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

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 Virginia, Medicare pays $79.22 for 64450 in the office and $37.52 when it’s performed in a hospital or facility.

$79.22Office (non-facility)
$37.52Hospital or facility
−2.0%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 Virginia
  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 Virginia 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. Virginia pays $79.22. The RVUs are the same everywhere; the geographic indexes change the dollars.

64450 in Virginia vs other payment areas
  1. Virginia · this page$79.22
  2. Los Angeles, CA · California$90.95+$11.73
  3. Washington, DC area · District of Columbia$92.04+$12.82
  4. Miami, FL · Florida$86.62+$7.40
  5. Chicago, IL · Illinois$84.30+$5.08
  6. Manhattan, NY · New York$92.53+$13.31
  7. Alaska · Alaska$95.49+$16.27

Other areas in Virginia 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 Virginia 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

106

Locality
Virginia
Physician work
1.000
Practice expense
0.983
Malpractice
0.706
Office calculation for 64450 in Virginia
ComponentRVULocality factorAdjusted
Physician work0.73× 1.0000.7300
Practice expense1.62× 0.9831.5925
Malpractice0.07× 0.7060.0494
Total RVUs2.3719
Conversion factor× 33.4009

Office rate, Virginia$79.22

Office: (0.73 × 1 + 1.62 × 0.983 + 0.07 × 0.706) × $33.4009 = $79.22

Facility: (0.73 × 1 + 0.35 × 0.983 + 0.07 × 0.706) × $33.4009 = $37.52

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 Virginia

64450 · Office / nonfacility

$79.22

Effective 2026-10-01

The base rate is $8.64 higher than on 2025-10-01, moving from $70.58 to $79.22 (12.2%).

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

    $70.58changed to$79.22

    • 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
    • Work GPCI 1.002 changed to 1.000
    • Practice expense GPCI 0.984 changed to 0.983
    • Malpractice GPCI 0.755 changed to 0.706

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $73.79changed to$70.58

    • 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

    $72.59changed to$73.79

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $74.96changed to$72.59

    • 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
    • Work GPCI 1.000 changed to 1.002
    • Practice expense GPCI 0.990 changed to 0.984
    • Malpractice GPCI 0.826 changed to 0.755
  5. January 1, 2023

    RVU23A

    $77.64changed to$74.96

    • 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 0.995 changed to 0.990
    • Malpractice GPCI 0.897 changed to 0.826

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $79.33changed to$77.64

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

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $77.93changed to$79.33

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 1.34 changed to 1.45
    • Practice expense GPCI 0.991 changed to 0.995
    • Malpractice GPCI 0.903 changed to 0.897

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $78.00changed to$77.93

    • 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 0.986 changed to 0.991
    • Malpractice GPCI 0.908 changed to 0.903

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $81.11changed to$78.00

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

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $80.35changed to$81.11

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 1.45 changed to 1.46
    • Practice expense GPCI 0.985 changed to 0.986
    • Malpractice GPCI 0.866 changed to 0.908

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $79.95changed to$80.35

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense GPCI 0.983 changed to 0.985
    • Malpractice GPCI 0.824 changed to 0.866

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $80.59changed to$79.95

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

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $80.19changed to$80.59

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $79.44changed to$80.19

    • 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 0.980 changed to 0.983
    • Malpractice GPCI 0.778 changed to 0.824

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $79.53changed to$79.44

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 1.58 changed to 1.45
    • Practice expense GPCI 0.977 changed to 0.980
    • Malpractice GPCI 0.731 changed to 0.778

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $79.53

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$79.22$37.52RVU26D
2026-07-01$79.22$37.52RVU26C
2026-04-01$79.22$37.52RVU26B
2026-01-01$79.22$37.52RVU26A
2025-10-01$70.58$39.39RVU25D
2025-07-01$70.58$39.39RVU25C
2025-04-01$70.58$39.39RVU25B
2025-01-01$70.58$39.39RVU25A
2024-10-01$73.79$40.71RVU24D
2024-07-01$73.79$40.71RVU24C
2024-04-01$73.79$40.71RVU24B
2024-03-09$73.79$40.71RVU24AR
2024-01-01$72.59$40.04RVU24A
2023-10-01$74.96$41.41RVU23D
2023-07-01$74.96$41.41RVU23C
2023-04-01$74.96$41.41RVU23B
2023-01-01$74.96$41.41RVU23A
2022-10-01$77.64$42.52RVU22D
2022-07-01$77.64$42.52RVU22C
2022-04-01$77.64$42.52RVU22B
2022-01-01$77.64$42.52RVU22A
2021-10-01$79.33$42.87RVU21D
2021-07-01$79.33$42.87RVU21C
2021-04-01$79.33$42.87RVU21B
2021-01-01$79.33$42.87RVU21A
2020-10-01$77.93$43.95RVU20D
2020-07-01$77.93$43.95RVU20C
2020-04-01$77.93$43.95RVU20B
2020-01-01$77.93$43.95RVU20A
2019-10-01$78.00$45.67RVU19D
2019-07-01$78.00$45.67RVU19C
2019-04-01$78.00$45.67RVU19B
2019-01-01$78.00$45.67RVU19A
2018-10-01$81.11$46.33RVU18D
2018-07-01$81.11$46.33RVU18C
2018-04-01$81.11$46.33RVU18B
2018-01-01$81.11$46.33RVU18AR1
2017-10-01$80.35$46.06RVU17D
2017-07-01$80.35$46.06RVU17C
2017-04-01$80.35$46.06RVU17B
2017-01-01$80.35$46.06RVU17A
2016-10-01$79.95$46.16RVU16D
2016-07-01$79.95$46.16RVU16C
2016-04-01$79.95$46.16RVU16B
2016-01-01$79.95$46.16RVU16A
2015-10-01$80.59$46.33RVU15D
2015-07-01$80.59$46.33RVU15C
2015-04-01$80.19$46.10RVU15B
2015-01-01$80.19$46.10RVU15A
2014-10-01$79.44$46.09RVU14D
2014-07-01$79.44$46.09RVU14C
2014-04-01$79.44$46.09RVU14B
2014-01-01$79.44$46.09RVU14A
2013-10-01$79.53$44.29RVU13D
2013-07-01$79.53$44.29RVU13C
2013-04-01$79.53$44.29RVU13B
2013-01-01$79.53$44.29RVU13AR

Price 64450 for an earlier date of service

Where the Virginia rate applies

Virginia is a Medicare payment area, not a city. Our Census mapping connects it to 628 cities and communities in Virginia. Some span more than one payment area; confirm with the service ZIP.

  • Abbs Valley
  • Abingdon
  • Accomac
  • Adwolf
  • Afton
  • Alberta
  • Aldie
  • Allison Gap

Browse all communities in Virginia

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 VirginiaGPCI2026.csv, line 106 (RVU26D)

Open CMS sourceHow we calculate rates

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