CPT code 64491: Facet injection, cervical/thoracic second level2026 Medicare rate & RVUs in South Dakota
Reports an additional cervical or thoracic facet-joint injection level performed with a primary-level procedure during the same treatment session.
In South Dakota, Medicare pays $99.43 for 64491 in the office and $48.33 when it’s performed in a hospital or facility.
Check a contract rate as a % of Medicare · 64491 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 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.
How South Dakota compares for 64491
Across 109 of 109 payment localities, the office rate for 64491 runs from $91.57 in Arkansas to $131.04 in San Benito County, CA. South Dakota pays $99.43. The RVUs are the same everywhere; the geographic indexes change the dollars.
- South Dakota · this page$99.43
- Los Angeles, CA · California$113.25+$13.82
- Washington, DC area · District of Columbia$115.09+$15.66
- Miami, FL · Florida$109.97+$10.54
- Chicago, IL · Illinois$107.20+$7.77
- Manhattan, NY · New York$116.24+$16.81
- Alaska · Alaska$123.02+$23.59
Other areas in South Dakota first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| AlabamaAlabama | $92.72 | $48.01 |
| ArkansasArkansas | $91.57 | $47.67 |
| ArizonaArizona | $99.47 | $49.95 |
| Bakersfield, CACalifornia | $106.96 | $50.95 |
| Chico, CACalifornia | $106.61 | $50.60 |
| El Centro, CACalifornia | $106.63 | $50.62 |
| Fresno, CACalifornia | $106.61 | $50.60 |
| Hanford, CACalifornia | $106.61 | $50.60 |
| Madera, CACalifornia | $106.61 | $50.60 |
| Merced, CACalifornia | $106.61 | $50.60 |
| Modesto, CACalifornia | $106.61 | $50.60 |
| Napa, CACalifornia | $121.67 | $54.31 |
| Oxnard, CACalifornia | $112.55 | $52.14 |
| Redding, CACalifornia | $106.61 | $50.60 |
| Rest of CaliforniaCalifornia | $106.61 | $50.60 |
| Riverside, CACalifornia | $107.82 | $51.81 |
| Sacramento, CACalifornia | $111.38 | $51.95 |
| Salinas, CACalifornia | $110.95 | $51.72 |
| San Diego, CACalifornia | $113.17 | $52.05 |
| Marin County, CACalifornia | $128.26 | $56.20 |
| San Francisco, CACalifornia | $128.13 | $56.08 |
| San Benito County, CACalifornia | $131.04 | $57.35 |
| Santa Clara County, CACalifornia | $130.53 | $56.84 |
| San Luis Obispo, CACalifornia | $109.21 | $51.01 |
| Santa Cruz, CACalifornia | $113.96 | $51.87 |
| Santa Maria, CACalifornia | $111.26 | $51.67 |
| Santa Rosa, CACalifornia | $115.08 | $52.33 |
| Stockton, CACalifornia | $106.61 | $50.60 |
| Vallejo, CACalifornia | $121.49 | $54.13 |
| Visalia, CACalifornia | $106.61 | $50.60 |
| Yuba City, CACalifornia | $106.61 | $50.60 |
| ColoradoColorado | $105.39 | $51.02 |
| ConnecticutConnecticut | $108.05 | $53.02 |
| DelawareDelaware | $100.96 | $50.47 |
| Fort Lauderdale, FLFlorida | $105.63 | $53.86 |
| Rest of FloridaFlorida | $101.06 | $52.21 |
| Atlanta, GAGeorgia | $103.69 | $51.77 |
| Rest of GeorgiaGeorgia | $96.05 | $50.46 |
| Hawaii, Guam, HIHawaii | $108.61 | $50.50 |
| IowaIowa | $94.52 | $47.76 |
| IdahoIdaho | $95.10 | $48.08 |
| East St. Louis, ILIllinois | $100.76 | $53.75 |
| Rest of IllinoisIllinois | $98.68 | $52.02 |
| Suburban Chicago, ILIllinois | $106.61 | $54.12 |
| IndianaIndiana | $95.57 | $48.20 |
| KansasKansas | $94.25 | $48.05 |
| KentuckyKentucky | $94.85 | $49.42 |
| New Orleans, LALouisiana | $98.81 | $50.72 |
| Rest of LouisianaLouisiana | $94.77 | $49.54 |
| Metropolitan Boston, MAMassachusetts | $114.74 | $53.73 |
| Rest of MassachusettsMassachusetts | $104.93 | $51.12 |
| Baltimore area, MDMaryland | $107.76 | $52.93 |
| Rest of MarylandMaryland | $102.67 | $50.96 |
| Rest of MaineMaine | $95.65 | $48.63 |
| Southern Maine, MEMaine | $99.97 | $49.33 |
| Detroit, MIMichigan | $102.28 | $52.96 |
| Rest of MichiganMichigan | $97.09 | $50.43 |
| MinnesotaMinnesota | $101.04 | $48.45 |
| Metropolitan Kansas City, MOMissouri | $98.10 | $50.11 |
| Metropolitan St. Louis, MOMissouri | $98.98 | $50.33 |
| Rest of MissouriMissouri | $93.43 | $49.38 |
| MississippiMississippi | $92.51 | $48.51 |
| MontanaMontana | $101.87 | $50.76 |
| North CarolinaNorth Carolina | $96.50 | $48.82 |
| North DakotaNorth Dakota | $99.69 | $48.59 |
| NebraskaNebraska | $94.93 | $47.76 |
| New HampshireNew Hampshire | $103.89 | $50.69 |
| Northern New JerseyNew Jersey | $114.17 | $54.89 |
| Rest of New JerseyNew Jersey | $109.30 | $53.50 |
| New MexicoNew Mexico | $97.59 | $50.73 |
| NevadaNevada | $101.32 | $50.17 |
| NYC suburbs and Long Island, NYNew York | $118.86 | $58.10 |
| Poughkeepsie and northern NYC suburbs, NYNew York | $110.09 | $54.13 |
| Queens, NYNew York | $116.92 | $56.51 |
| Rest of New YorkNew York | $97.76 | $49.21 |
| OhioOhio | $96.64 | $49.99 |
| OklahomaOklahoma | $94.58 | $48.95 |
| Portland, OROregon | $108.25 | $51.47 |
| Rest of OregonOregon | $100.54 | $49.64 |
| Metropolitan Philadelphia, PAPennsylvania | $105.74 | $52.54 |
| Rest of PennsylvaniaPennsylvania | $96.71 | $49.80 |
| Puerto RicoPuerto Rico | $102.48 | $50.82 |
| Rhode IslandRhode Island | $104.19 | $51.40 |
| South CarolinaSouth Carolina | $96.73 | $49.51 |
| TennesseeTennessee | $94.67 | $48.22 |
| Austin, TXTexas | $105.04 | $50.97 |
| Beaumont, TXTexas | $96.17 | $49.67 |
| Brazoria, TXTexas | $100.82 | $50.18 |
| Dallas, TXTexas | $101.45 | $50.55 |
| Fort Worth, TXTexas | $100.89 | $50.50 |
| Galveston, TXTexas | $101.12 | $50.37 |
| Houston, TXTexas | $103.13 | $52.39 |
| Rest of TexasTexas | $98.43 | $49.94 |
| UtahUtah | $97.87 | $49.83 |
| VirginiaVirginia | $99.76 | $49.53 |
| Virgin Islands, VIUnited States Virgin Islands | $102.48 | $50.82 |
| VermontVermont | $99.45 | $48.86 |
| Rest of WashingtonWashington | $104.69 | $50.88 |
| King County, WAWashington | $116.81 | $54.11 |
| WisconsinWisconsin | $96.79 | $47.83 |
| West VirginiaWest Virginia | $95.54 | $51.13 |
| WyomingWyoming | $100.92 | $49.81 |
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.
The exact South Dakota inputs and CMS source lines
PPRRVU2026_Oct_nonQPP.csv
7,135
- Code
- 64491
- Physician work
- 1.13
- Practice expense
- 1.81
- Malpractice
- 0.11
GPCI2026.csv
94
- Locality
- South Dakota
- Physician work
- 1.000
- Practice expense
- 1.000
- Malpractice
- 0.336
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 1.13 | × 1.000 | 1.1300 |
| Practice expense | 1.81 | × 1.000 | 1.8100 |
| Malpractice | 0.11 | × 0.336 | 0.0370 |
| Total RVUs | 2.9770 | ||
| Conversion factor | × 33.4009 | ||
Office rate, South Dakota$99.43
Office: (1.13 × 1 + 1.81 × 1 + 0.11 × 0.336) × $33.4009 = $99.43
Facility: (1.13 × 1 + 0.28 × 1 + 0.11 × 0.336) × $33.4009 = $48.33
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).
How 64491 has changed in South Dakota
64491 · Office / nonfacility
$99.43
Effective 2026-10-01
The base rate is $7.25 higher than on 2025-10-01, moving from $92.18 to $99.43 (7.9%).
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
$92.18changed to$99.43
- Conversion factor 32.3465 changed to 33.4009
- Work RVU 1.16 changed to 1.13
- Practice expense RVU 1.64 changed to 1.81
- Malpractice RVU 0.13 changed to 0.11
- Malpractice GPCI 0.382 changed to 0.336
Held through RVU26B, RVU26C, RVU26D.
January 1, 2025
RVU25A
$94.73changed to$92.18
- Conversion factor 33.2875 changed to 32.3465
- Malpractice RVU 0.12 changed to 0.13
Held through RVU25B, RVU25C, RVU25D.
March 9, 2024
RVU24AR
$93.18changed to$94.73
- Conversion factor 32.7442 changed to 33.2875
Held through RVU24B, RVU24C, RVU24D.
January 1, 2024
RVU24A
$95.35changed to$93.18
- Conversion factor 33.8872 changed to 32.7442
- Practice expense RVU 1.61 changed to 1.64
- Malpractice GPCI 0.364 changed to 0.382
January 1, 2023
RVU23A
$96.83changed to$95.35
- Conversion factor 34.6062 changed to 33.8872
- Practice expense RVU 1.60 changed to 1.61
- Malpractice RVU 0.11 changed to 0.12
- Malpractice GPCI 0.347 changed to 0.364
Held through RVU23B, RVU23C, RVU23D.
January 1, 2022
RVU22A
$97.88changed to$96.83
- Conversion factor 34.8931 changed to 34.6062
- Malpractice RVU 0.13 changed to 0.11
Held through RVU22B, RVU22C, RVU22D.
January 1, 2021
RVU21A
$95.65changed to$97.88
- Conversion factor 36.0896 changed to 34.8931
- Practice expense RVU 1.45 changed to 1.60
- Malpractice RVU 0.11 changed to 0.13
- Malpractice GPCI 0.368 changed to 0.347
Held through RVU21B, RVU21C, RVU21D.
January 1, 2020
RVU20A
$94.38changed to$95.65
- Conversion factor 36.0391 changed to 36.0896
- Practice expense RVU 1.42 changed to 1.45
- Malpractice RVU 0.10 changed to 0.11
- Malpractice GPCI 0.389 changed to 0.368
Held through RVU20B, RVU20C, RVU20D.
January 1, 2019
RVU19A
$93.20changed to$94.38
- Conversion factor 35.9996 changed to 36.0391
- Practice expense RVU 1.39 changed to 1.42
Held through RVU19B, RVU19C, RVU19D.
January 1, 2018
RVU18AR1
$92.93changed to$93.20
- Conversion factor 35.8887 changed to 35.9996
- Malpractice GPCI 0.395 changed to 0.389
Held through RVU18B, RVU18C, RVU18D.
January 1, 2017
RVU17A
$93.81changed to$92.93
- Conversion factor 35.8043 changed to 35.8887
- Practice expense RVU 1.42 changed to 1.39
- Malpractice GPCI 0.400 changed to 0.395
Held through RVU17B, RVU17C, RVU17D.
January 1, 2016
RVU16A
$94.15changed to$93.81
- Conversion factor 35.9335 changed to 35.8043
Held through RVU16B, RVU16C, RVU16D.
July 1, 2015
RVU15C
$93.68changed to$94.15
- Conversion factor 35.7547 changed to 35.9335
Held through RVU15D.
January 1, 2015
RVU15A
$94.06changed to$93.68
- Conversion factor 35.8228 changed to 35.7547
- Malpractice RVU 0.11 changed to 0.10
- Malpractice GPCI 0.416 changed to 0.400
Held through RVU15B.
January 1, 2014
RVU14A
$95.86changed to$94.06
- Conversion factor 34.0230 changed to 35.8228
- Practice expense RVU 1.61 changed to 1.42
- Malpractice GPCI 0.432 changed to 0.416
Held through RVU14B, RVU14C, RVU14D.
January 1, 2013
RVU13AR
Earliest loaded release: $95.86
Held through RVU13B, RVU13C, RVU13D.
| Effective from | Office | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | $99.43 | $48.33 | RVU26D |
| 2026-07-01 | $99.43 | $48.33 | RVU26C |
| 2026-04-01 | $99.43 | $48.33 | RVU26B |
| 2026-01-01 | $99.43 | $48.33 | RVU26A |
| 2025-10-01 | $92.18 | $54.98 | RVU25D |
| 2025-07-01 | $92.18 | $54.98 | RVU25C |
| 2025-04-01 | $92.18 | $54.98 | RVU25B |
| 2025-01-01 | $92.18 | $54.98 | RVU25A |
| 2024-10-01 | $94.73 | $56.12 | RVU24D |
| 2024-07-01 | $94.73 | $56.12 | RVU24C |
| 2024-04-01 | $94.73 | $56.12 | RVU24B |
| 2024-03-09 | $94.73 | $56.12 | RVU24AR |
| 2024-01-01 | $93.18 | $55.20 | RVU24A |
| 2023-10-01 | $95.35 | $56.72 | RVU23D |
| 2023-07-01 | $95.35 | $56.72 | RVU23C |
| 2023-04-01 | $95.35 | $56.72 | RVU23B |
| 2023-01-01 | $95.35 | $56.72 | RVU23A |
| 2022-10-01 | $96.83 | $57.73 | RVU22D |
| 2022-07-01 | $96.83 | $57.73 | RVU22C |
| 2022-04-01 | $96.83 | $57.73 | RVU22B |
| 2022-01-01 | $96.83 | $57.73 | RVU22A |
| 2021-10-01 | $97.88 | $58.45 | RVU21D |
| 2021-07-01 | $97.88 | $58.45 | RVU21C |
| 2021-04-01 | $97.88 | $58.45 | RVU21B |
| 2021-01-01 | $97.88 | $58.45 | RVU21A |
| 2020-10-01 | $95.65 | $59.93 | RVU20D |
| 2020-07-01 | $95.65 | $59.93 | RVU20C |
| 2020-04-01 | $95.65 | $59.93 | RVU20B |
| 2020-01-01 | $95.65 | $59.93 | RVU20A |
| 2019-10-01 | $94.38 | $59.79 | RVU19D |
| 2019-07-01 | $94.38 | $59.79 | RVU19C |
| 2019-04-01 | $94.38 | $59.79 | RVU19B |
| 2019-01-01 | $94.38 | $59.79 | RVU19A |
| 2018-10-01 | $93.20 | $60.08 | RVU18D |
| 2018-07-01 | $93.20 | $60.08 | RVU18C |
| 2018-04-01 | $93.20 | $60.08 | RVU18B |
| 2018-01-01 | $93.20 | $60.08 | RVU18AR1 |
| 2017-10-01 | $92.93 | $59.92 | RVU17D |
| 2017-07-01 | $92.93 | $59.92 | RVU17C |
| 2017-04-01 | $92.93 | $59.92 | RVU17B |
| 2017-01-01 | $92.93 | $59.92 | RVU17A |
| 2016-10-01 | $93.81 | $60.15 | RVU16D |
| 2016-07-01 | $93.81 | $60.15 | RVU16C |
| 2016-04-01 | $93.81 | $60.15 | RVU16B |
| 2016-01-01 | $93.81 | $60.15 | RVU16A |
| 2015-10-01 | $94.15 | $60.37 | RVU15D |
| 2015-07-01 | $94.15 | $60.37 | RVU15C |
| 2015-04-01 | $93.68 | $60.07 | RVU15B |
| 2015-01-01 | $93.68 | $60.07 | RVU15A |
| 2014-10-01 | $94.06 | $60.75 | RVU14D |
| 2014-07-01 | $94.06 | $60.75 | RVU14C |
| 2014-04-01 | $94.06 | $60.75 | RVU14B |
| 2014-01-01 | $94.06 | $60.75 | RVU14A |
| 2013-10-01 | $95.86 | $59.46 | RVU13D |
| 2013-07-01 | $95.86 | $59.46 | RVU13C |
| 2013-04-01 | $95.86 | $59.46 | RVU13B |
| 2013-01-01 | $95.86 | $59.46 | 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
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
Show the CMS file lines behind this rate
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