CPT code 64450: Nerve block, other peripheral nerve or branch2026 Medicare rate & RVUs in Puerto Rico

Report 64450 for an anesthetic and/or steroid injection targeting a peripheral nerve or branch that does not have a more specific CPT code.

CMS RVU26DEffective Oct 1, 2026One payment locality387.6K Medicare services in 2024

In Puerto Rico, Medicare pays $81.39 for 64450 in the office and $38.50 when it’s performed in a hospital or facility.

$81.39Office (non-facility)
$38.50Hospital or facility
+0.7%vs the national office rate ($80.83)

Check a contract rate as a % of Medicare · 64450 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 64450 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Puerto Rico
  2. What 64450 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 64450 covers

A clinician injects anesthetic, steroid, or both around a peripheral nerve or branch not identified by a more specific nerve-block code. The block may be used to reduce pain or help evaluate whether a particular nerve is contributing to symptoms. Pain physicians, anesthesiologists, surgeons, and other clinicians may perform it in an office, outpatient procedure area, or hospital. The documented target must be the nerve or branch actually treated; this code is not a substitute for a code that names the nerve or anatomic target.

Report the service based on the documented nerve, indication, laterality, and injectate. The record should identify the target and support the clinical purpose of the block; for a diagnostic block, document the patient’s response when assessed. The code has a 0-day global period, so same-day preoperative and postoperative care is included. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and others are subject to the standard 50% reduction. Bilateral reporting with modifier 50 is paid at 150%. Assistant-at-surgery payment is restricted, and co-surgeon and team-surgery billing 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 64450

Across 109 of 109 payment localities, the office rate for 64450 runs from $72.07 in Arkansas to $106.34 in San Benito County, CA. Puerto Rico pays $81.39. The RVUs are the same everywhere; the geographic indexes change the dollars.

64450 in Puerto Rico vs other payment areas
  1. Puerto Rico · this page$81.39
  2. Los Angeles, CA · California$90.95+$9.56
  3. Washington, DC area · District of Columbia$92.04+$10.65
  4. Miami, FL · Florida$86.62+$5.23
  5. Chicago, IL · Illinois$84.30+$2.91
  6. Manhattan, NY · New York$92.53+$11.14
  7. Alaska · Alaska$95.49+$14.10

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

Every other payment area

64450 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$73.05$35.94
ArkansasArkansas$72.07$35.63
ArizonaArizona$78.82$37.71
Bakersfield, CACalifornia$85.57$39.08
Chico, CACalifornia$85.35$38.86
El Centro, CACalifornia$85.37$38.87
Fresno, CACalifornia$85.35$38.86
Hanford, CACalifornia$85.35$38.86

64450 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.

$72.07

$95.85

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

View every state and territory as a table
64450 office rate range by state
State / territoryOffice rate rangeLocalities
AK$95.491
AL$73.051
AR$72.071
AZ$78.821
CA$85.35–$106.3429
CO$84.071
CT$85.981
DC$92.041
DE$80.071
FL$79.63–$86.623
GA$75.44–$82.242
GU$87.261
HI$87.261
IA$74.821
ID$75.271
IL$77.44–$84.304
IN$75.681
KS$74.481
KY$74.631
LA$74.51–$77.962
MA$83.61–$92.072
MD$81.53–$92.043
ME$75.62–$79.482
MI$76.42–$80.542
MN$80.751
MO$73.30–$78.243
MS$72.701
MT$80.831
NC$76.361
ND$79.441
NE$75.211
NH$82.761
NJ$87.01–$91.182
NM$76.811
NV$80.491
NY$77.43–$94.625
OH$76.141
OK$74.521
OR$79.92–$86.632
PA$76.26–$83.942
PR$81.391
RI$82.831
SC$76.371
SD$79.281
TN$74.821
TX$75.79–$83.758
UT$77.351
VA$79.22–$92.042
VI$81.391
VT$79.131
WA$83.46–$93.902
WI$76.941
WV$74.751
WY$80.221

See 64450 in every payment locality

How the 64450 rate is calculated

Each of 64450’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 · 64450

RVUs × geographic indexes × conversion factor

Office or facility?

Work0.73

0.73 RVUs× 1.000 GPCI

Practice expense1.62

1.62 RVUs× 1.000 GPCI

Malpractice0.07

0.07 RVUs× 1.000 GPCI

Adjusted RVUs

2.4200

Conversion factor

$33.4009

Medicare rate

$80.83

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

7,113

Code
64450
Physician work
0.73
Practice expense
1.62
Malpractice
0.07

GPCI2026.csv

91

Locality
Puerto Rico
Physician work
1.000
Practice expense
1.011
Malpractice
0.985
Office calculation for 64450 in Puerto Rico
ComponentRVULocality factorAdjusted
Physician work0.73× 1.0000.7300
Practice expense1.62× 1.0111.6378
Malpractice0.07× 0.9850.0690
Total RVUs2.4368
Conversion factor× 33.4009

Office rate, Puerto Rico$81.39

Office: (0.73 × 1 + 1.62 × 1.011 + 0.07 × 0.985) × $33.4009 = $81.39

Facility: (0.73 × 1 + 0.35 × 1.011 + 0.07 × 0.985) × $33.4009 = $38.50

Open 64450 in the RVU calculator

Payment rules and modifiers for 64450

The CMS indicators that decide how 64450 is paid alongside other services.

CMS payment indicators · 64450

Nerve block, other peripheral nerve or branch

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

64450 without 50 · national office

$80.83

Nerve block, other peripheral nerve or branch

64450-50 · Bilateral: 150%

$121.25

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

How 64450 has changed in Puerto Rico

64450 · Office / nonfacility

$81.39

Effective 2026-10-01

The base rate is $9.30 higher than on 2025-10-01, moving from $72.09 to $81.39 (12.9%).

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

    $72.09changed to$81.39

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 0.75 changed to 0.73
    • Practice expense RVU 1.40 changed to 1.62
    • 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

    $75.51changed to$72.09

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 1.42 changed to 1.40
    • Malpractice RVU 0.09 changed to 0.07

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $74.27changed to$75.51

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $76.25changed to$74.27

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 1.41 changed to 1.42
    • Malpractice RVU 0.08 changed to 0.09
    • Practice expense GPCI 1.008 changed to 1.007
    • Malpractice GPCI 0.984 changed to 0.982
  5. October 1, 2023

    RVU23D

    $75.91changed to$76.25

    • Practice expense GPCI 1.000 changed to 1.008
    • Malpractice GPCI 1.000 changed to 0.984
  6. January 1, 2023

    RVU23A

    $78.56changed to$75.91

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 1.42 changed to 1.41
    • Malpractice RVU 0.09 changed to 0.08
    • 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

    $80.27changed to$78.56

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 1.45 changed to 1.42

    Held through RVU22B, RVU22C, RVU22D.

  8. January 1, 2021

    RVU21A

    $79.02changed to$80.27

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 1.34 changed to 1.45
    • Malpractice GPCI 0.988 changed to 0.986

    Held through RVU21B, RVU21C, RVU21D.

  9. January 1, 2020

    RVU20A

    $79.25changed to$79.02

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 1.37 changed to 1.34
    • Malpractice RVU 0.07 changed to 0.09
    • 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

    $82.42changed to$79.25

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 1.46 changed to 1.37

    Held through RVU19B, RVU19C, RVU19D.

  11. January 1, 2018

    RVU18AR1

    $73.07changed to$82.42

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 1.45 changed to 1.46
    • 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

    $64.19changed to$73.07

    • Conversion factor 35.8043 changed to 35.8887
    • 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

    $64.67changed to$64.19

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 1.46 changed to 1.45

    Held through RVU16B, RVU16C, RVU16D.

  14. July 1, 2015

    RVU15C

    $64.35changed to$64.67

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  15. January 1, 2015

    RVU15A

    $63.39changed to$64.35

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 1.45 changed to 1.46
    • Malpractice RVU 0.06 changed to 0.07
    • 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

    $62.47changed to$63.39

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 1.58 changed to 1.45
    • 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: $62.47

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$81.39$38.50RVU26D
2026-07-01$81.39$38.50RVU26C
2026-04-01$81.39$38.50RVU26B
2026-01-01$81.39$38.50RVU26A
2025-10-01$72.09$40.16RVU25D
2025-07-01$72.09$40.16RVU25C
2025-04-01$72.09$40.16RVU25B
2025-01-01$72.09$40.16RVU25A
2024-10-01$75.51$41.65RVU24D
2024-07-01$75.51$41.65RVU24C
2024-04-01$75.51$41.65RVU24B
2024-03-09$75.51$41.65RVU24AR
2024-01-01$74.27$40.97RVU24A
2023-10-01$76.25$42.09RVU23D
2023-07-01$75.91$42.02RVU23C
2023-04-01$75.91$42.02RVU23B
2023-01-01$75.91$42.02RVU23A
2022-10-01$78.56$42.98RVU22D
2022-07-01$78.56$42.98RVU22C
2022-04-01$78.56$42.98RVU22B
2022-01-01$78.56$42.98RVU22A
2021-10-01$80.27$43.34RVU21D
2021-07-01$80.27$43.34RVU21C
2021-04-01$80.27$43.34RVU21B
2021-01-01$80.27$43.34RVU21A
2020-10-01$79.02$44.46RVU20D
2020-07-01$79.02$44.46RVU20C
2020-04-01$79.02$44.46RVU20B
2020-01-01$79.02$44.46RVU20A
2019-10-01$79.25$46.22RVU19D
2019-07-01$79.25$46.22RVU19C
2019-04-01$79.25$46.22RVU19B
2019-01-01$79.25$46.22RVU19A
2018-10-01$82.42$46.90RVU18D
2018-07-01$82.42$46.90RVU18C
2018-04-01$82.42$46.90RVU18B
2018-01-01$82.42$46.90RVU18AR1
2017-10-01$73.07$43.28RVU17D
2017-07-01$73.07$43.28RVU17C
2017-04-01$73.07$43.28RVU17B
2017-01-01$73.07$43.28RVU17A
2016-10-01$64.19$39.96RVU16D
2016-07-01$64.19$39.96RVU16C
2016-04-01$64.19$39.96RVU16B
2016-01-01$64.19$39.96RVU16A
2015-10-01$64.67$40.10RVU15D
2015-07-01$64.67$40.10RVU15C
2015-04-01$64.35$39.90RVU15B
2015-01-01$64.35$39.90RVU15A
2014-10-01$63.39$39.84RVU14D
2014-07-01$63.39$39.84RVU14C
2014-04-01$63.39$39.84RVU14B
2014-01-01$63.39$39.84RVU14A
2013-10-01$62.47$38.02RVU13D
2013-07-01$62.47$38.02RVU13C
2013-04-01$62.47$38.02RVU13B
2013-01-01$62.47$38.02RVU13AR

Price 64450 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

64450 billing questions

When should 64450 be chosen instead of a code for a named nerve?

Use 64450 when the treated peripheral nerve or branch does not have a more specific code. For a nerve with its own code, report that code rather than using 64450 as a general substitute.

What should the procedure note identify?

Document the nerve or branch treated, the clinical indication, laterality, and the anesthetic and/or steroid injected. For a diagnostic block, record the response when it is assessed.

How is a bilateral service reported?

Use modifier 50 for a bilateral procedure; CMS pays it at 150%.

How does the multiple-procedure reduction affect 64450?

When it is performed with other procedures in the same session, the highest-valued procedure is paid in full and the others are paid at 50%.

Can an assistant, co-surgeon, or surgical team be billed for this procedure?

Assistant-at-surgery payment is restricted. Co-surgeons and team surgery are not permitted for this code.

Are same-day preoperative and postoperative services included?

Yes. The 0-day global period includes same-day preoperative and postoperative care.

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 64450PPRRVU2026_Oct_nonQPP.csv, line 7,113 (RVU26D)
Geographic factors for Puerto RicoGPCI2026.csv, line 91 (RVU26D)

Open CMS sourceHow we calculate rates

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