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CPT code 64494: Facet joint injection, lumbar/sacral, second level2026 Medicare rate & RVUs in Alabama

Report this add-on for the second lumbar or sacral facet level treated with image-guided injection after the first level is coded.

CMS RVU26DEffective Oct 1, 2026One payment locality383.1K Medicare services in 2024

In Alabama, Medicare pays $87.14 for 64494 in the office and $41.55 when it’s performed in a hospital or facility.

$87.14Office (non-facility)
$41.55Hospital or facility
−9.1%vs the national office rate ($95.86)

Check a contract rate as a % of Medicare · 64494 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 64494 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Alabama
  2. What 64494 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 64494 covers

Clinicians use this code for an image-guided injection at the second lumbar or sacral facet-joint level, or its innervating medial branch, commonly to evaluate or treat axial low-back pain attributed to facet joints. Interventional pain physicians, anesthesiologists, physiatrists, and other qualified clinicians perform the procedure in office-based or hospital outpatient settings, using fluoroscopic or CT guidance.

Report 64494 only with 64493 for the first lumbar/sacral level. It represents the second level, not another needle or joint treated at the first level. Documentation should identify the treated level and side, target, imaging guidance, injectate, and clinical rationale. This add-on is paid within the primary procedure's global period. For bilateral service, CMS pays 150% when modifier 50 is reported. The imaging guidance is included in the facet-injection service and is not separately reported.

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 Alabama compares for 64494

Across 109 of 109 payment localities, the office rate for 64494 runs from $86.04 in Arkansas to $124.94 in San Benito County, CA. Alabama pays $87.14. The RVUs are the same everywhere; the geographic indexes change the dollars.

64494 in Alabama vs other payment areas
  1. Alabama · this page$87.14
  2. Los Angeles, CA · California$107.37+$20.23
  3. Washington, DC area · District of Columbia$108.69+$21.55
  4. Miami, FL · Florida$102.42+$15.28
  5. Chicago, IL · Illinois$99.85+$12.71
  6. Manhattan, NY · New York$109.32+$22.18
  7. Alaska · Alaska$114.96+$27.82

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

Every other payment area

64494 in every other Medicare payment locality
Payment localityOfficeFacility
ArkansasArkansas$86.04$41.28
ArizonaArizona$93.60$43.11
Bakersfield, CACalifornia$101.24$44.13
Chico, CACalifornia$100.98$43.87
El Centro, CACalifornia$100.99$43.89
Fresno, CACalifornia$100.98$43.87
Hanford, CACalifornia$100.98$43.87
Madera, CACalifornia$100.98$43.87

64494 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.

$86.04

$114.96

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

View every state and territory as a table
64494 office rate range by state
State / territoryOffice rate rangeLocalities
AK$114.961
AL$87.141
AR$86.041
AZ$93.601
CA$100.98–$124.9429
CO$99.541
CT$101.731
DC$108.691
DE$95.031
FL$94.54–$102.423
GA$89.84–$97.462
GU$103.021
HI$103.021
IA$89.111
ID$89.621
IL$92.11–$99.854
IN$90.071
KS$88.731
KY$88.921
LA$88.80–$92.662
MA$99.05–$108.642
MD$96.69–$108.693
ME$90.01–$94.332
MI$90.95–$95.582
MN$95.731
MO$87.45–$92.963
MS$86.761
MT$95.861
NC$90.851
ND$94.271
NE$89.541
NH$98.011
NJ$102.99–$107.782
NM$91.381
NV$95.471
NY$92.04–$111.675
OH$90.621
OK$88.801
OR$94.83–$102.412
PA$90.76–$99.442
PR$96.491
RI$98.191
SC$90.871
SD$94.091
TN$89.121
TX$90.23–$99.138
UT$91.961
VA$94.05–$108.692
VI$96.491
VT$93.941
WA$98.85–$110.732
WI$91.471
WV$89.091
WY$95.171

See 64494 in every payment locality

How the 64494 rate is calculated

Each of 64494’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 · 64494

RVUs × geographic indexes × conversion factor

Office or facility?

Work0.98

0.98 RVUs× 1.000 GPCI

Practice expense1.81

1.81 RVUs× 1.000 GPCI

Malpractice0.08

0.08 RVUs× 1.000 GPCI

Adjusted RVUs

2.8700

Conversion factor

$33.4009

Medicare rate

$95.86

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

The exact Alabama inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

7,138

Code
64494
Physician work
0.98
Practice expense
1.81
Malpractice
0.08

GPCI2026.csv

4

Locality
Alabama
Physician work
1.000
Practice expense
0.875
Malpractice
0.566
Office calculation for 64494 in Alabama
ComponentRVULocality factorAdjusted
Physician work0.98× 1.0000.9800
Practice expense1.81× 0.8751.5837
Malpractice0.08× 0.5660.0453
Total RVUs2.6090
Conversion factor× 33.4009

Office rate, Alabama$87.14

Office: (0.98 × 1 + 1.81 × 0.875 + 0.08 × 0.566) × $33.4009 = $87.14

Facility: (0.98 × 1 + 0.25 × 0.875 + 0.08 × 0.566) × $33.4009 = $41.55

Open 64494 in the RVU calculator

Payment rules and modifiers for 64494

The CMS indicators that decide how 64494 is paid alongside other services.

CMS payment indicators · 64494

Facet joint injection, lumbar/sacral, second 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

64494 without 50 · national office

$95.86

Facet joint injection, lumbar/sacral, second level

64494-50 · Bilateral: 150%

$143.79

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 64494

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

Codes related to 64494
CodeHow it relatesOffice range, Alabama
Primary code
64493Facet joint injection, lumbar or sacral, one levelPrimary first-level lumbar/sacral facet service reported with this second-level add-on.$171.32
Same family
64495Facet injection, third and additional levelsRepresents the third lumbar/sacral facet level.$89.77
64491Facet injection, cervical/thoracic second levelRepresents a second facet level in the cervical or thoracic region.$92.72
64490Facet injection, cervical or thoracic, one levelRepresents the first facet level in the cervical or thoracic region.$185.08

How 64494 has changed in Alabama

64494 · Office / nonfacility

$87.14

Effective 2026-10-01

The base rate is $7.40 higher than on 2025-10-01, moving from $79.74 to $87.14 (9.3%).

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

    $79.74changed to$87.14

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 1.00 changed to 0.98
    • Practice expense RVU 1.62 changed to 1.81
    • Malpractice RVU 0.10 changed to 0.08
    • Practice expense GPCI 0.869 changed to 0.875
    • Malpractice GPCI 0.575 changed to 0.566

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $82.35changed to$79.74

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 1.63 changed to 1.62

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $81.01changed to$82.35

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $84.03changed to$81.01

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 1.60 changed to 1.63
    • Practice expense GPCI 0.878 changed to 0.869
    • Malpractice GPCI 0.748 changed to 0.575

  5. January 1, 2023

    RVU23A

    $86.96changed to$84.03

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense GPCI 0.888 changed to 0.878
    • Malpractice GPCI 0.921 changed to 0.748

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $87.37changed to$86.96

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 1.59 changed to 1.60

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $84.59changed to$87.37

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 1.44 changed to 1.59
    • Malpractice RVU 0.09 changed to 0.10
    • Practice expense GPCI 0.889 changed to 0.888
    • Malpractice GPCI 0.707 changed to 0.921

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $82.54changed to$84.59

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 1.40 changed to 1.44
    • Practice expense GPCI 0.890 changed to 0.889
    • Malpractice GPCI 0.492 changed to 0.707

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $81.17changed to$82.54

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 1.36 changed to 1.40

    Held through RVU19B, RVU19C, RVU19D.

  10. April 1, 2018

    RVU18B

    No ratechanged to$81.17

    Held through RVU18C, RVU18D.

  11. January 1, 2013

    RVU13AR

    Earliest loaded release: No rate

    Held through RVU13B, RVU13C, RVU13D, RVU14A, RVU14B, RVU14C, RVU14D, RVU15A, RVU15B, RVU15C, RVU15D, RVU16A, RVU16B, RVU16C, RVU16D, RVU17A, RVU17B, RVU17C, RVU17D, RVU18AR1.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$87.14$41.55RVU26D
2026-07-01$87.14$41.55RVU26C
2026-04-01$87.14$41.55RVU26B
2026-01-01$87.14$41.55RVU26A
2025-10-01$79.74$46.01RVU25D
2025-07-01$79.74$46.01RVU25C
2025-04-01$79.74$46.01RVU25B
2025-01-01$79.74$46.01RVU25A
2024-10-01$82.35$47.06RVU24D
2024-07-01$82.35$47.06RVU24C
2024-04-01$82.35$47.06RVU24B
2024-03-09$82.35$47.06RVU24AR
2024-01-01$81.01$46.29RVU24A
2023-10-01$84.03$48.62RVU23D
2023-07-01$84.03$48.62RVU23C
2023-04-01$84.03$48.62RVU23B
2023-01-01$84.03$48.62RVU23A
2022-10-01$86.96$50.09RVU22D
2022-07-01$86.96$50.09RVU22C
2022-04-01$86.96$50.09RVU22B
2022-01-01$86.96$50.09RVU22A
2021-10-01$87.37$50.81RVU21D
2021-07-01$87.37$50.81RVU21C
2021-04-01$87.37$50.81RVU21B
2021-01-01$87.37$50.81RVU21A
2020-10-01$84.59$51.22RVU20D
2020-07-01$84.59$51.22RVU20C
2020-04-01$84.59$51.22RVU20B
2020-01-01$84.59$51.22RVU20A
2019-10-01$82.54$50.46RVU19D
2019-07-01$82.54$50.46RVU19C
2019-04-01$82.54$50.46RVU19B
2019-01-01$82.54$50.46RVU19A
2018-10-01$81.17$50.41RVU18D
2018-07-01$81.17$50.41RVU18C
2018-04-01$81.17$50.41RVU18B
2018-01-01Rate data unavailableRate data unavailableRVU18AR1
2017-10-01Rate data unavailableRate data unavailableRVU17D
2017-07-01Rate data unavailableRate data unavailableRVU17C
2017-04-01Rate data unavailableRate data unavailableRVU17B
2017-01-01Rate data unavailableRate data unavailableRVU17A
2016-10-01Rate data unavailableRate data unavailableRVU16D
2016-07-01Rate data unavailableRate data unavailableRVU16C
2016-04-01Rate data unavailableRate data unavailableRVU16B
2016-01-01Rate data unavailableRate data unavailableRVU16A
2015-10-01Rate data unavailableRate data unavailableRVU15D
2015-07-01Rate data unavailableRate data unavailableRVU15C
2015-04-01Rate data unavailableRate data unavailableRVU15B
2015-01-01Rate data unavailableRate data unavailableRVU15A
2014-10-01Rate data unavailableRate data unavailableRVU14D
2014-07-01Rate data unavailableRate data unavailableRVU14C
2014-04-01Rate data unavailableRate data unavailableRVU14B
2014-01-01Rate data unavailableRate data unavailableRVU14A
2013-10-01Rate data unavailableRate data unavailableRVU13D
2013-07-01Rate data unavailableRate data unavailableRVU13C
2013-04-01Rate data unavailableRate data unavailableRVU13B
2013-01-01Rate data unavailableRate data unavailableRVU13AR

Price 64494 for an earlier date of service

Where the Alabama rate applies

Alabama is a Medicare payment area, not a city. Our Census mapping connects it to 595 cities and communities in Alabama. Some span more than one payment area; confirm with the service ZIP.

  • Abanda
  • Abbeville
  • Adamsville
  • Addison
  • Akron
  • Alabaster
  • Albertville
  • Alexander City

Browse all communities in Alabama

64494 billing questions

Can 64494 be reported by itself?

No. It is an add-on for the second lumbar or sacral level and is reported with 64493 for the first level.

How is 64494 different from 64495?

64494 represents the second lumbar/sacral level; 64495 represents the third. Select the code according to the number of distinct levels treated.

How should bilateral treatment be reported?

For bilateral service, report modifier 50. CMS pays the bilateral procedure at 150%.

Are fluoroscopy or CT guidance separately reportable?

No. Image guidance is included in this facet-injection service.

What should the procedure note support?

Document the second level treated, laterality, injection target, imaging guidance, injectate, and clinical rationale. The record should distinguish the second level from the first level reported with 64493.

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 64494PPRRVU2026_Oct_nonQPP.csv, line 7,138 (RVU26D)
Geographic factors for AlabamaGPCI2026.csv, line 4 (RVU26D)

Open CMS sourceHow we calculate rates

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