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CPT code 64479: Epidural injection, cervical/thoracic, first level2026 Medicare rate & RVUs in Puerto Rico

Reports an image-guided transforaminal epidural injection at one cervical or thoracic level to deliver anesthetic and/or steroid near a spinal nerve root.

CMS RVU26DEffective Oct 1, 2026One payment locality42.1K Medicare services in 2024

In Puerto Rico, Medicare pays $287.39 for 64479 in the office and $116.86 when it’s performed in a hospital or facility.

$287.39Office (non-facility)
$116.86Hospital or facility
+0.8%vs the national office rate ($285.24)

Check a contract rate as a % of Medicare · 64479 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 64479 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Puerto Rico
  2. What 64479 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 64479 covers

This service places anesthetic and/or steroid into the epidural space through a transforaminal approach at one cervical or thoracic spinal level. The clinician guides a needle toward the targeted nerve root using fluoroscopy or CT. Pain medicine physicians, anesthesiologists, physiatrists, and other qualified clinicians commonly perform it for cervical or thoracic radicular symptoms, such as pain associated with nerve-root irritation from foraminal narrowing or a disc problem, in an office or facility setting.

Report 64479 for the first treated level in the cervical or thoracic region; documentation should identify the level and side, clinical indication, approach, imaging guidance, and injected agents. Code 64480 is used for each qualifying additional level. The service has a 0-day global period, so same-day preoperative and postoperative care is included. When multiple procedures occur in one session, the highest-valued procedure is paid in full and others at 50%. For a bilateral procedure reported with modifier 50, CMS pays at 150%. An assistant at surgery is 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.

How Puerto Rico compares for 64479

Across 109 of 109 payment localities, the office rate for 64479 runs from $253.23 in Arkansas to $380.54 in San Benito County, CA. Puerto Rico pays $287.39. The RVUs are the same everywhere; the geographic indexes change the dollars.

64479 in Puerto Rico vs other payment areas
  1. Puerto Rico · this page$287.39
  2. Los Angeles, CA · California$323.40+$36.01
  3. Washington, DC area · District of Columbia$326.35+$38.96
  4. Miami, FL · Florida$303.82+$16.43
  5. Chicago, IL · Illinois$295.44+$8.05
  6. Manhattan, NY · New York$326.99+$39.60
  7. Alaska · Alaska$332.75+$45.36

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

Every other payment area

64479 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$256.83$109.24
ArkansasArkansas$253.23$108.34
ArizonaArizona$277.96$114.51
Bakersfield, CACalifornia$303.64$118.77
Chico, CACalifornia$303.00$118.13
El Centro, CACalifornia$303.04$118.17
Fresno, CACalifornia$303.00$118.13
Hanford, CACalifornia$303.00$118.13

64479 rates by state

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

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

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.

$253.23

$341.77

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

View every state and territory as a table
64479 office rate range by state
State / territoryOffice rate rangeLocalities
AK$332.751
AL$256.831
AR$253.231
AZ$277.961
CA$303.00–$380.5429
CO$297.741
CT$303.851
DC$326.351
DE$282.491
FL$279.62–$303.823
GA$264.49–$290.082
GU$310.391
HI$310.391
IA$263.871
ID$265.401
IL$271.25–$296.434
IN$266.911
KS$262.341
KY$262.021
LA$261.49–$274.112
MA$295.90–$327.152
MD$287.89–$326.353
ME$266.39–$280.942
MI$268.35–$282.682
MN$286.461
MO$256.91–$275.463
MS$255.131
MT$285.231
NC$269.161
ND$281.281
NE$265.371
NH$292.781
NJ$307.65–$323.042
NM$269.651
NV$284.331
NY$273.06–$334.315
OH$267.541
OK$261.921
OR$282.44–$307.382
PA$268.14–$296.242
PR$287.391
RI$292.671
SC$268.731
SD$280.811
TN$263.581
TX$266.40–$296.478
UT$272.321
VA$279.81–$326.352
VI$287.391
VT$279.901
WA$295.43–$334.072
WI$272.051
WV$261.391
WY$283.511

See 64479 in every payment locality

How the 64479 rate is calculated

Each of 64479’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 · 64479

RVUs × geographic indexes × conversion factor

Office or facility?

Work2.23

2.23 RVUs× 1.000 GPCI

Practice expense6.11

6.11 RVUs× 1.000 GPCI

Malpractice0.20

0.20 RVUs× 1.000 GPCI

Adjusted RVUs

8.5400

Conversion factor

$33.4009

Medicare rate

$285.24

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

7,126

Code
64479
Physician work
2.23
Practice expense
6.11
Malpractice
0.20

GPCI2026.csv

91

Locality
Puerto Rico
Physician work
1.000
Practice expense
1.011
Malpractice
0.985
Office calculation for 64479 in Puerto Rico
ComponentRVULocality factorAdjusted
Physician work2.23× 1.0002.2300
Practice expense6.11× 1.0116.1772
Malpractice0.20× 0.9850.1970
Total RVUs8.6042
Conversion factor× 33.4009

Office rate, Puerto Rico$287.39

Office: (2.23 × 1 + 6.11 × 1.011 + 0.2 × 0.985) × $33.4009 = $287.39

Facility: (2.23 × 1 + 1.06 × 1.011 + 0.2 × 0.985) × $33.4009 = $116.86

Open 64479 in the RVU calculator

Payment rules and modifiers for 64479

The CMS indicators that decide how 64479 is paid alongside other services.

CMS payment indicators · 64479

Epidural injection, cervical/thoracic, first level

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

64479 without 50 · national office

$285.24

Epidural injection, cervical/thoracic, first level

64479-50 · Bilateral: 150%

$427.86

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

Codes related to 64479

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

Codes related to 64479
CodeHow it relatesOffice range, Puerto Rico
Add-on codes
64480Epidural injection, additional cervical/thoracic levelAdd-on for each qualifying additional cervical or thoracic transforaminal level.$144.00
Used instead
64483Transforaminal epidural injection, lumbar or sacral, first levelFirst-level transforaminal epidural injection for the lumbar or sacral region.$266.96
64484Epidural injection, each additional lumbar or sacral levelAdditional-level counterpart for lumbar or sacral transforaminal epidural injections.$118.43
62321Epidural injection, cervical or thoracic, image-guidedCervical or thoracic epidural injection using an interlaminar rather than transforaminal approach.$278.75
64490Facet injection, cervical or thoracic, one levelCervical or thoracic facet-joint injection, targeting a joint rather than a nerve root.$206.54

How 64479 has changed in Puerto Rico

64479 · Office / nonfacility

$287.39

Effective 2026-10-01

The base rate is $30.10 higher than on 2025-10-01, moving from $257.29 to $287.39 (11.7%).

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

    $257.29changed to$287.39

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 2.29 changed to 2.23
    • Practice expense RVU 5.42 changed to 6.11
    • Malpractice RVU 0.21 changed to 0.20
    • 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

    $266.79changed to$257.29

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 5.48 changed to 5.42

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $262.43changed to$266.79

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $270.08changed to$262.43

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 5.42 changed to 5.48
    • Malpractice RVU 0.22 changed to 0.21
    • Practice expense GPCI 1.008 changed to 1.007
    • Malpractice GPCI 0.984 changed to 0.982

  5. October 1, 2023

    RVU23D

    $268.73changed to$270.08

    • Practice expense GPCI 1.000 changed to 1.008
    • Malpractice GPCI 1.000 changed to 0.984

  6. January 1, 2023

    RVU23A

    $278.26changed to$268.73

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 5.49 changed to 5.42
    • 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

    $276.36changed to$278.26

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 5.38 changed to 5.49
    • Malpractice RVU 0.21 changed to 0.22

    Held through RVU22B, RVU22C, RVU22D.

  8. January 1, 2021

    RVU21A

    $263.29changed to$276.36

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 4.75 changed to 5.38
    • Malpractice RVU 0.22 changed to 0.21
    • Malpractice GPCI 0.988 changed to 0.986

    Held through RVU21B, RVU21C, RVU21D.

  9. January 1, 2020

    RVU20A

    $251.52changed to$263.29

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 4.46 changed to 4.75
    • Malpractice RVU 0.20 changed to 0.22
    • 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

    $241.46changed to$251.52

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 4.19 changed to 4.46

    Held through RVU19B, RVU19C, RVU19D.

  11. January 1, 2018

    RVU18AR1

    $214.59changed to$241.46

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 4.16 changed to 4.19
    • 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

    $190.86changed to$214.59

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 4.23 changed to 4.16
    • 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

    $190.90changed to$190.86

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 4.20 changed to 4.23
    • Malpractice RVU 0.21 changed to 0.20

    Held through RVU16B, RVU16C, RVU16D.

  14. July 1, 2015

    RVU15C

    $189.95changed to$190.90

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  15. January 1, 2015

    RVU15A

    $190.41changed to$189.95

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 4.27 changed to 4.20
    • Malpractice RVU 0.26 changed to 0.21
    • 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

    $190.23changed to$190.41

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 4.77 changed to 4.27
    • Malpractice RVU 0.27 changed to 0.26
    • 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: $190.23

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$287.39$116.86RVU26D
2026-07-01$287.39$116.86RVU26C
2026-04-01$287.39$116.86RVU26B
2026-01-01$287.39$116.86RVU26A
2025-10-01$257.29$127.00RVU25D
2025-07-01$257.29$127.00RVU25C
2025-04-01$257.29$127.00RVU25B
2025-01-01$257.29$127.00RVU25A
2024-10-01$266.79$129.69RVU24D
2024-07-01$266.79$129.69RVU24C
2024-04-01$266.79$129.69RVU24B
2024-03-09$266.79$129.69RVU24AR
2024-01-01$262.43$127.57RVU24A
2023-10-01$270.08$130.71RVU23D
2023-07-01$268.73$130.47RVU23C
2023-04-01$268.73$130.47RVU23B
2023-01-01$268.73$130.47RVU23A
2022-10-01$278.26$133.15RVU22D
2022-07-01$278.26$133.15RVU22C
2022-04-01$278.26$133.15RVU22B
2022-01-01$278.26$133.15RVU22A
2021-10-01$276.36$133.56RVU21D
2021-07-01$276.36$133.56RVU21C
2021-04-01$276.36$133.56RVU21B
2021-01-01$276.36$133.56RVU21A
2020-10-01$263.29$136.33RVU20D
2020-07-01$263.29$136.33RVU20C
2020-04-01$263.29$136.33RVU20B
2020-01-01$263.29$136.33RVU20A
2019-10-01$251.52$135.76RVU19D
2019-07-01$251.52$135.76RVU19C
2019-04-01$251.52$135.76RVU19B
2019-01-01$251.52$135.76RVU19A
2018-10-01$241.46$136.33RVU18D
2018-07-01$241.46$136.33RVU18C
2018-04-01$241.46$136.33RVU18B
2018-01-01$241.46$136.33RVU18AR1
2017-10-01$214.59$126.73RVU17D
2017-07-01$214.59$126.73RVU17C
2017-04-01$214.59$126.73RVU17B
2017-01-01$214.59$126.73RVU17A
2016-10-01$190.86$117.41RVU16D
2016-07-01$190.86$117.41RVU16C
2016-04-01$190.86$117.41RVU16B
2016-01-01$190.86$117.41RVU16A
2015-10-01$190.90$117.94RVU15D
2015-07-01$190.90$117.94RVU15C
2015-04-01$189.95$117.35RVU15B
2015-01-01$189.95$117.35RVU15A
2014-10-01$190.41$117.78RVU14D
2014-07-01$190.41$117.78RVU14C
2014-04-01$190.41$117.78RVU14B
2014-01-01$190.41$117.78RVU14A
2013-10-01$190.23$113.88RVU13D
2013-07-01$190.23$113.88RVU13C
2013-04-01$190.23$113.88RVU13B
2013-01-01$190.23$113.88RVU13AR

Price 64479 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

64479 billing questions

When should 64479 be chosen instead of 64483?

Use 64479 for a cervical or thoracic transforaminal epidural injection at the first level. Code 64483 describes the corresponding first-level service in the lumbar or sacral region.

How is an additional cervical or thoracic level reported?

Use add-on code 64480 for each qualifying additional level. It is reported with the primary-level service, not by itself.

Is imaging guidance included?

Yes. The service includes fluoroscopic or CT guidance for needle placement; the documentation should support the approach and targeted level.

What documentation supports this code?

Record the clinical indication, cervical or thoracic level, side, transforaminal approach, imaging guidance, and agents injected. The note should make clear whether an additional level was treated.

How does Medicare treat a bilateral service?

CMS identifies this as a bilateral procedure; when reported with modifier 50, it is paid at 150%.

What same-session payment rules apply?

The service has a 0-day global period, so same-day preoperative and postoperative care is included. Under the standard multiple procedure reduction, the highest-valued procedure is paid in full and other procedures are paid at 50%.

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 64479PPRRVU2026_Oct_nonQPP.csv, line 7,126 (RVU26D)
Geographic factors for Puerto RicoGPCI2026.csv, line 91 (RVU26D)

Open CMS sourceHow we calculate rates

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