 2.22
- Malpractice GPCI 0.554 changed to 0.547
Held through RVU17B, RVU17C, RVU17D.
January 1, 2016
RVU16A
$135.46changed to$135.85
- Conversion factor 35.9335 changed to 35.8043
- Practice expense RVU 2.22 changed to 2.25
- Malpractice RVU 0.18 changed to 0.17
Held through RVU16B, RVU16C, RVU16D.
July 1, 2015
RVU15C
$134.79changed to$135.46
- Conversion factor 35.7547 changed to 35.9335
Held through RVU15D.
January 1, 2015
RVU15A
$134.09changed to$134.79
- Conversion factor 35.8228 changed to 35.7547
- Practice expense RVU 2.17 changed to 2.22
- Malpractice RVU 0.23 changed to 0.18
- Malpractice GPCI 0.536 changed to 0.554
Held through RVU15B.
January 1, 2014
RVU14A
$135.21changed to$134.09
- Conversion factor 34.0230 changed to 35.8228
- Practice expense RVU 2.40 changed to 2.17
- Malpractice RVU 0.24 changed to 0.23
- Malpractice GPCI 0.517 changed to 0.536
Held through RVU14B, RVU14C, RVU14D.
January 1, 2013
RVU13AR
Earliest loaded release: $135.21
Held through RVU13B, RVU13C, RVU13D.
| Effective from | Office | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | $72.57 | $36.17 | RVU26D |
| 2026-07-01 | $72.57 | $36.17 | RVU26C |
| 2026-04-01 | $72.57 | $36.17 | RVU26B |
| 2026-01-01 | $72.57 | $36.17 | RVU26A |
| 2025-10-01 | $74.95 | $40.34 | RVU25D |
| 2025-07-01 | $74.95 | $40.34 | RVU25C |
| 2025-04-01 | $74.95 | $40.34 | RVU25B |
| 2025-01-01 | $74.95 | $40.34 | RVU25A |
| 2024-10-01 | $78.47 | $41.52 | RVU24D |
| 2024-07-01 | $78.47 | $41.52 | RVU24C |
| 2024-04-01 | $78.47 | $41.52 | RVU24B |
| 2024-03-09 | $78.47 | $41.52 | RVU24AR |
| 2024-01-01 | $77.18 | $40.84 | RVU24A |
| 2023-10-01 | $80.21 | $41.58 | RVU23D |
| 2023-07-01 | $80.21 | $41.58 | RVU23C |
| 2023-04-01 | $80.21 | $41.58 | RVU23B |
| 2023-01-01 | $80.21 | $41.58 | RVU23A |
| 2022-10-01 | $81.58 | $41.78 | RVU22D |
| 2022-07-01 | $81.58 | $41.78 | RVU22C |
| 2022-04-01 | $81.58 | $41.78 | RVU22B |
| 2022-01-01 | $81.58 | $41.78 | RVU22A |
| 2021-10-01 | $79.42 | $42.08 | RVU21D |
| 2021-07-01 | $79.42 | $42.08 | RVU21C |
| 2021-04-01 | $79.42 | $42.08 | RVU21B |
| 2021-01-01 | $79.42 | $42.08 | RVU21A |
| 2020-10-01 | $73.38 | $43.43 | RVU20D |
| 2020-07-01 | $73.38 | $43.43 | RVU20C |
| 2020-04-01 | $73.38 | $43.43 | RVU20B |
| 2020-01-01 | $73.38 | $43.43 | RVU20A |
| 2019-10-01 | $141.34 | $81.87 | RVU19D |
| 2019-07-01 | $141.34 | $81.87 | RVU19C |
| 2019-04-01 | $141.34 | $81.87 | RVU19B |
| 2019-01-01 | $141.34 | $81.87 | RVU19A |
| 2018-10-01 | $137.22 | $81.78 | RVU18D |
| 2018-07-01 | $137.22 | $81.78 | RVU18C |
| 2018-04-01 | $137.22 | $81.78 | RVU18B |
| 2018-01-01 | $137.22 | $81.78 | RVU18AR1 |
| 2017-10-01 | $135.05 | $82.65 | RVU17D |
| 2017-07-01 | $135.05 | $82.65 | RVU17C |
| 2017-04-01 | $135.05 | $82.65 | RVU17B |
| 2017-01-01 | $135.05 | $82.65 | RVU17A |
| 2016-10-01 | $135.85 | $82.86 | RVU16D |
| 2016-07-01 | $135.85 | $82.86 | RVU16C |
| 2016-04-01 | $135.85 | $82.86 | RVU16B |
| 2016-01-01 | $135.85 | $82.86 | RVU16A |
| 2015-10-01 | $135.46 | $83.36 | RVU15D |
| 2015-07-01 | $135.46 | $83.36 | RVU15C |
| 2015-04-01 | $134.79 | $82.94 | RVU15B |
| 2015-01-01 | $134.79 | $82.94 | RVU15A |
| 2014-10-01 | $134.09 | $83.58 | RVU14D |
| 2014-07-01 | $134.09 | $83.58 | RVU14C |
| 2014-04-01 | $134.09 | $83.58 | RVU14B |
| 2014-01-01 | $134.09 | $83.58 | RVU14A |
| 2013-10-01 | $135.21 | $81.11 | RVU13D |
| 2013-07-01 | $135.21 | $81.11 | RVU13C |
| 2013-04-01 | $135.21 | $81.11 | RVU13B |
| 2013-01-01 | $135.21 | $81.11 | RVU13AR |
Where the North Dakota rate applies
North Dakota is a Medicare payment area, not a city. Our Census mapping connects it to 406 cities and communities in North Dakota. Some span more than one payment area; confirm with the service ZIP.
- Abercrombie
- Adams
- Alamo
- Alexander
- Alice
- Almont
- Alsen
- Ambrose
64435 billing questions
How is this different from a pudendal nerve block?
This code is for injection at the paracervical (uterine) nerve. Use the pudendal nerve code, 64430, when the documented target is the pudendal nerve.
When should modifier 50 be reported?
When the paracervical nerve injection is performed bilaterally, report modifier 50. CMS pays the bilateral procedure at 150%.
What does the 0-day global period include?
Same-day preoperative and postoperative care is included in the procedure. The global period is 0 days.
What documentation supports reporting this code?
Document the paracervical nerve target, laterality, reason for the block, and the injection performed. The record should distinguish this target from another pelvic nerve.
How does CMS handle this with another procedure in the same session?
The highest-valued procedure is paid in full, and other procedures in the session are paid at 50% under the standard multiple procedure 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
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