CPT code 64461: Paravertebral block, thoracic, single site2026 Medicare rate & RVUs in Nevada
Reports a single-site thoracic paravertebral nerve block, commonly used to provide regional analgesia for thoracic or breast surgery.
In Nevada, Medicare pays $148.83 for 64461 in the office and $70.93 when it’s performed in a hospital or facility.
Check a contract rate as a % of Medicare · 64461 nationwide
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 11 sections
What 64461 covers
This service is a single-injection thoracic paravertebral nerve block using anesthetic medication, with or without steroid, to reduce pain in the relevant thoracic distribution. Anesthesiologists and acute pain or pain-management clinicians commonly perform it around thoracic procedures, including thoracotomy, or breast surgery. Imaging guidance may be used to place the injection and is included in the service. The block may be performed in an operating room or another procedural setting.
Select this code for one thoracic paravertebral injection site; report 64462 for each additional site when applicable. Document the indication, laterality, site count, medication, and guidance used. Medicare assigns a 0-day global period, so same-day preoperative and postoperative care is included. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and the others at 50%. For bilateral performance, modifier 50 is paid at 150%. Medicare does not pay an assistant at surgery for this code; 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 Nevada compares for 64461
Across 109 of 109 payment localities, the office rate for 64461 runs from $134.75 in Arkansas to $191.97 in San Benito County, CA. Nevada pays $148.83. The RVUs are the same everywhere; the geographic indexes change the dollars.
- Nevada · this page$148.83
- Los Angeles, CA · California$166.14+$17.31
- Washington, DC area · District of Columbia$168.84+$20.01
- Miami, FL · Florida$161.38+$12.55
- Chicago, IL · Illinois$157.39+$8.56
- Manhattan, NY · New York$170.55+$21.72
- Alaska · Alaska$181.46+$32.63
Other areas in Nevada first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| AlabamaAlabama | $136.42 | $68.32 |
| ArkansasArkansas | $134.75 | $67.90 |
| ArizonaArizona | $146.16 | $70.75 |
| Bakersfield, CACalifornia | $157.00 | $71.71 |
| Chico, CACalifornia | $156.50 | $71.20 |
| El Centro, CACalifornia | $156.52 | $71.23 |
| Fresno, CACalifornia | $156.50 | $71.20 |
| Hanford, CACalifornia | $156.50 | $71.20 |
| Madera, CACalifornia | $156.50 | $71.20 |
| Merced, CACalifornia | $156.50 | $71.20 |
| Modesto, CACalifornia | $156.50 | $71.20 |
| Napa, CACalifornia | $178.33 | $75.75 |
| Oxnard, CACalifornia | $165.09 | $73.10 |
| Redding, CACalifornia | $156.50 | $71.20 |
| Rest of CaliforniaCalifornia | $156.50 | $71.20 |
| Riverside, CACalifornia | $158.25 | $72.95 |
| Sacramento, CACalifornia | $163.42 | $72.91 |
| Salinas, CACalifornia | $162.79 | $72.59 |
| San Diego, CACalifornia | $165.99 | $72.91 |
| Marin County, CACalifornia | $187.91 | $78.18 |
| San Francisco, CACalifornia | $187.73 | $78.00 |
| San Benito County, CACalifornia | $191.97 | $79.75 |
| Santa Clara County, CACalifornia | $191.23 | $79.01 |
| San Luis Obispo, CACalifornia | $160.24 | $71.60 |
| Santa Cruz, CACalifornia | $167.10 | $72.54 |
| Santa Maria, CACalifornia | $163.23 | $72.48 |
| Santa Rosa, CACalifornia | $168.75 | $73.18 |
| Stockton, CACalifornia | $156.50 | $71.20 |
| Vallejo, CACalifornia | $178.07 | $75.49 |
| Visalia, CACalifornia | $156.50 | $71.20 |
| Yuba City, CACalifornia | $156.50 | $71.20 |
| ColoradoColorado | $154.73 | $71.93 |
| ConnecticutConnecticut | $158.61 | $74.80 |
| DelawareDelaware | $148.34 | $71.45 |
| Fort Lauderdale, FLFlorida | $155.09 | $76.25 |
| Rest of FloridaFlorida | $148.49 | $74.09 |
| Atlanta, GAGeorgia | $152.28 | $73.21 |
| Rest of GeorgiaGeorgia | $141.25 | $71.83 |
| Hawaii, Guam, HIHawaii | $159.33 | $70.84 |
| IowaIowa | $139.00 | $67.79 |
| IdahoIdaho | $139.85 | $68.25 |
| East St. Louis, ILIllinois | $148.08 | $76.48 |
| Rest of IllinoisIllinois | $145.06 | $74.01 |
| Suburban Chicago, ILIllinois | $156.52 | $76.59 |
| IndianaIndiana | $140.53 | $68.38 |
| KansasKansas | $138.62 | $68.26 |
| KentuckyKentucky | $139.51 | $70.32 |
| New Orleans, LALouisiana | $145.22 | $71.99 |
| Rest of LouisianaLouisiana | $139.39 | $70.51 |
| Metropolitan Boston, MAMassachusetts | $168.30 | $75.38 |
| Rest of MassachusettsMassachusetts | $154.09 | $72.14 |
| Baltimore area, MDMaryland | $158.18 | $74.68 |
| Rest of MarylandMaryland | $150.82 | $72.06 |
| Rest of MaineMaine | $140.64 | $69.04 |
| Southern Maine, MEMaine | $146.88 | $69.76 |
| Detroit, MIMichigan | $150.25 | $75.15 |
| Rest of MichiganMichigan | $142.74 | $71.69 |
| MinnesotaMinnesota | $148.40 | $68.32 |
| Metropolitan Kansas City, MOMissouri | $144.20 | $71.12 |
| Metropolitan St. Louis, MOMissouri | $145.46 | $71.37 |
| Rest of MissouriMissouri | $137.47 | $70.38 |
| MississippiMississippi | $136.12 | $69.12 |
| MontanaMontana | $149.63 | $71.80 |
| North CarolinaNorth Carolina | $141.87 | $69.26 |
| North DakotaNorth Dakota | $146.46 | $68.64 |
| NebraskaNebraska | $139.60 | $67.77 |
| New HampshireNew Hampshire | $152.54 | $71.53 |
| Northern New JerseyNew Jersey | $167.55 | $77.27 |
| Rest of New JerseyNew Jersey | $160.46 | $75.48 |
| New MexicoNew Mexico | $143.47 | $72.11 |
| NYC suburbs and Long Island, NYNew York | $174.35 | $81.81 |
| Poughkeepsie and northern NYC suburbs, NYNew York | $161.61 | $76.39 |
| Queens, NYNew York | $171.52 | $79.53 |
| Rest of New YorkNew York | $143.69 | $69.76 |
| OhioOhio | $142.09 | $71.04 |
| OklahomaOklahoma | $139.12 | $69.62 |
| Portland, OROregon | $158.86 | $72.40 |
| Rest of OregonOregon | $147.70 | $70.19 |
| Metropolitan Philadelphia, PAPennsylvania | $155.27 | $74.25 |
| Rest of PennsylvaniaPennsylvania | $142.19 | $70.75 |
| Puerto RicoPuerto Rico | $150.51 | $71.83 |
| Rhode IslandRhode Island | $153.02 | $72.63 |
| South CarolinaSouth Carolina | $142.21 | $70.30 |
| South DakotaSouth Dakota | $146.09 | $68.26 |
| TennesseeTennessee | $139.23 | $68.49 |
| Austin, TXTexas | $154.20 | $71.86 |
| Beaumont, TXTexas | $141.41 | $70.59 |
| Brazoria, TXTexas | $148.13 | $71.01 |
| Dallas, TXTexas | $149.04 | $71.53 |
| Fort Worth, TXTexas | $148.24 | $71.51 |
| Galveston, TXTexas | $148.56 | $71.28 |
| Houston, TXTexas | $151.49 | $74.21 |
| Rest of TexasTexas | $144.67 | $70.82 |
| UtahUtah | $143.86 | $70.71 |
| VirginiaVirginia | $146.58 | $70.08 |
| Virgin Islands, VIUnited States Virgin Islands | $150.51 | $71.83 |
| VermontVermont | $146.12 | $69.08 |
| Rest of WashingtonWashington | $153.72 | $71.77 |
| King County, WAWashington | $171.30 | $75.81 |
| WisconsinWisconsin | $142.28 | $67.72 |
| West VirginiaWest Virginia | $140.52 | $72.89 |
| WyomingWyoming | $148.25 | $70.42 |
64461 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.
$134.75
$181.46
Color shows the midpoint of each state’s locality range.
View every state and territory as a table
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | $181.46 | 1 |
| AL | $136.42 | 1 |
| AR | $134.75 | 1 |
| AZ | $146.16 | 1 |
| CA | $156.50–$191.97 | 29 |
| CO | $154.73 | 1 |
| CT | $158.61 | 1 |
| DC | $168.84 | 1 |
| DE | $148.34 | 1 |
| FL | $148.49–$161.38 | 3 |
| GA | $141.25–$152.28 | 2 |
| GU | $159.33 | 1 |
| HI | $159.33 | 1 |
| IA | $139.00 | 1 |
| ID | $139.85 | 1 |
| IL | $145.06–$157.39 | 4 |
| IN | $140.53 | 1 |
| KS | $138.62 | 1 |
| KY | $139.51 | 1 |
| LA | $139.39–$145.22 | 2 |
| MA | $154.09–$168.30 | 2 |
| MD | $150.82–$168.84 | 3 |
| ME | $140.64–$146.88 | 2 |
| MI | $142.74–$150.25 | 2 |
| MN | $148.40 | 1 |
| MO | $137.47–$145.46 | 3 |
| MS | $136.12 | 1 |
| MT | $149.63 | 1 |
| NC | $141.87 | 1 |
| ND | $146.46 | 1 |
| NE | $139.60 | 1 |
| NH | $152.54 | 1 |
| NJ | $160.46–$167.55 | 2 |
| NM | $143.47 | 1 |
| NV | $148.83 | 1 |
| NY | $143.69–$174.35 | 5 |
| OH | $142.09 | 1 |
| OK | $139.12 | 1 |
| OR | $147.70–$158.86 | 2 |
| PA | $142.19–$155.27 | 2 |
| PR | $150.51 | 1 |
| RI | $153.02 | 1 |
| SC | $142.21 | 1 |
| SD | $146.09 | 1 |
| TN | $139.23 | 1 |
| TX | $141.41–$154.20 | 8 |
| UT | $143.86 | 1 |
| VA | $146.58–$168.84 | 2 |
| VI | $150.51 | 1 |
| VT | $146.12 | 1 |
| WA | $153.72–$171.30 | 2 |
| WI | $142.28 | 1 |
| WV | $140.52 | 1 |
| WY | $148.25 | 1 |
How the 64461 rate is calculated
Each of 64461’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 · 64461
RVUs × geographic indexes × conversion factor
Work1.71
1.71 RVUs× 1.000 GPCI
Practice expense2.61
2.61 RVUs× 1.000 GPCI
Malpractice0.16
0.16 RVUs× 1.000 GPCI
Adjusted RVUs
4.4800
Conversion factor
$33.4009
Medicare rate
$149.64
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
The exact Nevada inputs and CMS source lines
PPRRVU2026_Oct_nonQPP.csv
7,117
- Code
- 64461
- Physician work
- 1.71
- Practice expense
- 2.61
- Malpractice
- 0.16
GPCI2026.csv
73
- Locality
- Nevada
- Physician work
- 1.000
- Practice expense
- 1.001
- Malpractice
- 0.833
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 1.71 | × 1.000 | 1.7100 |
| Practice expense | 2.61 | × 1.001 | 2.6126 |
| Malpractice | 0.16 | × 0.833 | 0.1333 |
| Total RVUs | 4.4559 | ||
| Conversion factor | × 33.4009 | ||
Office rate, Nevada$148.83
Office: (1.71 × 1 + 2.61 × 1.001 + 0.16 × 0.833) × $33.4009 = $148.83
Facility: (1.71 × 1 + 0.28 × 1.001 + 0.16 × 0.833) × $33.4009 = $70.93
Payment rules and modifiers for 64461
The CMS indicators that decide how 64461 is paid alongside other services.
CMS payment indicators · 64461
Paravertebral block, thoracic, single site
| 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
64461 without 50 · national office
$149.64
Paravertebral block, thoracic, single site
64461-50 · Bilateral: 150%
$224.46
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).
How 64461 has changed in Nevada
64461 · Office / nonfacility
$148.83
Effective 2026-10-01
The base rate is $21.22 higher than on 2025-10-01, moving from $127.61 to $148.83 (16.6%).
It is unchanged from the immediately preceding available release, effective 2026-07-01.
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
January 1, 2026
RVU26A
$127.61changed to$148.83
- Conversion factor 32.3465 changed to 33.4009
- Work RVU 1.75 changed to 1.71
- Practice expense RVU 2.06 changed to 2.61
- Practice expense GPCI 1.000 changed to 1.001
- Malpractice GPCI 0.844 changed to 0.833
Held through RVU26B, RVU26C, RVU26D.
January 1, 2025
RVU25A
$132.98changed to$127.61
- Conversion factor 33.2875 changed to 32.3465
- Practice expense RVU 2.11 changed to 2.06
Held through RVU25B, RVU25C, RVU25D.
March 9, 2024
RVU24AR
$130.81changed to$132.98
- Conversion factor 32.7442 changed to 33.2875
Held through RVU24B, RVU24C, RVU24D.
January 1, 2024
RVU24A
$137.47changed to$130.81
- Conversion factor 33.8872 changed to 32.7442
- Practice expense RVU 2.12 changed to 2.11
- Malpractice RVU 0.17 changed to 0.16
- Malpractice GPCI 1.098 changed to 0.844
January 1, 2023
RVU23A
$142.87changed to$137.47
- Conversion factor 34.6062 changed to 33.8872
- Practice expense RVU 2.14 changed to 2.12
- Work GPCI 1.005 changed to 1.000
- Malpractice GPCI 1.351 changed to 1.098
Held through RVU23B, RVU23C, RVU23D.
January 1, 2022
RVU22A
$139.97changed to$142.87
- Conversion factor 34.8931 changed to 34.6062
- Practice expense RVU 2.05 changed to 2.14
- Malpractice RVU 0.15 changed to 0.17
Held through RVU22B, RVU22C, RVU22D.
January 1, 2021
RVU21A
$136.20changed to$139.97
- Conversion factor 36.0896 changed to 34.8931
- Practice expense RVU 1.87 changed to 2.05
- Malpractice RVU 0.13 changed to 0.15
- Work GPCI 1.004 changed to 1.005
- Malpractice GPCI 1.130 changed to 1.351
Held through RVU21B, RVU21C, RVU21D.
January 1, 2020
RVU20A
$143.65changed to$136.20
- Conversion factor 36.0391 changed to 36.0896
- Practice expense RVU 2.07 changed to 1.87
- Malpractice RVU 0.14 changed to 0.13
- Work GPCI 1.002 changed to 1.004
- Practice expense GPCI 1.017 changed to 1.000
- Malpractice GPCI 0.909 changed to 1.130
Held through RVU20B, RVU20C, RVU20D.
January 1, 2019
RVU19A
$152.82changed to$143.65
- Conversion factor 35.9996 changed to 36.0391
- Practice expense RVU 2.28 changed to 2.07
- Malpractice RVU 0.19 changed to 0.14
Held through RVU19B, RVU19C, RVU19D.
January 1, 2018
RVU18AR1
$153.81changed to$152.82
- Conversion factor 35.8887 changed to 35.9996
- Practice expense RVU 2.29 changed to 2.28
- Malpractice RVU 0.17 changed to 0.19
- Work GPCI 1.004 changed to 1.002
- Practice expense GPCI 1.034 changed to 1.017
- Malpractice GPCI 0.946 changed to 0.909
Held through RVU18B, RVU18C, RVU18D.
January 1, 2017
RVU17A
$155.52changed to$153.81
- Conversion factor 35.8043 changed to 35.8887
- Practice expense RVU 2.31 changed to 2.29
- Malpractice RVU 0.16 changed to 0.17
- Work GPCI 1.005 changed to 1.004
- Practice expense GPCI 1.051 changed to 1.034
- Malpractice GPCI 0.982 changed to 0.946
Held through RVU17B, RVU17C, RVU17D.
January 1, 2016
RVU16A
No ratechanged to$155.52
Held through RVU16B, RVU16C, RVU16D.
January 1, 2013
RVU13AR
Earliest loaded release: No rate
Held through RVU13B, RVU13C, RVU13D, RVU14A, RVU14B, RVU14C, RVU14D, RVU15A, RVU15B, RVU15C, RVU15D.
| Effective from | Office | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | $148.83 | $70.93 | RVU26D |
| 2026-07-01 | $148.83 | $70.93 | RVU26C |
| 2026-04-01 | $148.83 | $70.93 | RVU26B |
| 2026-01-01 | $148.83 | $70.93 | RVU26A |
| 2025-10-01 | $127.61 | $73.91 | RVU25D |
| 2025-07-01 | $127.61 | $73.91 | RVU25C |
| 2025-04-01 | $127.61 | $73.91 | RVU25B |
| 2025-01-01 | $127.61 | $73.91 | RVU25A |
| 2024-10-01 | $132.98 | $76.06 | RVU24D |
| 2024-07-01 | $132.98 | $76.06 | RVU24C |
| 2024-04-01 | $132.98 | $76.06 | RVU24B |
| 2024-03-09 | $132.98 | $76.06 | RVU24AR |
| 2024-01-01 | $130.81 | $74.82 | RVU24A |
| 2023-10-01 | $137.47 | $78.84 | RVU23D |
| 2023-07-01 | $137.47 | $78.84 | RVU23C |
| 2023-04-01 | $137.47 | $78.84 | RVU23B |
| 2023-01-01 | $137.47 | $78.84 | RVU23A |
| 2022-10-01 | $142.87 | $81.96 | RVU22D |
| 2022-07-01 | $142.87 | $81.96 | RVU22C |
| 2022-04-01 | $142.87 | $81.96 | RVU22B |
| 2022-01-01 | $142.87 | $81.96 | RVU22A |
| 2021-10-01 | $139.97 | $80.65 | RVU21D |
| 2021-07-01 | $139.97 | $80.65 | RVU21C |
| 2021-04-01 | $139.97 | $80.65 | RVU21B |
| 2021-01-01 | $139.97 | $80.65 | RVU21A |
| 2020-10-01 | $136.20 | $80.98 | RVU20D |
| 2020-07-01 | $136.20 | $80.98 | RVU20C |
| 2020-04-01 | $136.20 | $80.98 | RVU20B |
| 2020-01-01 | $136.20 | $80.98 | RVU20A |
| 2019-10-01 | $143.65 | $83.91 | RVU19D |
| 2019-07-01 | $143.65 | $83.91 | RVU19C |
| 2019-04-01 | $143.65 | $83.91 | RVU19B |
| 2019-01-01 | $143.65 | $83.91 | RVU19A |
| 2018-10-01 | $152.82 | $89.85 | RVU18D |
| 2018-07-01 | $152.82 | $89.85 | RVU18C |
| 2018-04-01 | $152.82 | $89.85 | RVU18B |
| 2018-01-01 | $152.82 | $89.85 | RVU18AR1 |
| 2017-10-01 | $153.81 | $90.35 | RVU17D |
| 2017-07-01 | $153.81 | $90.35 | RVU17C |
| 2017-04-01 | $153.81 | $90.35 | RVU17B |
| 2017-01-01 | $153.81 | $90.35 | RVU17A |
| 2016-10-01 | $155.52 | $90.42 | RVU16D |
| 2016-07-01 | $155.52 | $90.42 | RVU16C |
| 2016-04-01 | $155.52 | $90.42 | RVU16B |
| 2016-01-01 | $155.52 | $90.42 | RVU16A |
| 2015-10-01 | Not in this release | Not in this release | RVU15D |
| 2015-07-01 | Not in this release | Not in this release | RVU15C |
| 2015-04-01 | Not in this release | Not in this release | RVU15B |
| 2015-01-01 | Not in this release | Not in this release | RVU15A |
| 2014-10-01 | Not in this release | Not in this release | RVU14D |
| 2014-07-01 | Not in this release | Not in this release | RVU14C |
| 2014-04-01 | Not in this release | Not in this release | RVU14B |
| 2014-01-01 | Not in this release | Not in this release | RVU14A |
| 2013-10-01 | Not in this release | Not in this release | RVU13D |
| 2013-07-01 | Not in this release | Not in this release | RVU13C |
| 2013-04-01 | Not in this release | Not in this release | RVU13B |
| 2013-01-01 | Not in this release | Not in this release | RVU13AR |
Where the Nevada rate applies
Nevada is a Medicare payment area, not a city. Our Census mapping connects it to 138 cities and communities in Nevada. Some span more than one payment area; confirm with the service ZIP.
- Alamo
- Amargosa Valley
- Austin
- Baker
- Battle Mountain
- Beatty
- Beaverdam
- Bennett Springs
64461 billing questions
When should 64462 be used instead?
Use 64461 for one thoracic paravertebral injection site. Code 64462 is the add-on for each additional site.
Can imaging guidance be billed separately?
Imaging guidance, when performed to place this block, is included in 64461 and should not be separately reported as guidance for the same service.
How is a bilateral block reported?
Report bilateral performance with modifier 50. CMS pays the bilateral procedure at 150%.
What should the procedure note support?
Document the thoracic paravertebral target, laterality, number of injection sites, medication, clinical indication, and imaging guidance if used.
Can an assistant or co-surgeon be billed?
Medicare does not pay an assistant at surgery for 64461. 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
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