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CPT code 64492: Facet injection, third cervical/thoracic level2026 Medicare rate & RVUs in Houston, TX

Reports an additional cervical or thoracic facet-joint injection level when diagnostic or therapeutic medication is delivered to the joint or its supplying nerve.

CMS RVU26DEffective Oct 1, 2026One payment locality418 Medicare services in 2024

In Houston, TX, Medicare pays $103.21 for 64492 in the office and $52.46 when it’s performed in a hospital or facility.

$103.21Office (non-facility)
$52.46Hospital or facility
+1.0%vs the national office rate ($102.21)

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.

We’ll open 64492 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Houston, TX
  2. What 64492 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 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 Houston, TX 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. Houston, TX pays $103.21. The RVUs are the same everywhere; the geographic indexes change the dollars.

64492 in Houston, TX vs other payment areas
  1. Houston, TX · this page$103.21
  2. Austin, TX · Texas$105.50+$2.29
  3. Beaumont, TX · Texas$96.46−$6.75
  4. Brazoria, TX · Texas$101.29−$1.92
  5. Dallas, TX · Texas$101.87−$1.34
  6. Fort Worth, TX · Texas$101.30−$1.91
  7. Galveston, TX · Texas$101.56−$1.65

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

Every other payment area

64492 in every other Medicare payment locality
Payment localityOfficeFacility
Rest of TexasTexas$98.78$50.28
Los Angeles, CACalifornia$113.99$53.54
Washington, DC areaDistrict of Columbia$115.52$55.32
Miami, FLFlorida$109.32$56.12
Chicago, ILIllinois$106.67$55.31
Manhattan, NYNew York$116.34$56.96
AlaskaAlaska$123.72$69.30
AlabamaAlabama$93.22$48.50

64492 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.

$92.08

$123.72

Color shows the midpoint of each state’s locality range.

View every state and territory as a table
64492 office rate range by state
State / territoryOffice rate rangeLocalities
AK$123.721
AL$93.221
AR$92.081
AZ$99.871
CA$107.35–$132.1329
CO$105.931
CT$108.331
DC$115.521
DE$101.351
FL$101.01–$109.323
GA$96.15–$103.912
GU$109.361
HI$109.361
IA$95.171
ID$95.711
IL$98.55–$106.674
IN$96.181
KS$94.821
KY$95.131
LA$95.01–$98.992
MA$105.46–$115.352
MD$103.08–$115.523
ME$96.15–$100.542
MI$97.25–$102.122
MN$101.871
MO$93.65–$99.263
MS$92.881
MT$102.201
NC$97.001
ND$100.421
NE$95.601
NH$104.351
NJ$109.66–$114.622
NM$97.711
NV$101.771
NY$98.24–$118.815
OH$96.881
OK$94.961
OR$101.07–$108.862
PA$97.00–$105.992
PR$102.841
RI$104.631
SC$97.091
SD$100.211
TN$95.221
TX$96.46–$105.508
UT$98.211
VA$100.28–$115.522
VI$102.841
VT$100.111
WA$105.24–$117.492
WI$97.551
WV$95.451
WY$101.431

See 64492 in every payment locality

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

Office or facility?

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 Houston, TX 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

102

Locality
Houston, TX
Physician work
1.008
Practice expense
0.993
Malpractice
1.376
Office calculation for 64492 in Houston, TX
ComponentRVULocality factorAdjusted
Physician work1.13× 1.0081.1390
Practice expense1.84× 0.9931.8271
Malpractice0.09× 1.3760.1238
Total RVUs3.0900
Conversion factor× 33.4009

Office rate, Houston, TX$103.21

Office: (1.13 × 1.008 + 1.84 × 0.993 + 0.09 × 1.376) × $33.4009 = $103.21

Facility: (1.13 × 1.008 + 0.31 × 0.993 + 0.09 × 1.376) × $33.4009 = $52.46

Open 64492 in the RVU calculator

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

RuleCMS valueWhat it means
Global periodZZZAdd-on code: falls within the primary procedure’s global period.
Multiple procedures0No multiple-procedure reduction.
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

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).

When to use modifier 50

Codes related to 64492

Related codes aren’t interchangeable: bill the code that matches the service performed.

Codes related to 64492
CodeHow it relatesOffice range, Houston, TX
Primary code
64490Facet injection, cervical or thoracic, one levelFirst cervical/thoracic facet level; establishes the primary service for the level series.$206.71
64491Facet injection, cervical/thoracic second levelSecond cervical/thoracic level; precedes the third or further level.$103.13
Used instead
64493Facet joint injection, lumbar or sacral, one levelUse for the first lumbar or sacral facet level rather than a cervical/thoracic level.$191.58
64494Facet joint injection, lumbar/sacral, second levelFor a second lumbar or sacral facet level, not a cervical/thoracic additional level.$96.70
64495Facet injection, third and additional levelsFor a third or further lumbar or sacral facet level.$99.69

How 64492 has changed in Houston, TX

64492 · Office / nonfacility

$103.21

Effective 2026-10-01

The base rate is $6.49 higher than on 2025-10-01, moving from $96.72 to $103.21 (6.7%).

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

    $96.72changed to$103.21

    • 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
    • Work GPCI 1.014 changed to 1.008
    • Practice expense GPCI 1.003 changed to 0.993
    • Malpractice GPCI 1.409 changed to 1.376

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $99.87changed to$96.72

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 1.65 changed to 1.64

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $98.24changed to$99.87

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $101.03changed to$98.24

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 1.63 changed to 1.65
    • Work GPCI 1.023 changed to 1.014
    • Practice expense GPCI 1.016 changed to 1.003
    • Malpractice GPCI 1.154 changed to 1.409

  5. January 1, 2023

    RVU23A

    $102.19changed to$101.03

    • 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
    • Work GPCI 1.032 changed to 1.023
    • Practice expense GPCI 1.029 changed to 1.016
    • Malpractice GPCI 0.900 changed to 1.154

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $103.66changed to$102.19

    • Conversion factor 34.8931 changed to 34.6062
    • Malpractice RVU 0.13 changed to 0.11

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $100.71changed to$103.66

    • 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
    • Work GPCI 1.026 changed to 1.032
    • Practice expense GPCI 1.020 changed to 1.029
    • Malpractice GPCI 0.918 changed to 0.900

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $98.53changed to$100.71

    • 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
    • Work GPCI 1.020 changed to 1.026
    • Practice expense GPCI 1.012 changed to 1.020
    • Malpractice GPCI 0.936 changed to 0.918

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $97.33changed to$98.53

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 1.41 changed to 1.44

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $96.55changed to$97.33

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 1.40 changed to 1.41
    • Practice expense GPCI 1.009 changed to 1.012
    • Malpractice GPCI 0.946 changed to 0.936

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $97.25changed to$96.55

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 1.43 changed to 1.40
    • Work GPCI 1.019 changed to 1.020
    • Practice expense GPCI 1.006 changed to 1.009
    • Malpractice GPCI 0.955 changed to 0.946

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $97.60changed to$97.25

    • Conversion factor 35.9335 changed to 35.8043

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $97.11changed to$97.60

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $97.63changed to$97.11

    • 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
    • Work GPCI 1.014 changed to 1.019
    • Practice expense GPCI 1.004 changed to 1.006
    • Malpractice GPCI 0.939 changed to 0.955

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $98.50changed to$97.63

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 1.62 changed to 1.44
    • Work GPCI 1.009 changed to 1.014
    • Practice expense GPCI 1.002 changed to 1.004
    • Malpractice GPCI 0.923 changed to 0.939

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $98.50

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$103.21$52.46RVU26D
2026-07-01$103.21$52.46RVU26C
2026-04-01$103.21$52.46RVU26B
2026-01-01$103.21$52.46RVU26A
2025-10-01$96.72$60.06RVU25D
2025-07-01$96.72$60.06RVU25C
2025-04-01$96.72$60.06RVU25B
2025-01-01$96.72$60.06RVU25A
2024-10-01$99.87$61.81RVU24D
2024-07-01$99.87$61.81RVU24C
2024-04-01$99.87$61.81RVU24B
2024-03-09$99.87$61.81RVU24AR
2024-01-01$98.24$60.80RVU24A
2023-10-01$101.03$62.12RVU23D
2023-07-01$101.03$62.12RVU23C
2023-04-01$101.03$62.12RVU23B
2023-01-01$101.03$62.12RVU23A
2022-10-01$102.19$62.30RVU22D
2022-07-01$102.19$62.30RVU22C
2022-04-01$102.19$62.30RVU22B
2022-01-01$102.19$62.30RVU22A
2021-10-01$103.66$63.81RVU21D
2021-07-01$103.66$63.81RVU21C
2021-04-01$103.66$63.81RVU21B
2021-01-01$103.66$63.81RVU21A
2020-10-01$100.71$64.27RVU20D
2020-07-01$100.71$64.27RVU20C
2020-04-01$100.71$64.27RVU20B
2020-01-01$100.71$64.27RVU20A
2019-10-01$98.53$63.52RVU19D
2019-07-01$98.53$63.52RVU19C
2019-04-01$98.53$63.52RVU19B
2019-01-01$98.53$63.52RVU19A
2018-10-01$97.33$63.82RVU18D
2018-07-01$97.33$63.82RVU18C
2018-04-01$97.33$63.82RVU18B
2018-01-01$97.33$63.82RVU18AR1
2017-10-01$96.55$63.60RVU17D
2017-07-01$96.55$63.60RVU17C
2017-04-01$96.55$63.60RVU17B
2017-01-01$96.55$63.60RVU17A
2016-10-01$97.25$63.75RVU16D
2016-07-01$97.25$63.75RVU16C
2016-04-01$97.25$63.75RVU16B
2016-01-01$97.25$63.75RVU16A
2015-10-01$97.60$63.98RVU15D
2015-07-01$97.60$63.98RVU15C
2015-04-01$97.11$63.66RVU15B
2015-01-01$97.11$63.66RVU15A
2014-10-01$97.63$64.18RVU14D
2014-07-01$97.63$64.18RVU14C
2014-04-01$97.63$64.18RVU14B
2014-01-01$97.63$64.18RVU14A
2013-10-01$98.50$62.37RVU13D
2013-07-01$98.50$62.37RVU13C
2013-04-01$98.50$62.37RVU13B
2013-01-01$98.50$62.37RVU13AR

Price 64492 for an earlier date of service

Where the Houston, TX rate applies

Houston, TX is a Medicare payment area, not a city. Our Census mapping connects it to 46 cities and communities in Texas. Some span more than one payment area; confirm with the service ZIP.

Browse all communities in Texas

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
RVUs for 64492PPRRVU2026_Oct_nonQPP.csv, line 7,136 (RVU26D)
Geographic factors for Houston, TXGPCI2026.csv, line 102 (RVU26D)

Open CMS sourceHow we calculate rates

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