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CPT code 64493: Facet joint injection, lumbar or sacral, one level2026 Medicare rate & RVUs in Washington, DC area

Reports an image-guided injection into a lumbar or sacral facet joint, or its innervating nerves, at one spinal level for diagnostic or therapeutic care.

CMS RVU26DEffective Oct 1, 2026One payment locality620.3K Medicare services in 2024

In Washington, DC area, Medicare pays $217.84 for 64493 in the office and $89.57 when it’s performed in a hospital or facility.

$217.84Office (non-facility)
$89.57Hospital or facility
+14.4%vs the national office rate ($190.39)

Check a contract rate as a % of Medicare · 64493 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 64493 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Washington, DC area
  2. What 64493 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 64493 covers

A physician, commonly a pain specialist, anesthesiologist, or radiologist, uses fluoroscopy or CT to guide an injection to a lumbar or sacral paravertebral facet joint or the nerves supplying it. The injection may be diagnostic, such as evaluating suspected facet-mediated back pain, or therapeutic. The code represents one spinal level, not one needle or one side; the documented target must be in the lumbar or sacral region.

Report 64493 for the first treated level. Document the spinal level, side, target, clinical reason, and image guidance. The imaging guidance is part of the service. CMS assigns a 0-day global period, so same-day preoperative and postoperative care is included. For multiple procedures in one session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Bilateral reporting with modifier 50 is paid at 150%. An assistant at surgery may be paid; co-surgeons and team surgery are not permitted.

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 Washington, DC area compares for 64493

Across 109 of 109 payment localities, the office rate for 64493 runs from $168.90 in Arkansas to $253.89 in San Benito County, CA. Washington, DC area pays $217.84. The RVUs are the same everywhere; the geographic indexes change the dollars.

64493 in Washington, DC area vs other payment areas
  1. Washington, DC area · this page$217.84
  2. Los Angeles, CA · California$215.78−$2.06
  3. Miami, FL · Florida$203.12−$14.72
  4. Chicago, IL · Illinois$197.47−$20.37
  5. Manhattan, NY · New York$218.37+$0.53
  6. Alaska · Alaska$221.86+$4.02
  7. Alabama · Alabama$171.32−$46.52

Other areas in District of Columbia first, then benchmark localities. Bars start at $0.

Every other payment area

64493 in every other Medicare payment locality
Payment localityOfficeFacility
ArkansasArkansas$168.90$75.37
ArizonaArizona$185.49$79.98
Bakersfield, CACalifornia$202.58$83.24
Chico, CACalifornia$202.14$82.80
El Centro, CACalifornia$202.16$82.82
Fresno, CACalifornia$202.14$82.80
Hanford, CACalifornia$202.14$82.80
Madera, CACalifornia$202.14$82.80

64493 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.

$168.90

$228.02

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

View every state and territory as a table
64493 office rate range by state
State / territoryOffice rate rangeLocalities
AK$221.861
AL$171.321
AR$168.901
AZ$185.491
CA$202.14–$253.8929
CO$198.681
CT$202.851
DC$217.841
DE$188.521
FL$186.74–$203.123
GA$176.57–$193.652
GU$207.091
HI$207.091
IA$175.981
ID$177.021
IL$181.16–$198.024
IN$178.031
KS$174.981
KY$174.861
LA$174.52–$182.982
MA$197.45–$218.342
MD$192.13–$217.843
ME$177.72–$187.432
MI$179.13–$188.822
MN$191.051
MO$171.46–$183.853
MS$170.221
MT$190.381
NC$179.571
ND$187.611
NE$176.981
NH$195.391
NJ$205.35–$215.622
NM$180.011
NV$189.741
NY$182.18–$223.315
OH$178.571
OK$174.761
OR$188.45–$205.112
PA$178.95–$197.762
PR$191.811
RI$195.321
SC$179.331
SD$187.281
TN$175.821
TX$177.79–$197.858
UT$181.731
VA$186.69–$217.842
VI$191.811
VT$186.711
WA$197.13–$222.942
WI$181.431
WV$174.551
WY$189.171

See 64493 in every payment locality

How the 64493 rate is calculated

Each of 64493’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 · 64493

RVUs × geographic indexes × conversion factor

Office or facility?

Work1.48

1.48 RVUs× 1.000 GPCI

Practice expense4.08

4.08 RVUs× 1.000 GPCI

Malpractice0.14

0.14 RVUs× 1.000 GPCI

Adjusted RVUs

5.7000

Conversion factor

$33.4009

Medicare rate

$190.39

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

The exact Washington, DC area inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

7,137

Code
64493
Physician work
1.48
Practice expense
4.08
Malpractice
0.14

GPCI2026.csv

39

Locality
Washington, DC area
Physician work
1.054
Practice expense
1.178
Malpractice
1.113
Office calculation for 64493 in Washington, DC area
ComponentRVULocality factorAdjusted
Physician work1.48× 1.0541.5599
Practice expense4.08× 1.1784.8062
Malpractice0.14× 1.1130.1558
Total RVUs6.5220
Conversion factor× 33.4009

Office rate, Washington, DC area$217.84

Office: (1.48 × 1.054 + 4.08 × 1.178 + 0.14 × 1.113) × $33.4009 = $217.84

Facility: (1.48 × 1.054 + 0.82 × 1.178 + 0.14 × 1.113) × $33.4009 = $89.57

Open 64493 in the RVU calculator

Payment rules and modifiers for 64493

The CMS indicators that decide how 64493 is paid alongside other services.

CMS payment indicators · 64493

Facet joint injection, lumbar or sacral, one level

RuleCMS valueWhat it means
Global period000Same-day global: pre- and post-op care on the day of the procedure is included.
Multiple procedures2Standard reduction: highest-valued procedure at 100%, others at 50%.
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

64493 without 50 · national office

$190.39

Facet joint injection, lumbar or sacral, one level

64493-50 · Bilateral: 150%

$285.59

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 64493

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

Codes related to 64493
CodeHow it relatesOffice range, Washington, DC area
Add-on codes
64494Facet joint injection, lumbar/sacral, second levelAdd-on code for the second lumbar or sacral facet-joint level.$108.69
64495Facet injection, third and additional levelsAdd-on code for the third lumbar or sacral facet-joint level.$112.23
Same family
64490Facet injection, cervical or thoracic, one levelSingle-level facet-joint injection code for the cervical or thoracic region.$233.89
64491Facet injection, cervical/thoracic second levelSecond-level cervical or thoracic facet-joint injection code.$115.09
Used instead
64483Transforaminal epidural injection, lumbar or sacral, first levelTargets a lumbar or sacral nerve root by transforaminal epidural injection, rather than a facet joint.$303.98

How 64493 has changed in Washington, DC area

64493 · Office / nonfacility

$217.84

Effective 2026-10-01

The base rate is $19.48 higher than on 2025-10-01, moving from $198.36 to $217.84 (9.8%).

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

    $198.36changed to$217.84

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 1.52 changed to 1.48
    • Practice expense RVU 3.64 changed to 4.08
    • Malpractice RVU 0.16 changed to 0.14
    • Work GPCI 1.057 changed to 1.054
    • Practice expense GPCI 1.192 changed to 1.178
    • Malpractice GPCI 1.168 changed to 1.113

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $204.54changed to$198.36

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 3.66 changed to 3.64
    • Malpractice RVU 0.15 changed to 0.16

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $201.20changed to$204.54

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $208.76changed to$201.20

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 3.58 changed to 3.66
    • Malpractice RVU 0.17 changed to 0.15
    • Work GPCI 1.056 changed to 1.057
    • Practice expense GPCI 1.214 changed to 1.192
    • Malpractice GPCI 1.231 changed to 1.168

  5. January 1, 2023

    RVU23A

    $213.98changed to$208.76

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 3.56 changed to 3.58
    • Malpractice RVU 0.14 changed to 0.17
    • Work GPCI 1.054 changed to 1.056
    • Practice expense GPCI 1.236 changed to 1.214
    • Malpractice GPCI 1.294 changed to 1.231

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $217.07changed to$213.98

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 3.58 changed to 3.56
    • Malpractice RVU 0.15 changed to 0.14

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $208.07changed to$217.07

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 3.28 changed to 3.58
    • Malpractice RVU 0.13 changed to 0.15
    • Work GPCI 1.049 changed to 1.054
    • Practice expense GPCI 1.221 changed to 1.236
    • Malpractice GPCI 1.277 changed to 1.294

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $204.72changed to$208.07

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 3.26 changed to 3.28
    • Work GPCI 1.045 changed to 1.049
    • Practice expense GPCI 1.205 changed to 1.221
    • Malpractice GPCI 1.261 changed to 1.277

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $203.20changed to$204.72

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 3.23 changed to 3.26

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $201.49changed to$203.20

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 3.20 changed to 3.23
    • Work GPCI 1.048 changed to 1.045
    • Malpractice GPCI 1.271 changed to 1.261

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $204.70changed to$201.49

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 3.27 changed to 3.20
    • Malpractice RVU 0.14 changed to 0.13
    • Work GPCI 1.051 changed to 1.048
    • Malpractice GPCI 1.280 changed to 1.271

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $204.14changed to$204.70

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 3.24 changed to 3.27

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $203.12changed to$204.14

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $204.88changed to$203.12

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 3.30 changed to 3.24
    • Malpractice RVU 0.13 changed to 0.14
    • Work GPCI 1.050 changed to 1.051
    • Practice expense GPCI 1.202 changed to 1.205
    • Malpractice GPCI 1.205 changed to 1.280

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $211.66changed to$204.88

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 3.73 changed to 3.30
    • Malpractice RVU 0.14 changed to 0.13
    • Work GPCI 1.049 changed to 1.050
    • Practice expense GPCI 1.198 changed to 1.202
    • Malpractice GPCI 1.130 changed to 1.205

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $211.66

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$217.84$89.57RVU26D
2026-07-01$217.84$89.57RVU26C
2026-04-01$217.84$89.57RVU26B
2026-01-01$217.84$89.57RVU26A
2025-10-01$198.36$98.50RVU25D
2025-07-01$198.36$98.50RVU25C
2025-04-01$198.36$98.50RVU25B
2025-01-01$198.36$98.50RVU25A
2024-10-01$204.54$100.18RVU24D
2024-07-01$204.54$100.18RVU24C
2024-04-01$204.54$100.18RVU24B
2024-03-09$204.54$100.18RVU24AR
2024-01-01$201.20$98.55RVU24A
2023-10-01$208.76$101.80RVU23D
2023-07-01$208.76$101.80RVU23C
2023-04-01$208.76$101.80RVU23B
2023-01-01$208.76$101.80RVU23A
2022-10-01$213.98$103.20RVU22D
2022-07-01$213.98$103.20RVU22C
2022-04-01$213.98$103.20RVU22B
2022-01-01$213.98$103.20RVU22A
2021-10-01$217.07$104.51RVU21D
2021-07-01$217.07$104.51RVU21C
2021-04-01$217.07$104.51RVU21B
2021-01-01$217.07$104.51RVU21A
2020-10-01$208.07$104.52RVU20D
2020-07-01$208.07$104.52RVU20C
2020-04-01$208.07$104.52RVU20B
2020-01-01$208.07$104.52RVU20A
2019-10-01$204.72$103.54RVU19D
2019-07-01$204.72$103.54RVU19C
2019-04-01$204.72$103.54RVU19B
2019-01-01$204.72$103.54RVU19A
2018-10-01$203.20$104.29RVU18D
2018-07-01$203.20$104.29RVU18C
2018-04-01$203.20$104.29RVU18B
2018-01-01$203.20$104.29RVU18AR1
2017-10-01$201.49$104.18RVU17D
2017-07-01$201.49$104.18RVU17C
2017-04-01$201.49$104.18RVU17B
2017-01-01$201.49$104.18RVU17A
2016-10-01$204.70$105.46RVU16D
2016-07-01$204.70$105.46RVU16C
2016-04-01$204.70$105.46RVU16B
2016-01-01$204.70$105.46RVU16A
2015-10-01$204.14$105.84RVU15D
2015-07-01$204.14$105.84RVU15C
2015-04-01$203.12$105.32RVU15B
2015-01-01$203.12$105.32RVU15A
2014-10-01$204.88$105.41RVU14D
2014-07-01$204.88$105.41RVU14C
2014-04-01$204.88$105.41RVU14B
2014-01-01$204.88$105.41RVU14A
2013-10-01$211.66$104.06RVU13D
2013-07-01$211.66$104.06RVU13C
2013-04-01$211.66$104.06RVU13B
2013-01-01$211.66$104.06RVU13AR

Price 64493 for an earlier date of service

Where the Washington, DC area rate applies

Washington, DC area is a Medicare payment area, not a city. Our Census mapping connects it to 1 cities and communities in District of Columbia. Some span more than one payment area; confirm with the service ZIP.

  • Washington

Browse all communities in District of Columbia

64493 billing questions

When should 64493 be used instead of 64494?

Use 64493 for the first lumbar or sacral spinal level treated. Report 64494 as the add-on for the second level.

Can 64493 be reported bilaterally?

Yes. For bilateral treatment, report modifier 50; CMS pays the bilateral procedure at 150%.

Is fluoroscopy or CT billed separately?

No. Image guidance by fluoroscopy or CT is included in the facet-joint injection service.

What documentation supports 64493?

Document the lumbar or sacral level, the side and injection target, the clinical indication, and use of fluoroscopy or CT guidance.

How does CMS handle other procedures in the same session?

The highest-valued procedure is paid in full, while other procedures are subject to the standard multiple-procedure reduction. Same-day preoperative and postoperative care is included in the 0-day global period.

Can an assistant or co-surgeon be reported?

An assistant at surgery may be paid. CMS does not permit co-surgeons or team surgery for this code.

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 64493PPRRVU2026_Oct_nonQPP.csv, line 7,137 (RVU26D)
Geographic factors for Washington, DC areaGPCI2026.csv, line 39 (RVU26D)

Open CMS sourceHow we calculate rates

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