CPT code 64492: Facet injection, third cervical/thoracic level2026 Medicare rate & RVUs in South Dakota
Reports an additional cervical or thoracic facet-joint injection level when diagnostic or therapeutic medication is delivered to the joint or its supplying nerve.
In South Dakota, Medicare pays $100.21 for 64492 in the office and $49.11 when it’s performed in a hospital or facility.
Check a contract rate as a % of Medicare · 64492 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 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.
How South Dakota compares for 64492
Across 109 of 109 payment localities, the office rate for 64492 runs from $92.08 in Arkansas to $132.13 in San Benito County, CA. South Dakota pays $100.21. The RVUs are the same everywhere; the geographic indexes change the dollars.
- South Dakota · this page$100.21
- Los Angeles, CA · California$113.99+$13.78
- Washington, DC area · District of Columbia$115.52+$15.31
- Miami, FL · Florida$109.32+$9.11
- Chicago, IL · Illinois$106.67+$6.46
- Manhattan, NY · New York$116.34+$16.13
- Alaska · Alaska$123.72+$23.51
Other areas in South Dakota first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| AlabamaAlabama | $93.22 | $48.50 |
| ArkansasArkansas | $92.08 | $48.19 |
| ArizonaArizona | $99.87 | $50.35 |
| Bakersfield, CACalifornia | $107.65 | $51.64 |
| Chico, CACalifornia | $107.35 | $51.34 |
| El Centro, CACalifornia | $107.37 | $51.36 |
| Fresno, CACalifornia | $107.35 | $51.34 |
| Hanford, CACalifornia | $107.35 | $51.34 |
| Madera, CACalifornia | $107.35 | $51.34 |
| Merced, CACalifornia | $107.35 | $51.34 |
| Modesto, CACalifornia | $107.35 | $51.34 |
| Napa, CACalifornia | $122.65 | $55.29 |
| Oxnard, CACalifornia | $113.32 | $52.91 |
| Redding, CACalifornia | $107.35 | $51.34 |
| Rest of CaliforniaCalifornia | $107.35 | $51.34 |
| Riverside, CACalifornia | $108.34 | $52.33 |
| Sacramento, CACalifornia | $112.19 | $52.76 |
| Salinas, CACalifornia | $111.75 | $52.52 |
| San Diego, CACalifornia | $114.01 | $52.89 |
| Marin County, CACalifornia | $129.36 | $57.31 |
| San Francisco, CACalifornia | $129.26 | $57.21 |
| San Benito County, CACalifornia | $132.13 | $58.44 |
| Santa Clara County, CACalifornia | $131.71 | $58.02 |
| San Luis Obispo, CACalifornia | $110.00 | $51.79 |
| Santa Cruz, CACalifornia | $114.82 | $52.73 |
| Santa Maria, CACalifornia | $112.07 | $52.48 |
| Santa Rosa, CACalifornia | $115.96 | $53.20 |
| Stockton, CACalifornia | $107.35 | $51.34 |
| Vallejo, CACalifornia | $122.50 | $55.15 |
| Visalia, CACalifornia | $107.35 | $51.34 |
| Yuba City, CACalifornia | $107.35 | $51.34 |
| ColoradoColorado | $105.93 | $51.56 |
| ConnecticutConnecticut | $108.33 | $53.29 |
| DelawareDelaware | $101.35 | $50.86 |
| Fort Lauderdale, FLFlorida | $105.43 | $53.67 |
| Rest of FloridaFlorida | $101.01 | $52.16 |
| Atlanta, GAGeorgia | $103.91 | $51.99 |
| Rest of GeorgiaGeorgia | $96.15 | $50.56 |
| Hawaii, Guam, HIHawaii | $109.36 | $51.26 |
| IowaIowa | $95.17 | $48.41 |
| IdahoIdaho | $95.71 | $48.69 |
| East St. Louis, ILIllinois | $100.34 | $53.32 |
| Rest of IllinoisIllinois | $98.55 | $51.89 |
| Suburban Chicago, ILIllinois | $106.45 | $53.97 |
| IndianaIndiana | $96.18 | $48.80 |
| KansasKansas | $94.82 | $48.62 |
| KentuckyKentucky | $95.13 | $49.70 |
| New Orleans, LALouisiana | $98.99 | $50.90 |
| Rest of LouisianaLouisiana | $95.01 | $49.79 |
| Metropolitan Boston, MAMassachusetts | $115.35 | $54.33 |
| Rest of MassachusettsMassachusetts | $105.46 | $51.65 |
| Baltimore area, MDMaryland | $108.01 | $53.18 |
| Rest of MarylandMaryland | $103.08 | $51.36 |
| Rest of MaineMaine | $96.15 | $49.14 |
| Southern Maine, MEMaine | $100.54 | $49.90 |
| Detroit, MIMichigan | $102.12 | $52.80 |
| Rest of MichiganMichigan | $97.25 | $50.59 |
| MinnesotaMinnesota | $101.87 | $49.29 |
| Metropolitan Kansas City, MOMissouri | $98.39 | $50.40 |
| Metropolitan St. Louis, MOMissouri | $99.26 | $50.61 |
| Rest of MissouriMissouri | $93.65 | $49.60 |
| MississippiMississippi | $92.88 | $48.88 |
| MontanaMontana | $102.20 | $51.10 |
| North CarolinaNorth Carolina | $97.00 | $49.32 |
| North DakotaNorth Dakota | $100.42 | $49.32 |
| NebraskaNebraska | $95.60 | $48.44 |
| New HampshireNew Hampshire | $104.35 | $51.15 |
| Northern New JerseyNew Jersey | $114.62 | $55.34 |
| Rest of New JerseyNew Jersey | $109.66 | $53.86 |
| New MexicoNew Mexico | $97.71 | $50.85 |
| NevadaNevada | $101.77 | $50.61 |
| NYC suburbs and Long Island, NYNew York | $118.81 | $58.05 |
| Poughkeepsie and northern NYC suburbs, NYNew York | $110.37 | $54.42 |
| Queens, NYNew York | $117.14 | $56.73 |
| Rest of New YorkNew York | $98.24 | $49.69 |
| OhioOhio | $96.88 | $50.23 |
| OklahomaOklahoma | $94.96 | $49.33 |
| Portland, OROregon | $108.86 | $52.09 |
| Rest of OregonOregon | $101.07 | $50.17 |
| Metropolitan Philadelphia, PAPennsylvania | $105.99 | $52.79 |
| Rest of PennsylvaniaPennsylvania | $97.00 | $50.09 |
| Puerto RicoPuerto Rico | $102.84 | $51.17 |
| Rhode IslandRhode Island | $104.63 | $51.84 |
| South CarolinaSouth Carolina | $97.09 | $49.87 |
| TennesseeTennessee | $95.22 | $48.77 |
| Austin, TXTexas | $105.50 | $51.44 |
| Beaumont, TXTexas | $96.46 | $49.96 |
| Brazoria, TXTexas | $101.29 | $50.65 |
| Dallas, TXTexas | $101.87 | $50.97 |
| Fort Worth, TXTexas | $101.30 | $50.91 |
| Galveston, TXTexas | $101.56 | $50.82 |
| Houston, TXTexas | $103.21 | $52.46 |
| Rest of TexasTexas | $98.78 | $50.28 |
| UtahUtah | $98.21 | $50.18 |
| VirginiaVirginia | $100.28 | $50.04 |
| Virgin Islands, VIUnited States Virgin Islands | $102.84 | $51.17 |
| VermontVermont | $100.11 | $49.51 |
| Rest of WashingtonWashington | $105.24 | $51.42 |
| King County, WAWashington | $117.49 | $54.79 |
| WisconsinWisconsin | $97.55 | $48.59 |
| West VirginiaWest Virginia | $95.45 | $51.04 |
| WyomingWyoming | $101.43 | $50.32 |
64492 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.
$92.08
$123.72
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 | $123.72 | 1 |
| AL | $93.22 | 1 |
| AR | $92.08 | 1 |
| AZ | $99.87 | 1 |
| CA | $107.35–$132.13 | 29 |
| CO | $105.93 | 1 |
| CT | $108.33 | 1 |
| DC | $115.52 | 1 |
| DE | $101.35 | 1 |
| FL | $101.01–$109.32 | 3 |
| GA | $96.15–$103.91 | 2 |
| GU | $109.36 | 1 |
| HI | $109.36 | 1 |
| IA | $95.17 | 1 |
| ID | $95.71 | 1 |
| IL | $98.55–$106.67 | 4 |
| IN | $96.18 | 1 |
| KS | $94.82 | 1 |
| KY | $95.13 | 1 |
| LA | $95.01–$98.99 | 2 |
| MA | $105.46–$115.35 | 2 |
| MD | $103.08–$115.52 | 3 |
| ME | $96.15–$100.54 | 2 |
| MI | $97.25–$102.12 | 2 |
| MN | $101.87 | 1 |
| MO | $93.65–$99.26 | 3 |
| MS | $92.88 | 1 |
| MT | $102.20 | 1 |
| NC | $97.00 | 1 |
| ND | $100.42 | 1 |
| NE | $95.60 | 1 |
| NH | $104.35 | 1 |
| NJ | $109.66–$114.62 | 2 |
| NM | $97.71 | 1 |
| NV | $101.77 | 1 |
| NY | $98.24–$118.81 | 5 |
| OH | $96.88 | 1 |
| OK | $94.96 | 1 |
| OR | $101.07–$108.86 | 2 |
| PA | $97.00–$105.99 | 2 |
| PR | $102.84 | 1 |
| RI | $104.63 | 1 |
| SC | $97.09 | 1 |
| SD | $100.21 | 1 |
| TN | $95.22 | 1 |
| TX | $96.46–$105.50 | 8 |
| UT | $98.21 | 1 |
| VA | $100.28–$115.52 | 2 |
| VI | $102.84 | 1 |
| VT | $100.11 | 1 |
| WA | $105.24–$117.49 | 2 |
| WI | $97.55 | 1 |
| WV | $95.45 | 1 |
| WY | $101.43 | 1 |
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.
The exact South Dakota inputs and CMS source lines
PPRRVU2026_Oct_nonQPP.csv
7,136
- Code
- 64492
- Physician work
- 1.13
- Practice expense
- 1.84
- Malpractice
- 0.09
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 | 1.84 | × 1.000 | 1.8400 |
| Malpractice | 0.09 | × 0.336 | 0.0302 |
| Total RVUs | 3.0002 | ||
| Conversion factor | × 33.4009 | ||
Office rate, South Dakota$100.21
Office: (1.13 × 1 + 1.84 × 1 + 0.09 × 0.336) × $33.4009 = $100.21
Facility: (1.13 × 1 + 0.31 × 1 + 0.09 × 0.336) × $33.4009 = $49.11
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).
How 64492 has changed in South Dakota
64492 · Office / nonfacility
$100.21
Effective 2026-10-01
The base rate is $8.16 higher than on 2025-10-01, moving from $92.05 to $100.21 (8.9%).
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
$92.05changed to$100.21
- Conversion factor 32.3465 changed to 33.4009
- Work RVU 1.16 changed to 1.13
- Practice expense RVU 1.64 changed to 1.84
- Malpractice RVU 0.12 changed to 0.09
- Malpractice GPCI 0.382 changed to 0.336
Held through RVU26B, RVU26C, RVU26D.
January 1, 2025
RVU25A
$95.06changed to$92.05
- Conversion factor 33.2875 changed to 32.3465
- Practice expense RVU 1.65 changed to 1.64
Held through RVU25B, RVU25C, RVU25D.
March 9, 2024
RVU24AR
$93.51changed to$95.06
- Conversion factor 32.7442 changed to 33.2875
Held through RVU24B, RVU24C, RVU24D.
January 1, 2024
RVU24A
$96.03changed to$93.51
- Conversion factor 33.8872 changed to 32.7442
- Practice expense RVU 1.63 changed to 1.65
- Malpractice GPCI 0.364 changed to 0.382
January 1, 2023
RVU23A
$97.18changed to$96.03
- Conversion factor 34.6062 changed to 33.8872
- Practice expense RVU 1.61 changed to 1.63
- 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
$98.23changed to$97.18
- 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
$96.38changed to$98.23
- Conversion factor 36.0896 changed to 34.8931
- Practice expense RVU 1.47 changed to 1.61
- 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
$95.10changed to$96.38
- Conversion factor 36.0391 changed to 36.0896
- Practice expense RVU 1.44 changed to 1.47
- 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
$93.92changed to$95.10
- Conversion factor 35.9996 changed to 36.0391
- Practice expense RVU 1.41 changed to 1.44
Held through RVU19B, RVU19C, RVU19D.
January 1, 2018
RVU18AR1
$93.29changed to$93.92
- Conversion factor 35.8887 changed to 35.9996
- Practice expense RVU 1.40 changed to 1.41
- Malpractice GPCI 0.395 changed to 0.389
Held through RVU18B, RVU18C, RVU18D.
January 1, 2017
RVU17A
$94.17changed to$93.29
- Conversion factor 35.8043 changed to 35.8887
- Practice expense RVU 1.43 changed to 1.40
- Malpractice GPCI 0.400 changed to 0.395
Held through RVU17B, RVU17C, RVU17D.
January 1, 2016
RVU16A
$94.51changed to$94.17
- Conversion factor 35.9335 changed to 35.8043
Held through RVU16B, RVU16C, RVU16D.
July 1, 2015
RVU15C
$94.03changed to$94.51
- Conversion factor 35.7547 changed to 35.9335
Held through RVU15D.
January 1, 2015
RVU15A
$94.78changed to$94.03
- Conversion factor 35.8228 changed to 35.7547
- Practice expense RVU 1.44 changed to 1.43
- Malpractice RVU 0.11 changed to 0.10
- Malpractice GPCI 0.416 changed to 0.400
Held through RVU15B.
January 1, 2014
RVU14A
$96.20changed to$94.78
- Conversion factor 34.0230 changed to 35.8228
- Practice expense RVU 1.62 changed to 1.44
- Malpractice GPCI 0.432 changed to 0.416
Held through RVU14B, RVU14C, RVU14D.
January 1, 2013
RVU13AR
Earliest loaded release: $96.20
Held through RVU13B, RVU13C, RVU13D.
| Effective from | Office | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | $100.21 | $49.11 | RVU26D |
| 2026-07-01 | $100.21 | $49.11 | RVU26C |
| 2026-04-01 | $100.21 | $49.11 | RVU26B |
| 2026-01-01 | $100.21 | $49.11 | RVU26A |
| 2025-10-01 | $92.05 | $55.50 | RVU25D |
| 2025-07-01 | $92.05 | $55.50 | RVU25C |
| 2025-04-01 | $92.05 | $55.50 | RVU25B |
| 2025-01-01 | $92.05 | $55.50 | RVU25A |
| 2024-10-01 | $95.06 | $57.12 | RVU24D |
| 2024-07-01 | $95.06 | $57.12 | RVU24C |
| 2024-04-01 | $95.06 | $57.12 | RVU24B |
| 2024-03-09 | $95.06 | $57.12 | RVU24AR |
| 2024-01-01 | $93.51 | $56.18 | RVU24A |
| 2023-10-01 | $96.03 | $57.73 | RVU23D |
| 2023-07-01 | $96.03 | $57.73 | RVU23C |
| 2023-04-01 | $96.03 | $57.73 | RVU23B |
| 2023-01-01 | $96.03 | $57.73 | RVU23A |
| 2022-10-01 | $97.18 | $58.42 | RVU22D |
| 2022-07-01 | $97.18 | $58.42 | RVU22C |
| 2022-04-01 | $97.18 | $58.42 | RVU22B |
| 2022-01-01 | $97.18 | $58.42 | RVU22A |
| 2021-10-01 | $98.23 | $59.50 | RVU21D |
| 2021-07-01 | $98.23 | $59.50 | RVU21C |
| 2021-04-01 | $98.23 | $59.50 | RVU21B |
| 2021-01-01 | $98.23 | $59.50 | RVU21A |
| 2020-10-01 | $96.38 | $60.65 | RVU20D |
| 2020-07-01 | $96.38 | $60.65 | RVU20C |
| 2020-04-01 | $96.38 | $60.65 | RVU20B |
| 2020-01-01 | $96.38 | $60.65 | RVU20A |
| 2019-10-01 | $95.10 | $60.51 | RVU19D |
| 2019-07-01 | $95.10 | $60.51 | RVU19C |
| 2019-04-01 | $95.10 | $60.51 | RVU19B |
| 2019-01-01 | $95.10 | $60.51 | RVU19A |
| 2018-10-01 | $93.92 | $60.80 | RVU18D |
| 2018-07-01 | $93.92 | $60.80 | RVU18C |
| 2018-04-01 | $93.92 | $60.80 | RVU18B |
| 2018-01-01 | $93.92 | $60.80 | RVU18AR1 |
| 2017-10-01 | $93.29 | $60.63 | RVU17D |
| 2017-07-01 | $93.29 | $60.63 | RVU17C |
| 2017-04-01 | $93.29 | $60.63 | RVU17B |
| 2017-01-01 | $93.29 | $60.63 | RVU17A |
| 2016-10-01 | $94.17 | $60.87 | RVU16D |
| 2016-07-01 | $94.17 | $60.87 | RVU16C |
| 2016-04-01 | $94.17 | $60.87 | RVU16B |
| 2016-01-01 | $94.17 | $60.87 | RVU16A |
| 2015-10-01 | $94.51 | $61.09 | RVU15D |
| 2015-07-01 | $94.51 | $61.09 | RVU15C |
| 2015-04-01 | $94.03 | $60.78 | RVU15B |
| 2015-01-01 | $94.03 | $60.78 | RVU15A |
| 2014-10-01 | $94.78 | $61.46 | RVU14D |
| 2014-07-01 | $94.78 | $61.46 | RVU14C |
| 2014-04-01 | $94.78 | $61.46 | RVU14B |
| 2014-01-01 | $94.78 | $61.46 | RVU14A |
| 2013-10-01 | $96.20 | $60.14 | RVU13D |
| 2013-07-01 | $96.20 | $60.14 | RVU13C |
| 2013-04-01 | $96.20 | $60.14 | RVU13B |
| 2013-01-01 | $96.20 | $60.14 | 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
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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