CPT code 64490: Facet injection, cervical or thoracic, one level2026 Medicare rate & RVUs in South Dakota
Image-guided injection of a cervical or thoracic facet joint or its supplying nerve at one level for suspected facet-mediated pain.
In South Dakota, Medicare pays $201.31 for 64490 in the office and $90.42 when it’s performed in a hospital or facility.
Check a contract rate as a % of Medicare · 64490 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 64490 covers
Code 64490 represents an image-guided injection directed to a cervical or thoracic facet joint, or a nerve supplying that joint, at one spinal level. Pain physicians, anesthesiologists, physiatrists, and interventional radiologists commonly perform it for suspected facet-mediated neck or upper-back pain, including diagnostic blocks used to assess the facet joint as a pain source. The target is a facet joint or its supplying nerve, rather than a spinal nerve root approached through the foramen.
Report one unit for one treated level; use the cervical/thoracic additional-level codes when more levels are treated, and distinguish this region from the lumbar series. Document the spinal region, level, side, target, clinical indication, and image-guided technique. Fluoroscopy or CT guidance is included in the service. CMS assigns a 0-day global period, so same-day preoperative and postoperative care is included. With modifier 50, bilateral payment is 150%. In a same-session multiple-procedure situation, the highest-valued procedure is paid in full and others at 50%. Assistant-at-surgery payment may be made; 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 South Dakota compares for 64490
Across 109 of 109 payment localities, the office rate for 64490 runs from $182.55 in Arkansas to $270.96 in San Benito County, CA. South Dakota pays $201.31. The RVUs are the same everywhere; the geographic indexes change the dollars.
- South Dakota · this page$201.31
- Los Angeles, CA · California$231.27+$29.96
- Washington, DC area · District of Columbia$233.89+$32.58
- Miami, FL · Florida$219.52+$18.21
- Chicago, IL · Illinois$213.55+$12.24
- Manhattan, NY · New York$234.92+$33.61
- Alaska · Alaska$241.21+$39.90
Other areas in South Dakota first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| AlabamaAlabama | $185.08 | $88.05 |
| ArkansasArkansas | $182.55 | $87.29 |
| ArizonaArizona | $199.92 | $92.46 |
| Bakersfield, CACalifornia | $217.45 | $95.92 |
| Chico, CACalifornia | $216.92 | $95.38 |
| El Centro, CACalifornia | $216.95 | $95.41 |
| Fresno, CACalifornia | $216.92 | $95.38 |
| Hanford, CACalifornia | $216.92 | $95.38 |
| Madera, CACalifornia | $216.92 | $95.38 |
| Merced, CACalifornia | $216.92 | $95.38 |
| Modesto, CACalifornia | $216.92 | $95.38 |
| Napa, CACalifornia | $250.62 | $104.47 |
| Oxnard, CACalifornia | $230.13 | $99.05 |
| Redding, CACalifornia | $216.92 | $95.38 |
| Rest of CaliforniaCalifornia | $216.92 | $95.38 |
| Riverside, CACalifornia | $218.78 | $97.24 |
| Sacramento, CACalifornia | $227.44 | $98.48 |
| Salinas, CACalifornia | $226.58 | $98.06 |
| San Diego, CACalifornia | $231.75 | $99.12 |
| Marin County, CACalifornia | $265.14 | $108.79 |
| San Francisco, CACalifornia | $264.95 | $108.59 |
| San Benito County, CACalifornia | $270.96 | $111.05 |
| Santa Clara County, CACalifornia | $270.17 | $110.26 |
| San Luis Obispo, CACalifornia | $222.95 | $96.65 |
| Santa Cruz, CACalifornia | $233.85 | $99.12 |
| Santa Maria, CACalifornia | $227.39 | $98.09 |
| Santa Rosa, CACalifornia | $236.21 | $100.03 |
| Stockton, CACalifornia | $216.92 | $95.38 |
| Vallejo, CACalifornia | $250.34 | $104.19 |
| Visalia, CACalifornia | $216.92 | $95.38 |
| Yuba City, CACalifornia | $216.92 | $95.38 |
| ColoradoColorado | $213.53 | $95.54 |
| ConnecticutConnecticut | $218.26 | $98.83 |
| DelawareDelaware | $203.12 | $93.56 |
| Fort Lauderdale, FLFlorida | $211.49 | $99.16 |
| Rest of FloridaFlorida | $201.77 | $95.75 |
| Atlanta, GAGeorgia | $208.64 | $95.98 |
| Rest of GeorgiaGeorgia | $191.02 | $92.11 |
| Hawaii, Guam, HIHawaii | $221.91 | $95.83 |
| IowaIowa | $189.73 | $88.27 |
| IdahoIdaho | $190.87 | $88.85 |
| East St. Louis, ILIllinois | $199.62 | $97.60 |
| Rest of IllinoisIllinois | $196.07 | $94.83 |
| Suburban Chicago, ILIllinois | $213.67 | $99.78 |
| IndianaIndiana | $191.92 | $89.13 |
| KansasKansas | $188.80 | $88.55 |
| KentuckyKentucky | $189.03 | $90.45 |
| New Orleans, LALouisiana | $197.58 | $93.23 |
| Rest of LouisianaLouisiana | $188.71 | $90.57 |
| Metropolitan Boston, MAMassachusetts | $234.10 | $101.69 |
| Rest of MassachusettsMassachusetts | $212.31 | $95.54 |
| Baltimore area, MDMaryland | $217.61 | $98.63 |
| Rest of MarylandMaryland | $206.89 | $94.67 |
| Rest of MaineMaine | $191.71 | $89.69 |
| Southern Maine, MEMaine | $201.72 | $91.83 |
| Detroit, MIMichigan | $204.07 | $97.06 |
| Rest of MichiganMichigan | $193.61 | $92.37 |
| MinnesotaMinnesota | $205.15 | $91.05 |
| Metropolitan Kansas City, MOMissouri | $196.39 | $92.27 |
| Metropolitan St. Louis, MOMissouri | $198.36 | $92.79 |
| Rest of MissouriMissouri | $185.57 | $89.99 |
| MississippiMississippi | $184.10 | $88.62 |
| MontanaMontana | $205.07 | $94.18 |
| North CarolinaNorth Carolina | $193.63 | $90.17 |
| North DakotaNorth Dakota | $201.71 | $90.82 |
| NebraskaNebraska | $190.75 | $88.40 |
| New HampshireNew Hampshire | $210.12 | $94.69 |
| Northern New JerseyNew Jersey | $231.64 | $103.00 |
| Rest of New JerseyNew Jersey | $220.90 | $99.81 |
| New MexicoNew Mexico | $194.58 | $92.89 |
| NevadaNevada | $204.27 | $93.27 |
| NYC suburbs and Long Island, NYNew York | $240.24 | $108.40 |
| Poughkeepsie and northern NYC suburbs, NYNew York | $222.26 | $100.84 |
| Queens, NYNew York | $236.91 | $105.83 |
| Rest of New YorkNew York | $196.38 | $91.03 |
| OhioOhio | $192.92 | $91.68 |
| OklahomaOklahoma | $188.80 | $89.78 |
| Portland, OROregon | $220.15 | $96.95 |
| Rest of OregonOregon | $202.83 | $92.39 |
| Metropolitan Philadelphia, PAPennsylvania | $212.99 | $97.56 |
| Rest of PennsylvaniaPennsylvania | $193.27 | $91.47 |
| Puerto RicoPuerto Rico | $206.54 | $94.43 |
| Rhode IslandRhode Island | $210.22 | $95.67 |
| South CarolinaSouth Carolina | $193.57 | $91.10 |
| TennesseeTennessee | $189.69 | $88.89 |
| Austin, TXTexas | $212.69 | $95.37 |
| Beaumont, TXTexas | $192.05 | $91.14 |
| Brazoria, TXTexas | $203.04 | $93.15 |
| Dallas, TXTexas | $204.25 | $93.80 |
| Fort Worth, TXTexas | $202.92 | $93.58 |
| Galveston, TXTexas | $203.60 | $93.48 |
| Houston, TXTexas | $206.71 | $96.59 |
| Rest of TexasTexas | $197.38 | $92.14 |
| UtahUtah | $196.09 | $91.85 |
| VirginiaVirginia | $201.03 | $92.02 |
| Virgin Islands, VIUnited States Virgin Islands | $206.54 | $94.43 |
| VermontVermont | $200.87 | $91.09 |
| Rest of WashingtonWashington | $211.93 | $95.16 |
| King County, WAWashington | $238.84 | $102.78 |
| WisconsinWisconsin | $195.26 | $89.03 |
| West VirginiaWest Virginia | $189.15 | $92.79 |
| WyomingWyoming | $203.61 | $92.71 |
64490 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.
$182.55
$243.94
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 | $241.21 | 1 |
| AL | $185.08 | 1 |
| AR | $182.55 | 1 |
| AZ | $199.92 | 1 |
| CA | $216.92–$270.96 | 29 |
| CO | $213.53 | 1 |
| CT | $218.26 | 1 |
| DC | $233.89 | 1 |
| DE | $203.12 | 1 |
| FL | $201.77–$219.52 | 3 |
| GA | $191.02–$208.64 | 2 |
| GU | $221.91 | 1 |
| HI | $221.91 | 1 |
| IA | $189.73 | 1 |
| ID | $190.87 | 1 |
| IL | $196.07–$213.67 | 4 |
| IN | $191.92 | 1 |
| KS | $188.80 | 1 |
| KY | $189.03 | 1 |
| LA | $188.71–$197.58 | 2 |
| MA | $212.31–$234.10 | 2 |
| MD | $206.89–$233.89 | 3 |
| ME | $191.71–$201.72 | 2 |
| MI | $193.61–$204.07 | 2 |
| MN | $205.15 | 1 |
| MO | $185.57–$198.36 | 3 |
| MS | $184.10 | 1 |
| MT | $205.07 | 1 |
| NC | $193.63 | 1 |
| ND | $201.71 | 1 |
| NE | $190.75 | 1 |
| NH | $210.12 | 1 |
| NJ | $220.90–$231.64 | 2 |
| NM | $194.58 | 1 |
| NV | $204.27 | 1 |
| NY | $196.38–$240.24 | 5 |
| OH | $192.92 | 1 |
| OK | $188.80 | 1 |
| OR | $202.83–$220.15 | 2 |
| PA | $193.27–$212.99 | 2 |
| PR | $206.54 | 1 |
| RI | $210.22 | 1 |
| SC | $193.57 | 1 |
| SD | $201.31 | 1 |
| TN | $189.69 | 1 |
| TX | $192.05–$212.69 | 8 |
| UT | $196.09 | 1 |
| VA | $201.03–$233.89 | 2 |
| VI | $206.54 | 1 |
| VT | $200.87 | 1 |
| WA | $211.93–$238.84 | 2 |
| WI | $195.26 | 1 |
| WV | $189.15 | 1 |
| WY | $203.61 | 1 |
How the 64490 rate is calculated
Each of 64490’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 · 64490
RVUs × geographic indexes × conversion factor
Work1.77
1.77 RVUs× 1.000 GPCI
Practice expense4.20
4.20 RVUs× 1.000 GPCI
Malpractice0.17
0.17 RVUs× 1.000 GPCI
Adjusted RVUs
6.1400
Conversion factor
$33.4009
Medicare rate
$205.08
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
The exact South Dakota inputs and CMS source lines
PPRRVU2026_Oct_nonQPP.csv
7,134
- Code
- 64490
- Physician work
- 1.77
- Practice expense
- 4.20
- Malpractice
- 0.17
GPCI2026.csv
94
- Locality
- South Dakota
- Physician work
- 1.000
- Practice expense
- 1.000
- Malpractice
- 0.336
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 1.77 | × 1.000 | 1.7700 |
| Practice expense | 4.20 | × 1.000 | 4.2000 |
| Malpractice | 0.17 | × 0.336 | 0.0571 |
| Total RVUs | 6.0271 | ||
| Conversion factor | × 33.4009 | ||
Office rate, South Dakota$201.31
Office: (1.77 × 1 + 4.2 × 1 + 0.17 × 0.336) × $33.4009 = $201.31
Facility: (1.77 × 1 + 0.88 × 1 + 0.17 × 0.336) × $33.4009 = $90.42
Payment rules and modifiers for 64490
The CMS indicators that decide how 64490 is paid alongside other services.
CMS payment indicators · 64490
Facet injection, cervical or thoracic, one level
| 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) | 2 | Paid. |
| 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
64490 without 50 · national office
$205.08
Facet injection, cervical or thoracic, one level
64490-50 · Bilateral: 150%
$307.62
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 64490 has changed in South Dakota
64490 · Office / nonfacility
$201.31
Effective 2026-10-01
The base rate is $18.39 higher than on 2025-10-01, moving from $182.92 to $201.31 (10.1%).
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
$182.92changed to$201.31
- Conversion factor 32.3465 changed to 33.4009
- Work RVU 1.82 changed to 1.77
- Practice expense RVU 3.77 changed to 4.20
- Malpractice GPCI 0.382 changed to 0.336
Held through RVU26B, RVU26C, RVU26D.
January 1, 2025
RVU25A
$189.03changed to$182.92
- Conversion factor 33.2875 changed to 32.3465
- Practice expense RVU 3.79 changed to 3.77
- Malpractice RVU 0.18 changed to 0.17
Held through RVU25B, RVU25C, RVU25D.
March 9, 2024
RVU24AR
$185.95changed to$189.03
- Conversion factor 32.7442 changed to 33.2875
Held through RVU24B, RVU24C, RVU24D.
January 1, 2024
RVU24A
$189.28changed to$185.95
- Conversion factor 33.8872 changed to 32.7442
- Practice expense RVU 3.70 changed to 3.79
- Malpractice GPCI 0.364 changed to 0.382
January 1, 2023
RVU23A
$192.74changed to$189.28
- Conversion factor 34.6062 changed to 33.8872
- Practice expense RVU 3.68 changed to 3.70
- Malpractice RVU 0.20 changed to 0.18
- Malpractice GPCI 0.347 changed to 0.364
Held through RVU23B, RVU23C, RVU23D.
January 1, 2022
RVU22A
$195.26changed to$192.74
- Conversion factor 34.8931 changed to 34.6062
- Practice expense RVU 3.71 changed to 3.68
- Malpractice RVU 0.19 changed to 0.20
Held through RVU22B, RVU22C, RVU22D.
January 1, 2021
RVU21A
$191.50changed to$195.26
- Conversion factor 36.0896 changed to 34.8931
- Practice expense RVU 3.42 changed to 3.71
- Malpractice RVU 0.18 changed to 0.19
- Malpractice GPCI 0.368 changed to 0.347
Held through RVU21B, RVU21C, RVU21D.
January 1, 2020
RVU20A
$190.73changed to$191.50
- Conversion factor 36.0391 changed to 36.0896
- Practice expense RVU 3.41 changed to 3.42
- Malpractice RVU 0.16 changed to 0.18
- Malpractice GPCI 0.389 changed to 0.368
Held through RVU20B, RVU20C, RVU20D.
January 1, 2019
RVU19A
$190.16changed to$190.73
- Conversion factor 35.9996 changed to 36.0391
- Practice expense RVU 3.40 changed to 3.41
Held through RVU19B, RVU19C, RVU19D.
January 1, 2018
RVU18AR1
$188.53changed to$190.16
- Conversion factor 35.8887 changed to 35.9996
- Practice expense RVU 3.37 changed to 3.40
- Malpractice GPCI 0.395 changed to 0.389
Held through RVU18B, RVU18C, RVU18D.
January 1, 2017
RVU17A
$190.98changed to$188.53
- Conversion factor 35.8043 changed to 35.8887
- Practice expense RVU 3.45 changed to 3.37
- Malpractice GPCI 0.400 changed to 0.395
Held through RVU17B, RVU17C, RVU17D.
January 1, 2016
RVU16A
$190.74changed to$190.98
- Conversion factor 35.9335 changed to 35.8043
- Practice expense RVU 3.42 changed to 3.45
- Malpractice RVU 0.17 changed to 0.16
Held through RVU16B, RVU16C, RVU16D.
July 1, 2015
RVU15C
$189.79changed to$190.74
- Conversion factor 35.7547 changed to 35.9335
Held through RVU15D.
January 1, 2015
RVU15A
$192.33changed to$189.79
- Conversion factor 35.8228 changed to 35.7547
- Practice expense RVU 3.47 changed to 3.42
- Malpractice RVU 0.19 changed to 0.17
- Malpractice GPCI 0.416 changed to 0.400
Held through RVU15B.
January 1, 2014
RVU14A
$198.91changed to$192.33
- Conversion factor 34.0230 changed to 35.8228
- Practice expense RVU 3.94 changed to 3.47
- Malpractice RVU 0.20 changed to 0.19
- Malpractice GPCI 0.432 changed to 0.416
Held through RVU14B, RVU14C, RVU14D.
January 1, 2013
RVU13AR
Earliest loaded release: $198.91
Held through RVU13B, RVU13C, RVU13D.
| Effective from | Office | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | $201.31 | $90.42 | RVU26D |
| 2026-07-01 | $201.31 | $90.42 | RVU26C |
| 2026-04-01 | $201.31 | $90.42 | RVU26B |
| 2026-01-01 | $201.31 | $90.42 | RVU26A |
| 2025-10-01 | $182.92 | $98.82 | RVU25D |
| 2025-07-01 | $182.92 | $98.82 | RVU25C |
| 2025-04-01 | $182.92 | $98.82 | RVU25B |
| 2025-01-01 | $182.92 | $98.82 | RVU25A |
| 2024-10-01 | $189.03 | $100.82 | RVU24D |
| 2024-07-01 | $189.03 | $100.82 | RVU24C |
| 2024-04-01 | $189.03 | $100.82 | RVU24B |
| 2024-03-09 | $189.03 | $100.82 | RVU24AR |
| 2024-01-01 | $185.95 | $99.17 | RVU24A |
| 2023-10-01 | $189.28 | $101.17 | RVU23D |
| 2023-07-01 | $189.28 | $101.17 | RVU23C |
| 2023-04-01 | $189.28 | $101.17 | RVU23B |
| 2023-01-01 | $189.28 | $101.17 | RVU23A |
| 2022-10-01 | $192.74 | $102.76 | RVU22D |
| 2022-07-01 | $192.74 | $102.76 | RVU22C |
| 2022-04-01 | $192.74 | $102.76 | RVU22B |
| 2022-01-01 | $192.74 | $102.76 | RVU22A |
| 2021-10-01 | $195.26 | $103.49 | RVU21D |
| 2021-07-01 | $195.26 | $103.49 | RVU21C |
| 2021-04-01 | $195.26 | $103.49 | RVU21B |
| 2021-01-01 | $195.26 | $103.49 | RVU21A |
| 2020-10-01 | $191.50 | $105.61 | RVU20D |
| 2020-07-01 | $191.50 | $105.61 | RVU20C |
| 2020-04-01 | $191.50 | $105.61 | RVU20B |
| 2020-01-01 | $191.50 | $105.61 | RVU20A |
| 2019-10-01 | $190.73 | $105.68 | RVU19D |
| 2019-07-01 | $190.73 | $105.68 | RVU19C |
| 2019-04-01 | $190.73 | $105.68 | RVU19B |
| 2019-01-01 | $190.73 | $105.68 | RVU19A |
| 2018-10-01 | $190.16 | $105.92 | RVU18D |
| 2018-07-01 | $190.16 | $105.92 | RVU18C |
| 2018-04-01 | $190.16 | $105.92 | RVU18B |
| 2018-01-01 | $190.16 | $105.92 | RVU18AR1 |
| 2017-10-01 | $188.53 | $105.99 | RVU17D |
| 2017-07-01 | $188.53 | $105.99 | RVU17C |
| 2017-04-01 | $188.53 | $105.99 | RVU17B |
| 2017-01-01 | $188.53 | $105.99 | RVU17A |
| 2016-10-01 | $190.98 | $106.48 | RVU16D |
| 2016-07-01 | $190.98 | $106.48 | RVU16C |
| 2016-04-01 | $190.98 | $106.48 | RVU16B |
| 2016-01-01 | $190.98 | $106.48 | RVU16A |
| 2015-10-01 | $190.74 | $107.01 | RVU15D |
| 2015-07-01 | $190.74 | $107.01 | RVU15C |
| 2015-04-01 | $189.79 | $106.48 | RVU15B |
| 2015-01-01 | $189.79 | $106.48 | RVU15A |
| 2014-10-01 | $192.33 | $107.79 | RVU14D |
| 2014-07-01 | $192.33 | $107.79 | RVU14C |
| 2014-04-01 | $192.33 | $107.79 | RVU14B |
| 2014-01-01 | $192.33 | $107.79 | RVU14A |
| 2013-10-01 | $198.91 | $106.71 | RVU13D |
| 2013-07-01 | $198.91 | $106.71 | RVU13C |
| 2013-04-01 | $198.91 | $106.71 | RVU13B |
| 2013-01-01 | $198.91 | $106.71 | RVU13AR |
Where the South Dakota rate applies
South Dakota is a Medicare payment area, not a city. Our Census mapping connects it to 485 cities and communities in South Dakota. Some span more than one payment area; confirm with the service ZIP.
- Aberdeen
- Agar
- Agency Village
- Akaska
- Albee
- Alcester
- Alexandria
- Allen
64490 billing questions
When should 64490 be chosen over 64491 or 64492?
Use 64490 for one cervical or thoracic level. The additional-level codes apply when more levels in that region are treated during the session.
Can fluoroscopy or CT guidance be billed separately?
No. Image guidance is included in this facet injection service.
How is a bilateral injection reported?
Report modifier 50 for bilateral treatment; CMS pays the bilateral procedure at 150%.
What documentation supports reporting 64490?
Record the cervical or thoracic region, treated level and side, facet joint or supplying nerve targeted, clinical reason, and image-guided technique.
Is same-day evaluation and postoperative care separately included?
The 0-day global period includes same-day preoperative and postoperative care.
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
Fee sheets
Put 64490 and the rest of your codes on one sheet
Your codes at your locality, with payer contracts beside Medicare.
Build my fee sheet