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

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 Virginia, Medicare pays $100.28 for 64492 in the office and $50.04 when it’s performed in a hospital or facility.

$100.28Office (non-facility)
$50.04Hospital or facility
−1.9%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 Virginia
  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 Virginia 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. Virginia pays $100.28. The RVUs are the same everywhere; the geographic indexes change the dollars.

64492 in Virginia vs other payment areas
  1. Virginia · this page$100.28
  2. Los Angeles, CA · California$113.99+$13.71
  3. Washington, DC area · District of Columbia$115.52+$15.24
  4. Miami, FL · Florida$109.32+$9.04
  5. Chicago, IL · Illinois$106.67+$6.39
  6. Manhattan, NY · New York$116.34+$16.06
  7. Alaska · Alaska$123.72+$23.44

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

Every other payment area

64492 in every other Medicare payment locality
Payment localityOfficeFacility
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

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 Virginia 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

106

Locality
Virginia
Physician work
1.000
Practice expense
0.983
Malpractice
0.706
Office calculation for 64492 in Virginia
ComponentRVULocality factorAdjusted
Physician work1.13× 1.0001.1300
Practice expense1.84× 0.9831.8087
Malpractice0.09× 0.7060.0635
Total RVUs3.0023
Conversion factor× 33.4009

Office rate, Virginia$100.28

Office: (1.13 × 1 + 1.84 × 0.983 + 0.09 × 0.706) × $33.4009 = $100.28

Facility: (1.13 × 1 + 0.31 × 0.983 + 0.09 × 0.706) × $33.4009 = $50.04

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, Virginia
Primary code
64490Facet injection, cervical or thoracic, one levelFirst cervical/thoracic facet level; establishes the primary service for the level series.$201.03
64491Facet injection, cervical/thoracic second levelSecond cervical/thoracic level; precedes the third or further level.$99.76
Used instead
64493Facet joint injection, lumbar or sacral, one levelUse for the first lumbar or sacral facet level rather than a cervical/thoracic level.$186.69
64494Facet joint injection, lumbar/sacral, second levelFor a second lumbar or sacral facet level, not a cervical/thoracic additional level.$94.05
64495Facet injection, third and additional levelsFor a third or further lumbar or sacral facet level.$97.00

How 64492 has changed in Virginia

64492 · Office / nonfacility

$100.28

Effective 2026-10-01

The base rate is $7.55 higher than on 2025-10-01, moving from $92.73 to $100.28 (8.1%).

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

    $92.73changed to$100.28

    • 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 1.002 changed to 1.000
    • Practice expense GPCI 0.984 changed to 0.983
    • Malpractice GPCI 0.755 changed to 0.706

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $95.75changed to$92.73

    • 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

    $94.19changed to$95.75

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $97.35changed to$94.19

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 1.63 changed to 1.65
    • Work GPCI 1.000 changed to 1.002
    • Practice expense GPCI 0.990 changed to 0.984
    • Malpractice GPCI 0.826 changed to 0.755

  5. January 1, 2023

    RVU23A

    $99.00changed to$97.35

    • 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
    • Practice expense GPCI 0.995 changed to 0.990
    • Malpractice GPCI 0.897 changed to 0.826

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $100.44changed to$99.00

    • 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

    $98.02changed to$100.44

    • 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
    • Practice expense GPCI 0.991 changed to 0.995
    • Malpractice GPCI 0.903 changed to 0.897

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $96.25changed to$98.02

    • 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
    • Practice expense GPCI 0.986 changed to 0.991
    • Malpractice GPCI 0.908 changed to 0.903

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $95.08changed to$96.25

    • 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

    $94.23changed to$95.08

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 1.40 changed to 1.41
    • Practice expense GPCI 0.985 changed to 0.986
    • Malpractice GPCI 0.866 changed to 0.908

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $94.81changed to$94.23

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 1.43 changed to 1.40
    • Practice expense GPCI 0.983 changed to 0.985
    • Malpractice GPCI 0.824 changed to 0.866

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $95.16changed to$94.81

    • Conversion factor 35.9335 changed to 35.8043

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $94.68changed to$95.16

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $95.17changed to$94.68

    • 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
    • Practice expense GPCI 0.980 changed to 0.983
    • Malpractice GPCI 0.778 changed to 0.824

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $96.05changed to$95.17

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 1.62 changed to 1.44
    • Practice expense GPCI 0.977 changed to 0.980
    • Malpractice GPCI 0.731 changed to 0.778

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $96.05

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$100.28$50.04RVU26D
2026-07-01$100.28$50.04RVU26C
2026-04-01$100.28$50.04RVU26B
2026-01-01$100.28$50.04RVU26A
2025-10-01$92.73$56.76RVU25D
2025-07-01$92.73$56.76RVU25C
2025-04-01$92.73$56.76RVU25B
2025-01-01$92.73$56.76RVU25A
2024-10-01$95.75$58.41RVU24D
2024-07-01$95.75$58.41RVU24C
2024-04-01$95.75$58.41RVU24B
2024-03-09$95.75$58.41RVU24AR
2024-01-01$94.19$57.46RVU24A
2023-10-01$97.35$59.44RVU23D
2023-07-01$97.35$59.44RVU23C
2023-04-01$97.35$59.44RVU23B
2023-01-01$97.35$59.44RVU23A
2022-10-01$99.00$60.43RVU22D
2022-07-01$99.00$60.43RVU22C
2022-04-01$99.00$60.43RVU22B
2022-01-01$99.00$60.43RVU22A
2021-10-01$100.44$61.90RVU21D
2021-07-01$100.44$61.90RVU21C
2021-04-01$100.44$61.90RVU21B
2021-01-01$100.44$61.90RVU21A
2020-10-01$98.02$62.62RVU20D
2020-07-01$98.02$62.62RVU20C
2020-04-01$98.02$62.62RVU20B
2020-01-01$98.02$62.62RVU20A
2019-10-01$96.25$62.13RVU19D
2019-07-01$96.25$62.13RVU19C
2019-04-01$96.25$62.13RVU19B
2019-01-01$96.25$62.13RVU19A
2018-10-01$95.08$62.42RVU18D
2018-07-01$95.08$62.42RVU18C
2018-04-01$95.08$62.42RVU18B
2018-01-01$95.08$62.42RVU18AR1
2017-10-01$94.23$62.06RVU17D
2017-07-01$94.23$62.06RVU17C
2017-04-01$94.23$62.06RVU17B
2017-01-01$94.23$62.06RVU17A
2016-10-01$94.81$62.08RVU16D
2016-07-01$94.81$62.08RVU16C
2016-04-01$94.81$62.08RVU16B
2016-01-01$94.81$62.08RVU16A
2015-10-01$95.16$62.31RVU15D
2015-07-01$95.16$62.31RVU15C
2015-04-01$94.68$62.00RVU15B
2015-01-01$94.68$62.00RVU15A
2014-10-01$95.17$62.52RVU14D
2014-07-01$95.17$62.52RVU14C
2014-04-01$95.17$62.52RVU14B
2014-01-01$95.17$62.52RVU14A
2013-10-01$96.05$60.82RVU13D
2013-07-01$96.05$60.82RVU13C
2013-04-01$96.05$60.82RVU13B
2013-01-01$96.05$60.82RVU13AR

Price 64492 for an earlier date of service

Where the Virginia rate applies

Virginia is a Medicare payment area, not a city. Our Census mapping connects it to 628 cities and communities in Virginia. Some span more than one payment area; confirm with the service ZIP.

  • Abbs Valley
  • Abingdon
  • Accomac
  • Adwolf
  • Afton
  • Alberta
  • Aldie
  • Allison Gap

Browse all communities in Virginia

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 VirginiaGPCI2026.csv, line 106 (RVU26D)

Open CMS sourceHow we calculate rates

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