CPT code 64454: Genicular nerve block, anesthetic or steroid injection2026 Medicare rate & RVUs in California
Reports anesthetic and/or steroid injection of genicular nerve branches for knee pain, including imaging guidance when performed.
Medicare pays $251.01–$318.25 for 64454 in the office in California, from Chico, CA to San Benito County, CA. Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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On this page 9 sections
What 64454 covers
A clinician injects anesthetic, steroid, or both near sensory branches supplying the knee. This service is commonly used to evaluate or relieve knee pain, including pain associated with osteoarthritis, and may help assess a patient’s response before considering genicular nerve destruction. It is performed in office or facility settings; imaging guidance, when used, is included in the service.
Report 64454 for the genicular nerve branch injection rather than counting each needle placement or branch as a separate service. Documentation should identify the treated side and branches, the indication, medications administered, and guidance used when applicable. CMS assigns a 0-day global period, so same-day preoperative and postoperative care is included. For bilateral treatment, modifier 50 is paid at 150%. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and the others at 50%. Assistant-at-surgery payment is restricted; 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 64454 pays more and less in California
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
29 payment localities
$251.01 to $318.25
29 of 29 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Bakersfield, CA | $251.43 | $74.25 |
| Chico, CA | $251.01 | $73.83 |
| El Centro, CA | $251.03 | $73.86 |
| Fresno, CA | $251.01 | $73.83 |
| Hanford, CA | $251.01 | $73.83 |
| Los Angeles, CA | $268.51 | $77.26 |
| Madera, CA | $251.01 | $73.83 |
| Marin County, CA | $311.38 | $83.44 |
| Merced, CA | $251.01 | $73.83 |
| Modesto, CA | $251.01 | $73.83 |
| Napa, CA | $293.35 | $80.29 |
| Oxnard, CA | $267.50 | $76.42 |
| Redding, CA | $251.01 | $73.83 |
| Rest of California | $251.01 | $73.83 |
| Riverside, CA | $252.44 | $75.26 |
| Sacramento, CA | $264.08 | $76.07 |
| Salinas, CA | $263.11 | $75.75 |
| San Benito County, CA | $318.25 | $85.13 |
| San Diego, CA | $269.79 | $76.44 |
| San Francisco, CA | $311.23 | $83.29 |
| San Luis Obispo, CA | $258.80 | $74.67 |
| Santa Clara County, CA | $317.64 | $84.53 |
| Santa Cruz, CA | $272.75 | $76.34 |
| Santa Maria, CA | $264.23 | $75.73 |
| Santa Rosa, CA | $275.55 | $77.03 |
| Stockton, CA | $251.01 | $73.83 |
| Vallejo, CA | $293.14 | $80.07 |
| Visalia, CA | $251.01 | $73.83 |
| Yuba City, CA | $251.01 | $73.83 |
How the 64454 rate is calculated
Each of 64454’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 · 64454
RVUs × geographic indexes × conversion factor
Work1.48
1.48 RVUs× 1.000 GPCI
Practice expense5.42
5.42 RVUs× 1.000 GPCI
Malpractice0.13
0.13 RVUs× 1.000 GPCI
Adjusted RVUs
7.0300
Conversion factor
$33.4009
Medicare rate
$234.81
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 64454
The CMS indicators that decide how 64454 is paid alongside other services.
CMS payment indicators · 64454
Genicular nerve block, anesthetic or steroid injection
| 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
64454 without 50 · national office
$234.81
Genicular nerve block, anesthetic or steroid injection
64454-50 · Bilateral: 150%
$352.22
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).
64454 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 64624Genicular nerve ablationThree or more branches
- 64454 is for anesthetic and/or steroid injection of genicular branches; 64624 is for neurolytic destruction of those branches.
- 64450Nerve blockOther peripheral nerve or branch
- Use 64454 for the specifically identified genicular nerve branches. 64450 describes injection of another peripheral nerve or branch not represented by a more specific code.
- 20610Joint injectionMajor joint or bursa, no ultrasound
- 64454 targets sensory nerve branches supplying the knee. 20610 targets the major joint space, such as for an intra-articular knee injection.
64454 billing questions
Should each genicular branch or needle placement be reported as a unit?
No. Report the code for the genicular nerve branch injection on the treated side rather than billing separately for each branch or needle placement.
Is imaging guidance separately reported?
No. Imaging guidance is included when performed as part of the genicular nerve branch injection.
How is bilateral treatment reported?
Use modifier 50 for bilateral treatment. CMS pays the bilateral procedure at 150%.
How does this differ from genicular nerve destruction?
64454 reports injection of anesthetic and/or steroid. Use 64624 when the service is neurolytic destruction of genicular nerve branches.
What documentation supports the service?
Document the knee and side treated, the genicular branches targeted, the reason for the injection, the medications administered, and imaging guidance when used.
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.
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