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CPT code 64484: Epidural injection, each additional lumbar or sacral level2026 Medicare rate & RVUs in Virginia

Reports an image-guided transforaminal epidural injection at each additional lumbar or sacral level treated during the same procedure.

CMS RVU26DEffective Oct 1, 2026One payment locality276.7K Medicare services in 2024

In Virginia, Medicare pays $115.39 for 64484 in the office and $42.83 when it’s performed in a hospital or facility.

$115.39Office (non-facility)
$42.83Hospital or facility
−1.9%vs the national office rate ($117.57)

Check a contract rate as a % of Medicare · 64484 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 64484 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Virginia
  2. What 64484 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 64484 covers

This add-on reports an injection into the epidural space through a lumbar or sacral neural foramen at an additional spinal level. The clinician typically uses imaging guidance to position the needle near the affected nerve root and deliver medication for radicular pain, such as pain associated with disc disease or spinal stenosis. Pain specialists, anesthesiologists, and other clinicians who perform image-guided spine procedures commonly provide this service in an office or facility setting.

Report 64484 for each additional lumbar or sacral level treated after the first level, with 64483 for the initial level. The procedure note should identify the levels treated and support the additional injection. Imaging guidance is included in the injection service and is not separately reported for the same procedure. CMS treats this as an add-on code: it must be billed with its primary procedure and is paid within that procedure’s global period. When performed bilaterally and reported with modifier 50, CMS pays the bilateral procedure at 150%.

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 64484

Across 109 of 109 payment localities, the office rate for 64484 runs from $104.69 in Arkansas to $156.25 in San Benito County, CA. Virginia pays $115.39. The RVUs are the same everywhere; the geographic indexes change the dollars.

64484 in Virginia vs other payment areas
  1. Virginia · this page$115.39
  2. Los Angeles, CA · California$133.05+$17.66
  3. Washington, DC area · District of Columbia$134.27+$18.88
  4. Miami, FL · Florida$125.03+$9.64
  5. Chicago, IL · Illinois$121.67+$6.28
  6. Manhattan, NY · New York$134.54+$19.15
  7. Alaska · Alaska$138.08+$22.69

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

Every other payment area

64484 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$106.14$41.55
ArkansasArkansas$104.69$41.28
ArizonaArizona$114.64$43.11
Bakersfield, CACalifornia$125.04$44.13
Chico, CACalifornia$124.78$43.87
El Centro, CACalifornia$124.79$43.89
Fresno, CACalifornia$124.78$43.87
Hanford, CACalifornia$124.78$43.87

64484 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.

$104.69

$140.52

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

View every state and territory as a table
64484 office rate range by state
State / territoryOffice rate rangeLocalities
AK$138.081
AL$106.141
AR$104.691
AZ$114.641
CA$124.78–$156.2529
CO$122.641
CT$125.111
DC$134.271
DE$116.481
FL$115.30–$125.033
GA$109.21–$119.522
GU$127.701
HI$127.701
IA$108.981
ID$109.591
IL$111.93–$122.084
IN$110.201
KS$108.361
KY$108.221
LA$108.01–$113.092
MA$121.91–$134.562
MD$118.67–$134.273
ME$109.99–$115.852
MI$110.77–$116.532
MN$118.071
MO$106.16–$113.633
MS$105.451
MT$117.571
NC$111.101
ND$115.981
NE$109.581
NH$120.611
NJ$126.70–$132.962
NM$111.291
NV$117.211
NY$112.67–$137.495
OH$110.441
OK$108.181
OR$116.45–$126.532
PA$110.69–$122.042
PR$118.431
RI$120.621
SC$110.931
SD$115.801
TN$108.861
TX$109.99–$122.108
UT$112.371
VA$115.39–$134.272
VI$118.431
VT$115.431
WA$121.71–$137.372
WI$112.271
WV$107.961
WY$116.881

See 64484 in every payment locality

How the 64484 rate is calculated

Each of 64484’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 · 64484

RVUs × geographic indexes × conversion factor

Office or facility?

Work0.98

0.98 RVUs× 1.000 GPCI

Practice expense2.46

2.46 RVUs× 1.000 GPCI

Malpractice0.08

0.08 RVUs× 1.000 GPCI

Adjusted RVUs

3.5200

Conversion factor

$33.4009

Medicare rate

$117.57

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

7,129

Code
64484
Physician work
0.98
Practice expense
2.46
Malpractice
0.08

GPCI2026.csv

106

Locality
Virginia
Physician work
1.000
Practice expense
0.983
Malpractice
0.706
Office calculation for 64484 in Virginia
ComponentRVULocality factorAdjusted
Physician work0.98× 1.0000.9800
Practice expense2.46× 0.9832.4182
Malpractice0.08× 0.7060.0565
Total RVUs3.4547
Conversion factor× 33.4009

Office rate, Virginia$115.39

Office: (0.98 × 1 + 2.46 × 0.983 + 0.08 × 0.706) × $33.4009 = $115.39

Facility: (0.98 × 1 + 0.25 × 0.983 + 0.08 × 0.706) × $33.4009 = $42.83

Open 64484 in the RVU calculator

Payment rules and modifiers for 64484

The CMS indicators that decide how 64484 is paid alongside other services.

CMS payment indicators · 64484

Epidural injection, each additional lumbar or sacral level

RuleCMS valueWhat it means
Global periodZZZAdd-on code: falls within the primary procedure’s global period.
Multiple procedures0No multiple-procedure reduction.
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

64484 without 50 · national office

$117.57

Epidural injection, each additional lumbar or sacral level

64484-50 · Bilateral: 150%

$176.36

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 64484

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

Codes related to 64484
CodeHow it relatesOffice range, Virginia
Add-on codes
64483Transforaminal epidural injection, lumbar or sacral, first levelPrimary code for the first lumbar or sacral transforaminal epidural level.$259.84
Same family
64479Epidural injection, cervical/thoracic, first levelPrimary transforaminal epidural injection code for the cervical or thoracic region.$279.81
64480Epidural injection, additional cervical/thoracic levelAdditional-level counterpart for cervical or thoracic transforaminal epidural injections.$140.17
Used instead
64493Facet joint injection, lumbar or sacral, one levelLumbar facet-joint injection targets a different structure than a transforaminal epidural injection.$186.69

How 64484 has changed in Virginia

64484 · Office / nonfacility

$115.39

Effective 2026-10-01

The base rate is $11.00 higher than on 2025-10-01, moving from $104.39 to $115.39 (10.5%).

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

    $104.39changed to$115.39

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 1.00 changed to 0.98
    • Practice expense RVU 2.20 changed to 2.46
    • 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

    $109.24changed to$104.39

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 2.24 changed to 2.20
    • Malpractice RVU 0.10 changed to 0.08

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $107.46changed to$109.24

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $111.83changed to$107.46

    • Conversion factor 33.8872 changed to 32.7442
    • 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

    $115.87changed to$111.83

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 2.27 changed to 2.24
    • 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

    $114.06changed to$115.87

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 2.19 changed to 2.27

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $105.90changed to$114.06

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 1.87 changed to 2.19
    • Malpractice RVU 0.09 changed to 0.10
    • 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

    $99.42changed to$105.90

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 1.71 changed to 1.87
    • Malpractice RVU 0.08 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

    $93.28changed to$99.42

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 1.54 changed to 1.71

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $87.87changed to$93.28

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 1.40 changed to 1.54
    • 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

    $88.14changed to$87.87

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 1.42 changed to 1.40
    • 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

    $87.81changed to$88.14

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 1.41 changed to 1.42
    • Malpractice RVU 0.07 changed to 0.08

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $87.37changed to$87.81

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $87.90changed to$87.37

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 1.42 changed to 1.41
    • Malpractice RVU 0.08 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

    $89.20changed to$87.90

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 1.60 changed to 1.42
    • 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: $89.20

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$115.39$42.83RVU26D
2026-07-01$115.39$42.83RVU26C
2026-04-01$115.39$42.83RVU26B
2026-01-01$115.39$42.83RVU26A
2025-10-01$104.39$48.05RVU25D
2025-07-01$104.39$48.05RVU25C
2025-04-01$104.39$48.05RVU25B
2025-01-01$104.39$48.05RVU25A
2024-10-01$109.24$49.95RVU24D
2024-07-01$109.24$49.95RVU24C
2024-04-01$109.24$49.95RVU24B
2024-03-09$109.24$49.95RVU24AR
2024-01-01$107.46$49.14RVU24A
2023-10-01$111.83$50.78RVU23D
2023-07-01$111.83$50.78RVU23C
2023-04-01$111.83$50.78RVU23B
2023-01-01$111.83$50.78RVU23A
2022-10-01$115.87$51.83RVU22D
2022-07-01$115.87$51.83RVU22C
2022-04-01$115.87$51.83RVU22B
2022-01-01$115.87$51.83RVU22A
2021-10-01$114.06$52.60RVU21D
2021-07-01$114.06$52.60RVU21C
2021-04-01$114.06$52.60RVU21B
2021-01-01$114.06$52.60RVU21A
2020-10-01$105.90$53.69RVU20D
2020-07-01$105.90$53.69RVU20C
2020-04-01$105.90$53.69RVU20B
2020-01-01$105.90$53.69RVU20A
2019-10-01$99.42$53.23RVU19D
2019-07-01$99.42$53.23RVU19C
2019-04-01$99.42$53.23RVU19B
2019-01-01$99.42$53.23RVU19A
2018-10-01$93.28$53.17RVU18D
2018-07-01$93.28$53.17RVU18C
2018-04-01$93.28$53.17RVU18B
2018-01-01$93.28$53.17RVU18AR1
2017-10-01$87.87$52.87RVU17D
2017-07-01$87.87$52.87RVU17C
2017-04-01$87.87$52.87RVU17B
2017-01-01$87.87$52.87RVU17A
2016-10-01$88.14$52.95RVU16D
2016-07-01$88.14$52.95RVU16C
2016-04-01$88.14$52.95RVU16B
2016-01-01$88.14$52.95RVU16A
2015-10-01$87.81$52.84RVU15D
2015-07-01$87.81$52.84RVU15C
2015-04-01$87.37$52.58RVU15B
2015-01-01$87.37$52.58RVU15A
2014-10-01$87.90$53.15RVU14D
2014-07-01$87.90$53.15RVU14C
2014-04-01$87.90$53.15RVU14B
2014-01-01$87.90$53.15RVU14A
2013-10-01$89.20$51.64RVU13D
2013-07-01$89.20$51.64RVU13C
2013-04-01$89.20$51.64RVU13B
2013-01-01$89.20$51.64RVU13AR

Price 64484 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

64484 billing questions

When should 64484 be reported instead of 64483?

Use 64483 for the first lumbar or sacral transforaminal epidural level. Report 64484 for each additional level treated in the same procedure.

Can 64484 be billed by itself?

No. It is an add-on code and must be reported with the primary procedure, 64483.

Can imaging guidance be billed separately?

Imaging guidance is included in this injection service. Do not separately report guidance for the same injection.

How many units of 64484 should be reported?

Report one unit for each additional lumbar or sacral level treated beyond the first. Document the specific levels injected.

How is a bilateral procedure paid?

When the procedure is bilateral and reported with modifier 50, CMS pays it at 150%.

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 64484PPRRVU2026_Oct_nonQPP.csv, line 7,129 (RVU26D)
Geographic factors for VirginiaGPCI2026.csv, line 106 (RVU26D)

Open CMS sourceHow we calculate rates

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