CPT code 64491: Facet injection, cervical/thoracic second level2026 Medicare rate & RVUs
Reports an additional cervical or thoracic facet-joint injection level performed with a primary-level procedure during the same treatment session.
Medicare pays $101.87 for 64491 nationally in the office and $50.77 in a hospital or facility. Local office rates run $91.57–$131.04.
Medicare rate · 64491
Facet injection, cervical/thoracic second level
- Work RVUs
- 1.13
- Total RVUs
- 3.05
- Global days
- ZZZ
National rate · 2026
$101.87
Office setting, before claim adjustments.
See every locality for 64491 →Billed by an NP, PA or therapist? →
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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On this page 10 sections
What 64491 covers
This add-on code covers injection at a second cervical or thoracic paravertebral facet-joint level, or the nerves supplying that joint, commonly for diagnostic evaluation or treatment of suspected facet-mediated neck or upper-back pain. Pain-management physicians and other qualified practitioners perform the procedure, often using imaging to guide needle placement. The code is specific to the cervical or thoracic region; lumbar facet levels are reported from a separate code family.
Report 64491 with the primary-level code 64490 when a second level is treated; it is not reported by itself. Documentation should identify the spinal region, each treated level and side, and the procedure performed. Imaging guidance is included in the facet-injection service. CMS treats 64491 as an add-on paid within the primary procedure’s global period. For a bilateral procedure reported with modifier 50, CMS pays 150% of the applicable amount.
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 64491 pays more and less
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
109 payment localities
$91.57 to $131.04
109 of 109 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Alabama | $92.72 | $48.01 |
| Alaska | $123.02 | $68.60 |
| Arizona | $99.47 | $49.95 |
| Arkansas | $91.57 | $47.67 |
| Atlanta, GA | $103.69 | $51.77 |
| Austin, TX | $105.04 | $50.97 |
| Bakersfield, CA | $106.96 | $50.95 |
| Baltimore area, MD | $107.76 | $52.93 |
| Beaumont, TX | $96.17 | $49.67 |
| Brazoria, TX | $100.82 | $50.18 |
| Chicago, IL | $107.20 | $55.84 |
| Chico, CA | $106.61 | $50.60 |
| Colorado | $105.39 | $51.02 |
| Connecticut | $108.05 | $53.02 |
| Dallas, TX | $101.45 | $50.55 |
| Delaware | $100.96 | $50.47 |
| Detroit, MI | $102.28 | $52.96 |
| East St. Louis, IL | $100.76 | $53.75 |
| El Centro, CA | $106.63 | $50.62 |
| Fort Lauderdale, FL | $105.63 | $53.86 |
| Fort Worth, TX | $100.89 | $50.50 |
| Fresno, CA | $106.61 | $50.60 |
| Galveston, TX | $101.12 | $50.37 |
| Hanford, CA | $106.61 | $50.60 |
| Hawaii, Guam, HI | $108.61 | $50.50 |
| Houston, TX | $103.13 | $52.39 |
| Idaho | $95.10 | $48.08 |
| Indiana | $95.57 | $48.20 |
| Iowa | $94.52 | $47.76 |
| Kansas | $94.25 | $48.05 |
| Kentucky | $94.85 | $49.42 |
| King County, WA | $116.81 | $54.11 |
| Los Angeles, CA | $113.25 | $52.79 |
| Madera, CA | $106.61 | $50.60 |
| Manhattan, NY | $116.24 | $56.85 |
| Marin County, CA | $128.26 | $56.20 |
| Merced, CA | $106.61 | $50.60 |
| Metropolitan Boston, MA | $114.74 | $53.73 |
| Metropolitan Kansas City, MO | $98.10 | $50.11 |
| Metropolitan Philadelphia, PA | $105.74 | $52.54 |
| Metropolitan St. Louis, MO | $98.98 | $50.33 |
| Miami, FL | $109.97 | $56.77 |
| Minnesota | $101.04 | $48.45 |
| Mississippi | $92.51 | $48.51 |
| Modesto, CA | $106.61 | $50.60 |
| Montana | $101.87 | $50.76 |
| Napa, CA | $121.67 | $54.31 |
| Nebraska | $94.93 | $47.76 |
| Nevada | $101.32 | $50.17 |
| New Hampshire | $103.89 | $50.69 |
| New Mexico | $97.59 | $50.73 |
| New Orleans, LA | $98.81 | $50.72 |
| North Carolina | $96.50 | $48.82 |
| North Dakota | $99.69 | $48.59 |
| Northern New Jersey | $114.17 | $54.89 |
| NYC suburbs and Long Island, NY | $118.86 | $58.10 |
| Ohio | $96.64 | $49.99 |
| Oklahoma | $94.58 | $48.95 |
| Oxnard, CA | $112.55 | $52.14 |
| Portland, OR | $108.25 | $51.47 |
| Poughkeepsie and northern NYC suburbs, NY | $110.09 | $54.13 |
| Puerto Rico | $102.48 | $50.82 |
| Queens, NY | $116.92 | $56.51 |
| Redding, CA | $106.61 | $50.60 |
| Rest of California | $106.61 | $50.60 |
| Rest of Florida | $101.06 | $52.21 |
| Rest of Georgia | $96.05 | $50.46 |
| Rest of Illinois | $98.68 | $52.02 |
| Rest of Louisiana | $94.77 | $49.54 |
| Rest of Maine | $95.65 | $48.63 |
| Rest of Maryland | $102.67 | $50.96 |
| Rest of Massachusetts | $104.93 | $51.12 |
| Rest of Michigan | $97.09 | $50.43 |
| Rest of Missouri | $93.43 | $49.38 |
| Rest of New Jersey | $109.30 | $53.50 |
| Rest of New York | $97.76 | $49.21 |
| Rest of Oregon | $100.54 | $49.64 |
| Rest of Pennsylvania | $96.71 | $49.80 |
| Rest of Texas | $98.43 | $49.94 |
| Rest of Washington | $104.69 | $50.88 |
| Rhode Island | $104.19 | $51.40 |
| Riverside, CA | $107.82 | $51.81 |
| Sacramento, CA | $111.38 | $51.95 |
| Salinas, CA | $110.95 | $51.72 |
| San Benito County, CA | $131.04 | $57.35 |
| San Diego, CA | $113.17 | $52.05 |
| San Francisco, CA | $128.13 | $56.08 |
| San Luis Obispo, CA | $109.21 | $51.01 |
| Santa Clara County, CA | $130.53 | $56.84 |
| Santa Cruz, CA | $113.96 | $51.87 |
| Santa Maria, CA | $111.26 | $51.67 |
| Santa Rosa, CA | $115.08 | $52.33 |
| South Carolina | $96.73 | $49.51 |
| South Dakota | $99.43 | $48.33 |
| Southern Maine, ME | $99.97 | $49.33 |
| Stockton, CA | $106.61 | $50.60 |
| Suburban Chicago, IL | $106.61 | $54.12 |
| Tennessee | $94.67 | $48.22 |
| Utah | $97.87 | $49.83 |
| Vallejo, CA | $121.49 | $54.13 |
| Vermont | $99.45 | $48.86 |
| Virgin Islands, VI | $102.48 | $50.82 |
| Virginia | $99.76 | $49.53 |
| Visalia, CA | $106.61 | $50.60 |
| Washington, DC area | $115.09 | $54.89 |
| West Virginia | $95.54 | $51.13 |
| Wisconsin | $96.79 | $47.83 |
| Wyoming | $100.92 | $49.81 |
| Yuba City, CA | $106.61 | $50.60 |
64491 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.
$91.57
$123.02
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 | $123.02 | 1 |
| AL | $92.72 | 1 |
| AR | $91.57 | 1 |
| AZ | $99.47 | 1 |
| CA | $106.61–$131.04 | 29 |
| CO | $105.39 | 1 |
| CT | $108.05 | 1 |
| DC | $115.09 | 1 |
| DE | $100.96 | 1 |
| FL | $101.06–$109.97 | 3 |
| GA | $96.05–$103.69 | 2 |
| GU | $108.61 | 1 |
| HI | $108.61 | 1 |
| IA | $94.52 | 1 |
| ID | $95.10 | 1 |
| IL | $98.68–$107.20 | 4 |
| IN | $95.57 | 1 |
| KS | $94.25 | 1 |
| KY | $94.85 | 1 |
| LA | $94.77–$98.81 | 2 |
| MA | $104.93–$114.74 | 2 |
| MD | $102.67–$115.09 | 3 |
| ME | $95.65–$99.97 | 2 |
| MI | $97.09–$102.28 | 2 |
| MN | $101.04 | 1 |
| MO | $93.43–$98.98 | 3 |
| MS | $92.51 | 1 |
| MT | $101.87 | 1 |
| NC | $96.50 | 1 |
| ND | $99.69 | 1 |
| NE | $94.93 | 1 |
| NH | $103.89 | 1 |
| NJ | $109.30–$114.17 | 2 |
| NM | $97.59 | 1 |
| NV | $101.32 | 1 |
| NY | $97.76–$118.86 | 5 |
| OH | $96.64 | 1 |
| OK | $94.58 | 1 |
| OR | $100.54–$108.25 | 2 |
| PA | $96.71–$105.74 | 2 |
| PR | $102.48 | 1 |
| RI | $104.19 | 1 |
| SC | $96.73 | 1 |
| SD | $99.43 | 1 |
| TN | $94.67 | 1 |
| TX | $96.17–$105.04 | 8 |
| UT | $97.87 | 1 |
| VA | $99.76–$115.09 | 2 |
| VI | $102.48 | 1 |
| VT | $99.45 | 1 |
| WA | $104.69–$116.81 | 2 |
| WI | $96.79 | 1 |
| WV | $95.54 | 1 |
| WY | $100.92 | 1 |
How the 64491 rate is calculated
Each of 64491’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 · 64491
RVUs × geographic indexes × conversion factor
Work1.13
1.13 RVUs× 1.000 GPCI
Practice expense1.81
1.81 RVUs× 1.000 GPCI
Malpractice0.11
0.11 RVUs× 1.000 GPCI
Adjusted RVUs
3.0500
Conversion factor
$33.4009
Medicare rate
$101.87
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 64491
The CMS indicators that decide how 64491 is paid alongside other services.
CMS payment indicators · 64491
Facet injection, cervical/thoracic second 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) | 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
64491 without 50 · national office
$101.87
Facet injection, cervical/thoracic second level
64491-50 · Bilateral: 150%
$152.81
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).
64491 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 64490Facet injectionCervical or thoracic, one level
- Use 64490 for the primary cervical or thoracic facet level. Use 64491 only for an additional second level and report it with the primary-level service.
- 64492Facet injectionThird cervical/thoracic level
- 64492 represents an additional cervical or thoracic level beyond the second; 64491 represents the second level.
- 64494Facet joint injectionLumbar/sacral, second level
- 64494 is the additional second-level code for lumbar or sacral facet injections. Choose 64491 when the treated levels are cervical or thoracic.
64491 billing questions
When is 64491 reported with 64490?
Report 64491 for a second cervical or thoracic facet-joint level in the same session as the primary-level service reported with 64490. It cannot be reported alone.
How does 64491 differ from 64490?
64490 represents the primary level; 64491 represents the additional second level. The documentation should show that a distinct second level was treated.
Can 64491 be reported with 64492?
When a third cervical or thoracic level is treated, 64492 is the additional-level code for that level, alongside the primary-level service. The record should support each treated level.
How is bilateral treatment handled?
For a bilateral procedure, CMS pays 150% when modifier 50 is used. Document the treated side or sides and levels.
Is imaging guidance separately reported?
Imaging guidance is included in the facet-injection service. Do not separately report guidance for the injection represented by 64491.
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
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