CPT code 64492: Facet injection, third cervical/thoracic level2026 Medicare rate & RVUs in Maryland
Reports an additional cervical or thoracic facet-joint injection level when diagnostic or therapeutic medication is delivered to the joint or its supplying nerve.
Medicare pays $103.08–$115.52 for 64492 in the office in Maryland, from Rest of Maryland to Washington, DC area. Which amount applies depends on the service address.
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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What 64492 covers
This service covers the third or a further cervical or thoracic paravertebral facet-joint level treated with diagnostic or therapeutic medication, or a block of the nerve supplying that joint. An interventional pain physician, anesthesiologist, or other qualified clinician typically performs it with fluoroscopic or CT guidance for evaluation or treatment of axial neck or upper-back pain. The code is for facet joints or their innervating nerves, not an epidural injection.
Report 64492 only as an add-on in the cervical/thoracic level series: 64490 identifies the first level, 64491 the second, and 64492 the third or further level. Document the spinal region, each treated level, side, target, indication, and image-guided technique. CMS pays this add-on within the primary procedure’s global period; it is not submitted alone. For bilateral procedures, CMS pays modifier 50 at 150%.
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 64492 pays more and less in Maryland
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
3 payment localities
$103.08 to $115.52
| Payment locality | Office | Facility |
|---|---|---|
| Baltimore area, MD | $108.01 | $53.18 |
| Rest of Maryland | $103.08 | $51.36 |
| Washington, DC area | $115.52 | $55.32 |
How the 64492 rate is calculated
Each of 64492’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 · 64492
RVUs × geographic indexes × conversion factor
Work1.13
1.13 RVUs× 1.000 GPCI
Practice expense1.84
1.84 RVUs× 1.000 GPCI
Malpractice0.09
0.09 RVUs× 1.000 GPCI
Adjusted RVUs
3.0600
Conversion factor
$33.4009
Medicare rate
$102.21
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 64492
The CMS indicators that decide how 64492 is paid alongside other services.
CMS payment indicators · 64492
Facet injection, third cervical/thoracic 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
64492 without 50 · national office
$102.21
Facet injection, third cervical/thoracic level
64492-50 · Bilateral: 150%
$153.31
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).
64492 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 64490Facet injectionCervical or thoracic, one level
- 64490 identifies the first cervical or thoracic facet level. Use 64492 only for a third or further level in the same region.
- 64491Facet injectionCervical/thoracic second level
- 64491 identifies the second cervical or thoracic facet level; 64492 identifies the third or further level.
- 64493Facet joint injectionLumbar or sacral, one level
- 64493 is for the first lumbar or sacral facet level. Choose the 64490–64492 series for cervical or thoracic levels.
64492 billing questions
Can 64492 be reported by itself?
No. It is an add-on for a third or further cervical or thoracic facet level and must be reported with the applicable primary facet procedure.
How does 64492 differ from 64491?
64491 identifies the second cervical or thoracic level. Use 64492 for the third or a further level in that region.
Is image guidance included?
The facet injection service includes fluoroscopic or CT guidance. Document the guidance and treated levels; 64492 is not a separate image-guidance service.
How is bilateral work reported?
When the procedure is bilateral, CMS applies modifier 50 and pays 150%.
Can 64492 be used for lumbar facet levels?
No. It is for cervical or thoracic facet levels; lumbar or sacral facet levels use the corresponding lumbar/sacral code series.
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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