CPT code 64484: Epidural injection, each additional lumbar or sacral level2026 Medicare rate & RVUs in Washington
Reports an image-guided transforaminal epidural injection at each additional lumbar or sacral level treated during the same procedure.
Medicare pays $121.71–$137.37 for 64484 in the office in Washington, from Rest of Washington to King County, WA. 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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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.
Where 64484 pays more and less in Washington
| Payment locality | Office | Facility |
|---|---|---|
| King County, WA | $137.37 | $46.80 |
| Rest of Washington | $121.71 | $43.98 |
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
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.
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
| Rule | CMS value | What it means |
|---|---|---|
| Global period | ZZZ | Add-on code: falls within the primary procedure’s global period. |
| Multiple procedures | 0 | No multiple-procedure reduction. |
| 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
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).
64484 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 64483Transforaminal epidural injectionLumbar or sacral, first level
- 64483 reports the first lumbar or sacral transforaminal epidural level; 64484 reports each additional level and is not reported alone.
- 64480Epidural injectionAdditional cervical/thoracic level
- 64480 is the additional-level code for cervical or thoracic transforaminal epidural injections. Use 64484 for additional lumbar or sacral levels.
- 64493Facet joint injectionLumbar or sacral, one level
- 64493 describes an injection targeting a lumbar or sacral paravertebral facet joint, not medication delivered through a neural foramen into the epidural space.
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
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