CPT code 64494: Facet joint injection, lumbar/sacral, second level2026 Medicare rate & RVUs in Florida
Report this add-on for the second lumbar or sacral facet level treated with image-guided injection after the first level is coded.
Medicare pays $94.54–$102.42 for 64494 in the office in Florida, from Rest of Florida to Miami, FL. Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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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.
Where 64494 pays more and less in Florida
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
3 payment localities
$94.54 to $102.42
| Payment locality | Office | Facility |
|---|---|---|
| Fort Lauderdale, FL | $98.81 | $46.02 |
| Miami, FL | $102.42 | $48.18 |
| Rest of Florida | $94.54 | $44.73 |
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
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.
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
| 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
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).
64494 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 64493Facet joint injectionLumbar or sacral, one level
- Use 64493 for the first lumbar/sacral facet level. Add 64494 for the second level in the same procedure.
- 64495Facet injectionThird and additional levels
- Use 64494 for the second lumbar/sacral level and 64495 for the third level.
- 64491Facet injectionCervical/thoracic second level
- 64491 is for a second facet level in the cervical or thoracic region; 64494 is for the lumbar or sacral region.
- 64483Transforaminal epidural injectionLumbar or sacral, first level
- 64483 describes a lumbar/sacral transforaminal epidural injection targeting a nerve root, not a facet joint or its innervating medial branch.
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
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