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

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 Virginia, Medicare pays $201.03 for 64490 in the office and $92.02 when it’s performed in a hospital or facility.

$201.03Office (non-facility)
$92.02Hospital or facility
−2.0%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 Virginia
  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 Virginia 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. Virginia pays $201.03. The RVUs are the same everywhere; the geographic indexes change the dollars.

64490 in Virginia vs other payment areas
  1. Virginia · this page$201.03
  2. Los Angeles, CA · California$231.27+$30.24
  3. Washington, DC area · District of Columbia$233.89+$32.86
  4. Miami, FL · Florida$219.52+$18.49
  5. Chicago, IL · Illinois$213.55+$12.52
  6. Manhattan, NY · New York$234.92+$33.89
  7. Alaska · Alaska$241.21+$40.18

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

Every other payment area

64490 in every other Medicare payment locality
Payment localityOfficeFacility
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

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 Virginia 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

106

Locality
Virginia
Physician work
1.000
Practice expense
0.983
Malpractice
0.706
Office calculation for 64490 in Virginia
ComponentRVULocality factorAdjusted
Physician work1.77× 1.0001.7700
Practice expense4.20× 0.9834.1286
Malpractice0.17× 0.7060.1200
Total RVUs6.0186
Conversion factor× 33.4009

Office rate, Virginia$201.03

Office: (1.77 × 1 + 4.2 × 0.983 + 0.17 × 0.706) × $33.4009 = $201.03

Facility: (1.77 × 1 + 0.88 × 0.983 + 0.17 × 0.706) × $33.4009 = $92.02

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, Virginia
Same family
64491Facet injection, cervical/thoracic second levelAdditional cervical or thoracic level in the same facet-injection series.$99.76
64492Facet injection, third cervical/thoracic levelFurther additional cervical or thoracic level in the same series.$100.28
64493Facet joint injection, lumbar or sacral, one levelCorresponding single-level facet injection code for the lumbar or sacral region.$186.69
64494Facet joint injection, lumbar/sacral, second levelAdditional lumbar or sacral level in the facet-injection series.$94.05
64495Facet injection, third and additional levelsFurther additional lumbar or sacral level in the facet-injection series.$97.00

How 64490 has changed in Virginia

64490 · Office / nonfacility

$201.03

Effective 2026-10-01

The base rate is $17.89 higher than on 2025-10-01, moving from $183.14 to $201.03 (9.8%).

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

    $183.14changed to$201.03

    • 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 1.002 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

    $189.37changed to$183.14

    • 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

    $186.28changed to$189.37

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $190.84changed to$186.28

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 3.70 changed to 3.79
    • 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

    $195.91changed to$190.84

    • 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
    • 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

    $198.26changed to$195.91

    • 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

    $193.86changed to$198.26

    • 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
    • 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

    $192.00changed to$193.86

    • 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
    • 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

    $191.43changed to$192.00

    • 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

    $189.42changed to$191.43

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 3.37 changed to 3.40
    • 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

    $191.31changed to$189.42

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 3.45 changed to 3.37
    • 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

    $191.24changed to$191.31

    • 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

    $190.28changed to$191.24

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $192.31changed to$190.28

    • 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
    • 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

    $197.86changed to$192.31

    • 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
    • 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: $197.86

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$201.03$92.02RVU26D
2026-07-01$201.03$92.02RVU26C
2026-04-01$201.03$92.02RVU26B
2026-01-01$201.03$92.02RVU26A
2025-10-01$183.14$100.38RVU25D
2025-07-01$183.14$100.38RVU25C
2025-04-01$183.14$100.38RVU25B
2025-01-01$183.14$100.38RVU25A
2024-10-01$189.37$102.57RVU24D
2024-07-01$189.37$102.57RVU24C
2024-04-01$189.37$102.57RVU24B
2024-03-09$189.37$102.57RVU24AR
2024-01-01$186.28$100.89RVU24A
2023-10-01$190.84$103.62RVU23D
2023-07-01$190.84$103.62RVU23C
2023-04-01$190.84$103.62RVU23B
2023-01-01$190.84$103.62RVU23A
2022-10-01$195.91$106.38RVU22D
2022-07-01$195.91$106.38RVU22C
2022-04-01$195.91$106.38RVU22B
2022-01-01$195.91$106.38RVU22A
2021-10-01$198.26$106.95RVU21D
2021-07-01$198.26$106.95RVU21C
2021-04-01$198.26$106.95RVU21B
2021-01-01$198.26$106.95RVU21A
2020-10-01$193.86$108.74RVU20D
2020-07-01$193.86$108.74RVU20C
2020-04-01$193.86$108.74RVU20B
2020-01-01$193.86$108.74RVU20A
2019-10-01$192.00$108.14RVU19D
2019-07-01$192.00$108.14RVU19C
2019-04-01$192.00$108.14RVU19B
2019-01-01$192.00$108.14RVU19A
2018-10-01$191.43$108.37RVU18D
2018-07-01$191.43$108.37RVU18C
2018-04-01$191.43$108.37RVU18B
2018-01-01$191.43$108.37RVU18AR1
2017-10-01$189.42$108.12RVU17D
2017-07-01$189.42$108.12RVU17C
2017-04-01$189.42$108.12RVU17B
2017-01-01$189.42$108.12RVU17A
2016-10-01$191.31$108.25RVU16D
2016-07-01$191.31$108.25RVU16C
2016-04-01$191.31$108.25RVU16B
2016-01-01$191.31$108.25RVU16A
2015-10-01$191.24$108.93RVU15D
2015-07-01$191.24$108.93RVU15C
2015-04-01$190.28$108.39RVU15B
2015-01-01$190.28$108.39RVU15A
2014-10-01$192.31$109.46RVU14D
2014-07-01$192.31$109.46RVU14C
2014-04-01$192.31$109.46RVU14B
2014-01-01$192.31$109.46RVU14A
2013-10-01$197.86$107.78RVU13D
2013-07-01$197.86$107.78RVU13C
2013-04-01$197.86$107.78RVU13B
2013-01-01$197.86$107.78RVU13AR

Price 64490 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

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 VirginiaGPCI2026.csv, line 106 (RVU26D)

Open CMS sourceHow we calculate rates

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