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CPT code 64435: Nerve block, paracervical (uterine)2026 Medicare rate & RVUs in Puerto Rico

Reports injection around a paracervical uterine nerve to provide regional anesthesia or pain relief during cervical or uterine care.

CMS RVU26DEffective Oct 1, 2026One payment locality60 Medicare services in 2024

In Puerto Rico, Medicare pays $75.60 for 64435 in the office and $38.79 when it’s performed in a hospital or facility.

$75.60Office (non-facility)
$38.79Hospital or facility
+0.6%vs the national office rate ($75.15)

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.

We’ll open 64435 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Puerto Rico
  2. What 64435 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 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 Puerto Rico 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. Puerto Rico pays $75.60. The RVUs are the same everywhere; the geographic indexes change the dollars.

64435 in Puerto Rico vs other payment areas
  1. Puerto Rico · this page$75.60
  2. Los Angeles, CA · California$83.19+$7.59
  3. Washington, DC area · District of Columbia$85.22+$9.62
  4. Miami, FL · Florida$83.69+$8.09
  5. Chicago, IL · Illinois$81.18+$5.58
  6. Manhattan, NY · New York$86.78+$11.18
  7. Alaska · Alaska$88.41+$12.81

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

Every other payment area

64435 in every other Medicare payment locality
Payment localityOfficeFacility
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

64435 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.

$66.50

$88.41

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

View every state and territory as a table
64435 office rate range by state
State / territoryOffice rate rangeLocalities
AK$88.411
AL$67.461
AR$66.501
AZ$73.091
CA$78.01–$96.3429
CO$77.471
CT$80.131
DC$85.221
DE$74.281
FL$75.29–$83.693
GA$70.97–$76.842
GU$79.681
HI$79.681
IA$68.591
ID$69.151
IL$73.56–$81.184
IN$69.531
KS$68.541
KY$69.631
LA$69.63–$73.002
MA$77.12–$84.682
MD$75.60–$85.223
ME$69.80–$73.132
MI$71.67–$76.512
MN$73.441
MO$68.63–$72.933
MS$67.571
MT$75.141
NC$70.471
ND$72.571
NE$68.881
NH$76.511
NJ$80.82–$84.412
NM$72.171
NV$74.471
NY$71.54–$89.215
OH$71.151
OK$69.221
OR$73.68–$79.582
PA$71.11–$78.332
PR$75.601
RI$76.681
SC$70.971
SD$72.271
TN$68.921
TX$70.67–$77.408
UT$71.921
VA$73.09–$85.222
VI$75.601
VT$72.541
WA$76.89–$86.122
WI$70.201
WV$70.941
WY$74.021

See 64435 in every payment locality

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

Office or facility?

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 Puerto Rico 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

91

Locality
Puerto Rico
Physician work
1.000
Practice expense
1.011
Malpractice
0.985
Office calculation for 64435 in Puerto Rico
ComponentRVULocality factorAdjusted
Physician work0.73× 1.0000.7300
Practice expense1.39× 1.0111.4053
Malpractice0.13× 0.9850.1280
Total RVUs2.2633
Conversion factor× 33.4009

Office rate, Puerto Rico$75.60

Office: (0.73 × 1 + 1.39 × 1.011 + 0.13 × 0.985) × $33.4009 = $75.60

Facility: (0.73 × 1 + 0.3 × 1.011 + 0.13 × 0.985) × $33.4009 = $38.79

Open 64435 in the RVU calculator

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)

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

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).

When to use modifier 50

Codes related to 64435

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

Codes related to 64435
CodeHow it relatesOffice range, Puerto Rico
Used instead
64430Nerve block, pudendal nerveFor a documented pudendal nerve block rather than a paracervical nerve block.$96.46
64425Nerve block, ilioinguinal and iliohypogastricTargets the ilioinguinal or iliohypogastric nerves, not the paracervical nerve.$121.80
64450Nerve block, other peripheral nerve or branchFor an eligible peripheral nerve or branch without a more specific listed injection code.$81.39

How 64435 has changed in Puerto Rico

64435 · Office / nonfacility

$75.60

Effective 2026-10-01

The base rate is $1.65 lower than on 2025-10-01, moving from $77.25 to $75.60 (2.1%).

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

    $77.25changed to$75.60

    • 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
    • Practice expense GPCI 1.007 changed to 1.011
    • Malpractice GPCI 0.982 changed to 0.985

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $80.84changed to$77.25

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 1.54 changed to 1.50

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $79.52changed to$80.84

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $82.70changed to$79.52

    • 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
    • Practice expense GPCI 1.008 changed to 1.007
    • Malpractice GPCI 0.984 changed to 0.982

  5. October 1, 2023

    RVU23D

    $82.35changed to$82.70

    • Practice expense GPCI 1.000 changed to 1.008
    • Malpractice GPCI 1.000 changed to 0.984

  6. January 1, 2023

    RVU23A

    $84.13changed to$82.35

    • Conversion factor 34.6062 changed to 33.8872
    • Malpractice RVU 0.11 changed to 0.12
    • Practice expense GPCI 1.008 changed to 1.000
    • Malpractice GPCI 0.986 changed to 1.000

    Held through RVU23B, RVU23C.

  7. January 1, 2022

    RVU22A

    $82.35changed to$84.13

    • 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.

  8. January 1, 2021

    RVU21A

    $75.73changed to$82.35

    • 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 0.988 changed to 0.986

    Held through RVU21B, RVU21C, RVU21D.

  9. January 1, 2020

    RVU20A

    $144.70changed to$75.73

    • 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
    • Practice expense GPCI 1.007 changed to 1.008
    • Malpractice GPCI 0.990 changed to 0.988

    Held through RVU20B, RVU20C, RVU20D.

  10. January 1, 2019

    RVU19A

    $140.55changed to$144.70

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 2.27 changed to 2.38

    Held through RVU19B, RVU19C, RVU19D.

  11. January 1, 2018

    RVU18AR1

    $124.16changed to$140.55

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 2.22 changed to 2.27
    • Practice expense GPCI 0.856 changed to 1.007
    • Malpractice GPCI 0.642 changed to 0.990

    Held through RVU18B, RVU18C, RVU18D.

  12. January 1, 2017

    RVU17A

    $110.49changed to$124.16

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 2.25 changed to 2.22
    • Practice expense GPCI 0.705 changed to 0.856
    • Malpractice GPCI 0.293 changed to 0.642

    Held through RVU17B, RVU17C, RVU17D.

  13. January 1, 2016

    RVU16A

    $110.24changed to$110.49

    • 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.

  14. July 1, 2015

    RVU15C

    $109.69changed to$110.24

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  15. January 1, 2015

    RVU15A

    $107.97changed to$109.69

    • 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
    • Practice expense GPCI 0.692 changed to 0.705
    • Malpractice GPCI 0.271 changed to 0.293

    Held through RVU15B.

  16. January 1, 2014

    RVU14A

    $106.73changed to$107.97

    • 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
    • Practice expense GPCI 0.678 changed to 0.692
    • Malpractice GPCI 0.249 changed to 0.271

    Held through RVU14B, RVU14C, RVU14D.

  17. January 1, 2013

    RVU13AR

    Earliest loaded release: $106.73

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$75.60$38.79RVU26D
2026-07-01$75.60$38.79RVU26C
2026-04-01$75.60$38.79RVU26B
2026-01-01$75.60$38.79RVU26A
2025-10-01$77.25$42.40RVU25D
2025-07-01$77.25$42.40RVU25C
2025-04-01$77.25$42.40RVU25B
2025-01-01$77.25$42.40RVU25A
2024-10-01$80.84$43.63RVU24D
2024-07-01$80.84$43.63RVU24C
2024-04-01$80.84$43.63RVU24B
2024-03-09$80.84$43.63RVU24AR
2024-01-01$79.52$42.92RVU24A
2023-10-01$82.70$43.76RVU23D
2023-07-01$82.35$43.71RVU23C
2023-04-01$82.35$43.71RVU23B
2023-01-01$82.35$43.71RVU23A
2022-10-01$84.13$44.01RVU22D
2022-07-01$84.13$44.01RVU22C
2022-04-01$84.13$44.01RVU22B
2022-01-01$84.13$44.01RVU22A
2021-10-01$82.35$44.71RVU21D
2021-07-01$82.35$44.71RVU21C
2021-04-01$82.35$44.71RVU21B
2021-01-01$82.35$44.71RVU21A
2020-10-01$75.73$45.54RVU20D
2020-07-01$75.73$45.54RVU20C
2020-04-01$75.73$45.54RVU20B
2020-01-01$75.73$45.54RVU20A
2019-10-01$144.70$84.81RVU19D
2019-07-01$144.70$84.81RVU19C
2019-04-01$144.70$84.81RVU19B
2019-01-01$144.70$84.81RVU19A
2018-10-01$140.55$84.72RVU18D
2018-07-01$140.55$84.72RVU18C
2018-04-01$140.55$84.72RVU18B
2018-01-01$140.55$84.72RVU18AR1
2017-10-01$124.16$79.30RVU17D
2017-07-01$124.16$79.30RVU17C
2017-04-01$124.16$79.30RVU17B
2017-01-01$124.16$79.30RVU17A
2016-10-01$110.49$73.14RVU16D
2016-07-01$110.49$73.14RVU16C
2016-04-01$110.49$73.14RVU16B
2016-01-01$110.49$73.14RVU16A
2015-10-01$110.24$73.51RVU15D
2015-07-01$110.24$73.51RVU15C
2015-04-01$109.69$73.14RVU15B
2015-01-01$109.69$73.14RVU15A
2014-10-01$107.97$73.02RVU14D
2014-07-01$107.97$73.02RVU14C
2014-04-01$107.97$73.02RVU14B
2014-01-01$107.97$73.02RVU14A
2013-10-01$106.73$70.05RVU13D
2013-07-01$106.73$70.05RVU13C
2013-04-01$106.73$70.05RVU13B
2013-01-01$106.73$70.05RVU13AR

Price 64435 for an earlier date of service

Where the Puerto Rico rate applies

Puerto Rico is a Medicare payment area, not a city. Our Census mapping connects it to 292 cities and communities in Puerto Rico. Some span more than one payment area; confirm with the service ZIP.

  • Aceitunas
  • Adjuntas
  • Aguada
  • Aguadilla
  • Aguas Buenas
  • Aguas Claras
  • Aguilita
  • Aibonito

Browse all communities in Puerto Rico

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
RVUs for 64435PPRRVU2026_Oct_nonQPP.csv, line 7,107 (RVU26D)
Geographic factors for Puerto RicoGPCI2026.csv, line 91 (RVU26D)

Open CMS sourceHow we calculate rates

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