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CPT code 64490: Facet injection, cervical or thoracic, one level2026 Medicare rate & RVUs in Houston, TX

Image-guided injection of a cervical or thoracic facet joint or its supplying nerve at one level for suspected facet-mediated pain.

CMS RVU26DEffective Oct 1, 2026One payment locality220.8K Medicare services in 2024

In Houston, TX, Medicare pays $206.71 for 64490 in the office and $96.59 when it’s performed in a hospital or facility.

$206.71Office (non-facility)
$96.59Hospital or facility
+0.8%vs the national office rate ($205.08)

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.

We’ll open 64490 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Houston, TX
  2. What 64490 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 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 Houston, TX 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. Houston, TX pays $206.71. The RVUs are the same everywhere; the geographic indexes change the dollars.

64490 in Houston, TX vs other payment areas
  1. Houston, TX · this page$206.71
  2. Austin, TX · Texas$212.69+$5.98
  3. Beaumont, TX · Texas$192.05−$14.66
  4. Brazoria, TX · Texas$203.04−$3.67
  5. Dallas, TX · Texas$204.25−$2.46
  6. Fort Worth, TX · Texas$202.92−$3.79
  7. Galveston, TX · Texas$203.60−$3.11

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

Every other payment area

64490 in every other Medicare payment locality
Payment localityOfficeFacility
Rest of TexasTexas$197.38$92.14
Los Angeles, CACalifornia$231.27$100.09
Washington, DC areaDistrict of Columbia$233.89$103.26
Miami, FLFlorida$219.52$104.08
Chicago, ILIllinois$213.55$102.10
Manhattan, NYNew York$234.92$106.06
AlaskaAlaska$241.21$123.11
AlabamaAlabama$185.08$88.05

64490 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.

$182.55

$243.94

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

View every state and territory as a table
64490 office rate range by state
State / territoryOffice rate rangeLocalities
AK$241.211
AL$185.081
AR$182.551
AZ$199.921
CA$216.92–$270.9629
CO$213.531
CT$218.261
DC$233.891
DE$203.121
FL$201.77–$219.523
GA$191.02–$208.642
GU$221.911
HI$221.911
IA$189.731
ID$190.871
IL$196.07–$213.674
IN$191.921
KS$188.801
KY$189.031
LA$188.71–$197.582
MA$212.31–$234.102
MD$206.89–$233.893
ME$191.71–$201.722
MI$193.61–$204.072
MN$205.151
MO$185.57–$198.363
MS$184.101
MT$205.071
NC$193.631
ND$201.711
NE$190.751
NH$210.121
NJ$220.90–$231.642
NM$194.581
NV$204.271
NY$196.38–$240.245
OH$192.921
OK$188.801
OR$202.83–$220.152
PA$193.27–$212.992
PR$206.541
RI$210.221
SC$193.571
SD$201.311
TN$189.691
TX$192.05–$212.698
UT$196.091
VA$201.03–$233.892
VI$206.541
VT$200.871
WA$211.93–$238.842
WI$195.261
WV$189.151
WY$203.611

See 64490 in every payment locality

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

Office or facility?

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 Houston, TX 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

102

Locality
Houston, TX
Physician work
1.008
Practice expense
0.993
Malpractice
1.376
Office calculation for 64490 in Houston, TX
ComponentRVULocality factorAdjusted
Physician work1.77× 1.0081.7842
Practice expense4.20× 0.9934.1706
Malpractice0.17× 1.3760.2339
Total RVUs6.1887
Conversion factor× 33.4009

Office rate, Houston, TX$206.71

Office: (1.77 × 1.008 + 4.2 × 0.993 + 0.17 × 1.376) × $33.4009 = $206.71

Facility: (1.77 × 1.008 + 0.88 × 0.993 + 0.17 × 1.376) × $33.4009 = $96.59

Open 64490 in the RVU calculator

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

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)2Paid.
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

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).

When to use modifier 50

Codes related to 64490

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

Codes related to 64490
CodeHow it relatesOffice range, Houston, TX
Same family
64491Facet injection, cervical/thoracic second levelAdditional cervical or thoracic level in the same facet-injection series.$103.13
64492Facet injection, third cervical/thoracic levelFurther additional cervical or thoracic level in the same series.$103.21
64493Facet joint injection, lumbar or sacral, one levelCorresponding single-level facet injection code for the lumbar or sacral region.$191.58
64494Facet joint injection, lumbar/sacral, second levelAdditional lumbar or sacral level in the facet-injection series.$96.70
64495Facet injection, third and additional levelsFurther additional lumbar or sacral level in the facet-injection series.$99.69

How 64490 has changed in Houston, TX

64490 · Office / nonfacility

$206.71

Effective 2026-10-01

The base rate is $16.96 higher than on 2025-10-01, moving from $189.75 to $206.71 (8.9%).

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

    $189.75changed to$206.71

    • 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
    • Work GPCI 1.014 changed to 1.008
    • Practice expense GPCI 1.003 changed to 0.993
    • Malpractice GPCI 1.409 changed to 1.376

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $196.41changed to$189.75

    • 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.

  3. March 9, 2024

    RVU24AR

    $193.21changed to$196.41

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $197.52changed to$193.21

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 3.70 changed to 3.79
    • Work GPCI 1.023 changed to 1.014
    • Practice expense GPCI 1.016 changed to 1.003
    • Malpractice GPCI 1.154 changed to 1.409

  5. January 1, 2023

    RVU23A

    $202.27changed to$197.52

    • 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
    • Work GPCI 1.032 changed to 1.023
    • Practice expense GPCI 1.029 changed to 1.016
    • Malpractice GPCI 0.900 changed to 1.154

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $204.71changed to$202.27

    • 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.

  7. January 1, 2021

    RVU21A

    $199.25changed to$204.71

    • 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
    • Work GPCI 1.026 changed to 1.032
    • Practice expense GPCI 1.020 changed to 1.029
    • Malpractice GPCI 0.918 changed to 0.900

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $196.67changed to$199.25

    • 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
    • Work GPCI 1.020 changed to 1.026
    • Practice expense GPCI 1.012 changed to 1.020
    • Malpractice GPCI 0.936 changed to 0.918

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $196.09changed to$196.67

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 3.40 changed to 3.41

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $194.09changed to$196.09

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 3.37 changed to 3.40
    • Practice expense GPCI 1.009 changed to 1.012
    • Malpractice GPCI 0.946 changed to 0.936

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $196.14changed to$194.09

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 3.45 changed to 3.37
    • Work GPCI 1.019 changed to 1.020
    • Practice expense GPCI 1.006 changed to 1.009
    • Malpractice GPCI 0.955 changed to 0.946

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $196.11changed to$196.14

    • 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.

  13. July 1, 2015

    RVU15C

    $195.13changed to$196.11

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $197.30changed to$195.13

    • 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
    • Work GPCI 1.014 changed to 1.019
    • Practice expense GPCI 1.004 changed to 1.006
    • Malpractice GPCI 0.939 changed to 0.955

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $203.08changed to$197.30

    • 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
    • Work GPCI 1.009 changed to 1.014
    • Practice expense GPCI 1.002 changed to 1.004
    • Malpractice GPCI 0.923 changed to 0.939

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $203.08

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$206.71$96.59RVU26D
2026-07-01$206.71$96.59RVU26C
2026-04-01$206.71$96.59RVU26B
2026-01-01$206.71$96.59RVU26A
2025-10-01$189.75$105.40RVU25D
2025-07-01$189.75$105.40RVU25C
2025-04-01$189.75$105.40RVU25B
2025-01-01$189.75$105.40RVU25A
2024-10-01$196.41$107.94RVU24D
2024-07-01$196.41$107.94RVU24C
2024-04-01$196.41$107.94RVU24B
2024-03-09$196.41$107.94RVU24AR
2024-01-01$193.21$106.17RVU24A
2023-10-01$197.52$108.00RVU23D
2023-07-01$197.52$108.00RVU23C
2023-04-01$197.52$108.00RVU23B
2023-01-01$197.52$108.00RVU23A
2022-10-01$202.27$109.69RVU22D
2022-07-01$202.27$109.69RVU22C
2022-04-01$202.27$109.69RVU22B
2022-01-01$202.27$109.69RVU22A
2021-10-01$204.71$110.28RVU21D
2021-07-01$204.71$110.28RVU21C
2021-04-01$204.71$110.28RVU21B
2021-01-01$204.71$110.28RVU21A
2020-10-01$199.25$111.64RVU20D
2020-07-01$199.25$111.64RVU20C
2020-04-01$199.25$111.64RVU20B
2020-01-01$199.25$111.64RVU20A
2019-10-01$196.67$110.60RVU19D
2019-07-01$196.67$110.60RVU19C
2019-04-01$196.67$110.60RVU19B
2019-01-01$196.67$110.60RVU19A
2018-10-01$196.09$110.84RVU18D
2018-07-01$196.09$110.84RVU18C
2018-04-01$196.09$110.84RVU18B
2018-01-01$196.09$110.84RVU18AR1
2017-10-01$194.09$110.80RVU17D
2017-07-01$194.09$110.80RVU17C
2017-04-01$194.09$110.80RVU17B
2017-01-01$194.09$110.80RVU17A
2016-10-01$196.14$111.13RVU16D
2016-07-01$196.14$111.13RVU16C
2016-04-01$196.14$111.13RVU16B
2016-01-01$196.14$111.13RVU16A
2015-10-01$196.11$111.88RVU15D
2015-07-01$196.11$111.88RVU15C
2015-04-01$195.13$111.32RVU15B
2015-01-01$195.13$111.32RVU15A
2014-10-01$197.30$112.42RVU14D
2014-07-01$197.30$112.42RVU14C
2014-04-01$197.30$112.42RVU14B
2014-01-01$197.30$112.42RVU14A
2013-10-01$203.08$110.69RVU13D
2013-07-01$203.08$110.69RVU13C
2013-04-01$203.08$110.69RVU13B
2013-01-01$203.08$110.69RVU13AR

Price 64490 for an earlier date of service

Where the Houston, TX rate applies

Houston, TX is a Medicare payment area, not a city. Our Census mapping connects it to 46 cities and communities in Texas. Some span more than one payment area; confirm with the service ZIP.

Browse all communities in Texas

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
RVUs for 64490PPRRVU2026_Oct_nonQPP.csv, line 7,134 (RVU26D)
Geographic factors for Houston, TXGPCI2026.csv, line 102 (RVU26D)

Open CMS sourceHow we calculate rates

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