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CPT code 64449: Lumbar plexus block, anesthetic or steroid injection2026 Medicare rate & RVUs

Reports injection of anesthetic and/or steroid at the lumbar plexus for regional anesthesia, perioperative analgesia, or selected pain treatment.

CMS RVU26DEffective Oct 1, 2026109 payment localities521 Medicare services in 2024

Medicare pays $60.46 for 64449 nationally in a facility.

Medicare rate · 64449

Lumbar plexus block, anesthetic or steroid injection

Office or facility?

Work RVUs
1.24
Total RVUs
1.81
Global days
000

National rate · 2026

$60.46

Facility setting, before claim adjustments.

See every locality for 64449 →Billed by an NP, PA or therapist? →

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

Your location

Medicare pays by the payment locality where the service is performed.

On this page 10 sections
  1. Medicare rate
  2. What 64449 covers
  3. By payment locality
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Similar codes
  8. Related codes
  9. Billing questions
  10. Sources

What 64449 covers

This service places anesthetic and/or steroid near the lumbar plexus to interrupt nerve signals from the lower extremity. Anesthesiologists and pain physicians commonly perform it in an operating room, procedure suite, or other setting where regional blocks are provided. A lumbar plexus block may support anesthesia or postoperative pain control for hip or femur procedures, or be used in selected pain-treatment plans.

Report the code when the documented target is the lumbar plexus, rather than an individual femoral or sciatic nerve. The record should identify the indication, laterality, target, and medication injected. This is a minor procedure with a 0-day global period, so same-day preoperative and postoperative care is included. When performed in the same session with other procedures, the highest-valued procedure is paid in full and other procedures are subject to the standard multiple-procedure reduction. For bilateral service, modifier 50 is paid at 150%. Assistant-at-surgery services are 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.

Where 64449 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

64449 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$56.63
AlaskaUnavailable$80.00
ArizonaUnavailable$59.34
ArkansasUnavailable$56.16
Atlanta, GAUnavailable$61.75
Austin, TXUnavailable$60.84
Bakersfield, CAUnavailable$60.79
Baltimore area, MDUnavailable$63.27
Beaumont, TXUnavailable$58.83
Brazoria, TXUnavailable$59.63

64449 rates by state

Office rate range in each state. Select a state to see its payment localities.

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Local rates. Clear comparisons.

Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.

View every state and territory as a table
64449 office rate range by state
State / territoryOffice rate rangeLocalities
AKNo published base rate1
ALNo published base rate1
ARNo published base rate1
AZNo published base rate1
CANo published base rate29
CONo published base rate1
CTNo published base rate1
DCNo published base rate1
DENo published base rate1
FLNo published base rate3
GANo published base rate2
GUNo published base rate1
HINo published base rate1
IANo published base rate1
IDNo published base rate1
ILNo published base rate4
INNo published base rate1
KSNo published base rate1
KYNo published base rate1
LANo published base rate2
MANo published base rate2
MDNo published base rate3
MENo published base rate2
MINo published base rate2
MNNo published base rate1
MONo published base rate3
MSNo published base rate1
MTNo published base rate1
NCNo published base rate1
NDNo published base rate1
NENo published base rate1
NHNo published base rate1
NJNo published base rate2
NMNo published base rate1
NVNo published base rate1
NYNo published base rate5
OHNo published base rate1
OKNo published base rate1
ORNo published base rate2
PANo published base rate2
PRNo published base rate1
RINo published base rate1
SCNo published base rate1
SDNo published base rate1
TNNo published base rate1
TXNo published base rate8
UTNo published base rate1
VANo published base rate2
VINo published base rate1
VTNo published base rate1
WANo published base rate2
WINo published base rate1
WVNo published base rate1
WYNo published base rate1

How the 64449 rate is calculated

Each of 64449’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 · 64449

RVUs × geographic indexes × conversion factor

Office or facility?

Work1.24

1.24 RVUs× 1.000 GPCI

Practice expense0.43

0.43 RVUs× 1.000 GPCI

Malpractice0.14

0.14 RVUs× 1.000 GPCI

Adjusted RVUs

1.8100

Conversion factor

$33.4009

Medicare rate

$60.46

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

Payment rules and modifiers for 64449

The CMS indicators that decide how 64449 is paid alongside other services.

CMS payment indicators · 64449

Lumbar plexus block, anesthetic or steroid injection

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

64449 without 50 · national facility

$60.46

Lumbar plexus block, anesthetic or steroid injection

64449-50 · Bilateral: 150%

$90.69

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

64449 compared with similar codes

Compare codes · National

5 codes, side by side

Office or facility?

  • 64449

    Lumbar plexus block, anesthetic or steroid injection1.24 wRVU

    Not priced

  • 64447

    Femoral nerve block, single injection1.31 wRVU

    $134.27

  • 64448

    Femoral nerve block, continuous catheter infusion1.64 wRVU

    Not priced

  • 64445

    Sciatic nerve block, single injection1.36 wRVU

    $173.35

  • 64446

    Sciatic nerve block, continuous catheter infusion1.71 wRVU

    Not priced

How to choose

64447Femoral nerve blockSingle injection
Use 64449 for a lumbar plexus target; use 64447 when the injection is directed specifically at the femoral nerve.
64448Femoral nerve blockContinuous catheter infusion
64448 describes a femoral nerve block delivered by continuous catheter infusion. It is not the code for a lumbar plexus injection.
64445Sciatic nerve blockSingle injection
64445 is directed at the sciatic nerve, not the lumbar plexus.
64446Sciatic nerve blockContinuous catheter infusion
64446 describes continuous catheter infusion at the sciatic nerve; 64449 identifies the lumbar plexus target.

Codes related to 64449

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

Codes related to 64449
CodeHow it relatesNational office range
Used instead
64447Femoral nerve block, single injectionTargets the femoral nerve rather than the lumbar plexus.$120.13–$175.46
64448Femoral nerve block, continuous catheter infusionFemoral nerve block with continuous catheter infusion, rather than a lumbar plexus injection.No office rate
64445Sciatic nerve block, single injectionTargets the sciatic nerve for lower-extremity regional anesthesia or analgesia.$153.59–$230.35
64446Sciatic nerve block, continuous catheter infusionSciatic nerve block with continuous catheter infusion.No office rate

64449 billing questions

How is this code distinguished from a femoral nerve block?

Use this code when the documented injection targets the lumbar plexus. A block directed at the femoral nerve is reported with the femoral nerve code instead.

Does the code include same-day preoperative and postoperative care?

Yes. It has a 0-day global period, and same-day preoperative and postoperative care is included.

How is bilateral lumbar plexus injection reported?

Report bilateral service with modifier 50. CMS pays the bilateral procedure at 150%.

What happens when this is performed with another procedure in the same session?

The highest-valued procedure is paid in full, and other procedures are subject to the standard multiple-procedure reduction.

Can an assistant or co-surgeon be reported for this procedure?

Assistant-at-surgery services are not paid. Co-surgeons and team surgery are not permitted.

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 64449PPRRVU2026_Oct_nonQPP.csv, line 7,112 (RVU26D)

Open CMS sourceHow we calculate rates

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