CPT code 64494: Facet joint injection, lumbar/sacral, second level2026 Medicare rate & RVUs in North Dakota
Report this add-on for the second lumbar or sacral facet level treated with image-guided injection after the first level is coded.
In North Dakota, Medicare pays $94.27 for 64494 in the office and $42.17 when it’s performed in a hospital or facility.
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.
On this page 11 sections
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 North Dakota 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. North Dakota pays $94.27. The RVUs are the same everywhere; the geographic indexes change the dollars.
- North Dakota · this page$94.27
- Los Angeles, CA · California$107.37+$13.10
- Washington, DC area · District of Columbia$108.69+$14.42
- Miami, FL · Florida$102.42+$8.15
- Chicago, IL · Illinois$99.85+$5.58
- Manhattan, NY · New York$109.32+$15.05
- Alaska · Alaska$114.96+$20.69
Other areas in North Dakota first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| AlabamaAlabama | $87.14 | $41.55 |
| 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 |
| Merced, CACalifornia | $100.98 | $43.87 |
| Modesto, CACalifornia | $100.98 | $43.87 |
| Napa, CACalifornia | $115.83 | $47.16 |
| Oxnard, CACalifornia | $106.77 | $45.18 |
| Redding, CACalifornia | $100.98 | $43.87 |
| Rest of CaliforniaCalifornia | $100.98 | $43.87 |
| Riverside, CACalifornia | $101.86 | $44.75 |
| Sacramento, CACalifornia | $105.65 | $45.05 |
| Salinas, CACalifornia | $105.25 | $44.86 |
| San Diego, CACalifornia | $107.47 | $45.15 |
| Marin County, CACalifornia | $122.31 | $48.84 |
| San Francisco, CACalifornia | $122.22 | $48.75 |
| San Benito County, CACalifornia | $124.94 | $49.81 |
| Santa Clara County, CACalifornia | $124.57 | $49.44 |
| San Luis Obispo, CACalifornia | $103.58 | $44.23 |
| Santa Cruz, CACalifornia | $108.31 | $45.00 |
| Santa Maria, CACalifornia | $105.57 | $44.82 |
| Santa Rosa, CACalifornia | $109.39 | $45.40 |
| Stockton, CACalifornia | $100.98 | $43.87 |
| Vallejo, CACalifornia | $115.70 | $47.03 |
| Visalia, CACalifornia | $100.98 | $43.87 |
| Yuba City, CACalifornia | $100.98 | $43.87 |
| ColoradoColorado | $99.54 | $44.10 |
| ConnecticutConnecticut | $101.73 | $45.61 |
| DelawareDelaware | $95.03 | $43.55 |
| Fort Lauderdale, FLFlorida | $98.81 | $46.02 |
| Rest of FloridaFlorida | $94.54 | $44.73 |
| Atlanta, GAGeorgia | $97.46 | $44.52 |
| Rest of GeorgiaGeorgia | $89.84 | $43.37 |
| Hawaii, Guam, HIHawaii | $103.02 | $43.77 |
| IowaIowa | $89.11 | $41.43 |
| IdahoIdaho | $89.62 | $41.68 |
| East St. Louis, ILIllinois | $93.73 | $45.80 |
| Rest of IllinoisIllinois | $92.11 | $44.53 |
| Suburban Chicago, ILIllinois | $99.78 | $46.27 |
| IndianaIndiana | $90.07 | $41.77 |
| KansasKansas | $88.73 | $41.63 |
| KentuckyKentucky | $88.92 | $42.60 |
| New Orleans, LALouisiana | $92.66 | $43.63 |
| Rest of LouisianaLouisiana | $88.80 | $42.68 |
| Metropolitan Boston, MAMassachusetts | $108.64 | $46.42 |
| Rest of MassachusettsMassachusetts | $99.05 | $44.18 |
| Baltimore area, MDMaryland | $101.43 | $45.52 |
| Rest of MarylandMaryland | $96.69 | $43.96 |
| Rest of MaineMaine | $90.01 | $42.08 |
| Southern Maine, MEMaine | $94.33 | $42.69 |
| Detroit, MIMichigan | $95.58 | $45.30 |
| Rest of MichiganMichigan | $90.95 | $43.37 |
| MinnesotaMinnesota | $95.73 | $42.12 |
| Metropolitan Kansas City, MOMissouri | $92.11 | $43.18 |
| Metropolitan St. Louis, MOMissouri | $92.96 | $43.36 |
| Rest of MissouriMissouri | $87.45 | $42.53 |
| MississippiMississippi | $86.76 | $41.90 |
| MontanaMontana | $95.86 | $43.75 |
| North CarolinaNorth Carolina | $90.85 | $42.23 |
| NebraskaNebraska | $89.54 | $41.45 |
| New HampshireNew Hampshire | $98.01 | $43.76 |
| Northern New JerseyNew Jersey | $107.78 | $47.34 |
| Rest of New JerseyNew Jersey | $102.99 | $46.09 |
| New MexicoNew Mexico | $91.38 | $43.60 |
| NevadaNevada | $95.47 | $43.32 |
| NYC suburbs and Long Island, NYNew York | $111.67 | $49.72 |
| Poughkeepsie and northern NYC suburbs, NYNew York | $103.64 | $46.58 |
| Queens, NYNew York | $110.14 | $48.55 |
| Rest of New YorkNew York | $92.04 | $42.54 |
| OhioOhio | $90.62 | $43.05 |
| OklahomaOklahoma | $88.80 | $42.27 |
| Portland, OROregon | $102.41 | $44.52 |
| Rest of OregonOregon | $94.83 | $42.93 |
| Metropolitan Philadelphia, PAPennsylvania | $99.44 | $45.20 |
| Rest of PennsylvaniaPennsylvania | $90.76 | $42.92 |
| Puerto RicoPuerto Rico | $96.49 | $43.81 |
| Rhode IslandRhode Island | $98.19 | $44.36 |
| South CarolinaSouth Carolina | $90.87 | $42.72 |
| South DakotaSouth Dakota | $94.09 | $41.98 |
| TennesseeTennessee | $89.12 | $41.76 |
| Austin, TXTexas | $99.13 | $44.00 |
| Beaumont, TXTexas | $90.23 | $42.81 |
| Brazoria, TXTexas | $94.99 | $43.35 |
| Dallas, TXTexas | $95.53 | $43.64 |
| Fort Worth, TXTexas | $94.96 | $43.59 |
| Galveston, TXTexas | $95.24 | $43.50 |
| Houston, TXTexas | $96.70 | $44.96 |
| Rest of TexasTexas | $92.52 | $43.07 |
| UtahUtah | $91.96 | $42.98 |
| VirginiaVirginia | $94.05 | $42.83 |
| Virgin Islands, VIUnited States Virgin Islands | $96.49 | $43.81 |
| VermontVermont | $93.94 | $42.35 |
| Rest of WashingtonWashington | $98.85 | $43.98 |
| King County, WAWashington | $110.73 | $46.80 |
| WisconsinWisconsin | $91.47 | $41.56 |
| West VirginiaWest Virginia | $89.09 | $43.81 |
| WyomingWyoming | $95.17 | $43.06 |
64494 rates by state
Office rate range in each state. Select a state to see its payment localities.
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
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | $114.96 | 1 |
| AL | $87.14 | 1 |
| AR | $86.04 | 1 |
| AZ | $93.60 | 1 |
| CA | $100.98–$124.94 | 29 |
| CO | $99.54 | 1 |
| CT | $101.73 | 1 |
| DC | $108.69 | 1 |
| DE | $95.03 | 1 |
| FL | $94.54–$102.42 | 3 |
| GA | $89.84–$97.46 | 2 |
| GU | $103.02 | 1 |
| HI | $103.02 | 1 |
| IA | $89.11 | 1 |
| ID | $89.62 | 1 |
| IL | $92.11–$99.85 | 4 |
| IN | $90.07 | 1 |
| KS | $88.73 | 1 |
| KY | $88.92 | 1 |
| LA | $88.80–$92.66 | 2 |
| MA | $99.05–$108.64 | 2 |
| MD | $96.69–$108.69 | 3 |
| ME | $90.01–$94.33 | 2 |
| MI | $90.95–$95.58 | 2 |
| MN | $95.73 | 1 |
| MO | $87.45–$92.96 | 3 |
| MS | $86.76 | 1 |
| MT | $95.86 | 1 |
| NC | $90.85 | 1 |
| ND | $94.27 | 1 |
| NE | $89.54 | 1 |
| NH | $98.01 | 1 |
| NJ | $102.99–$107.78 | 2 |
| NM | $91.38 | 1 |
| NV | $95.47 | 1 |
| NY | $92.04–$111.67 | 5 |
| OH | $90.62 | 1 |
| OK | $88.80 | 1 |
| OR | $94.83–$102.41 | 2 |
| PA | $90.76–$99.44 | 2 |
| PR | $96.49 | 1 |
| RI | $98.19 | 1 |
| SC | $90.87 | 1 |
| SD | $94.09 | 1 |
| TN | $89.12 | 1 |
| TX | $90.23–$99.13 | 8 |
| UT | $91.96 | 1 |
| VA | $94.05–$108.69 | 2 |
| VI | $96.49 | 1 |
| VT | $93.94 | 1 |
| WA | $98.85–$110.73 | 2 |
| WI | $91.47 | 1 |
| WV | $89.09 | 1 |
| WY | $95.17 | 1 |
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.
The exact North Dakota 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
84
- Locality
- North Dakota
- Physician work
- 1.000
- Practice expense
- 1.000
- Malpractice
- 0.406
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 0.98 | × 1.000 | 0.9800 |
| Practice expense | 1.81 | × 1.000 | 1.8100 |
| Malpractice | 0.08 | × 0.406 | 0.0325 |
| Total RVUs | 2.8225 | ||
| Conversion factor | × 33.4009 | ||
Office rate, North Dakota$94.27
Office: (0.98 × 1 + 1.81 × 1 + 0.08 × 0.406) × $33.4009 = $94.27
Facility: (0.98 × 1 + 0.25 × 1 + 0.08 × 0.406) × $33.4009 = $42.17
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).
How 64494 has changed in North Dakota
64494 · Office / nonfacility
$94.27
Effective 2026-10-01
The base rate is $7.85 higher than on 2025-10-01, moving from $86.42 to $94.27 (9.1%).
It is unchanged from the immediately preceding available release, effective 2026-07-01.
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
January 1, 2026
RVU26A
$86.42changed to$94.27
- 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
- Malpractice GPCI 0.517 changed to 0.406
Held through RVU26B, RVU26C, RVU26D.
January 1, 2025
RVU25A
$89.27changed to$86.42
- Conversion factor 33.2875 changed to 32.3465
- Practice expense RVU 1.63 changed to 1.62
Held through RVU25B, RVU25C, RVU25D.
March 9, 2024
RVU24AR
$87.81changed to$89.27
- Conversion factor 32.7442 changed to 33.2875
Held through RVU24B, RVU24C, RVU24D.
January 1, 2024
RVU24A
$89.71changed to$87.81
- Conversion factor 33.8872 changed to 32.7442
- Practice expense RVU 1.60 changed to 1.63
- Malpractice GPCI 0.474 changed to 0.517
January 1, 2023
RVU23A
$91.47changed to$89.71
- Conversion factor 34.6062 changed to 33.8872
- Malpractice GPCI 0.431 changed to 0.474
Held through RVU23B, RVU23C, RVU23D.
January 1, 2022
RVU22A
$91.88changed to$91.47
- Conversion factor 34.8931 changed to 34.6062
- Practice expense RVU 1.59 changed to 1.60
Held through RVU22B, RVU22C, RVU22D.
January 1, 2021
RVU21A
$89.63changed to$91.88
- 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
- Malpractice GPCI 0.485 changed to 0.431
Held through RVU21B, RVU21C, RVU21D.
January 1, 2020
RVU20A
$88.25changed to$89.63
- Conversion factor 36.0391 changed to 36.0896
- Practice expense RVU 1.40 changed to 1.44
- Malpractice GPCI 0.540 changed to 0.485
Held through RVU20B, RVU20C, RVU20D.
January 1, 2019
RVU19A
$86.71changed to$88.25
- Conversion factor 35.9996 changed to 36.0391
- Practice expense RVU 1.36 changed to 1.40
Held through RVU19B, RVU19C, RVU19D.
January 1, 2018
RVU18AR1
$86.11changed to$86.71
- Conversion factor 35.8887 changed to 35.9996
- Practice expense RVU 1.35 changed to 1.36
- Malpractice GPCI 0.547 changed to 0.540
Held through RVU18B, RVU18C, RVU18D.
January 1, 2017
RVU17A
$87.00changed to$86.11
- Conversion factor 35.8043 changed to 35.8887
- Practice expense RVU 1.38 changed to 1.35
- Malpractice GPCI 0.554 changed to 0.547
Held through RVU17B, RVU17C, RVU17D.
January 1, 2016
RVU16A
$87.31changed to$87.00
- Conversion factor 35.9335 changed to 35.8043
Held through RVU16B, RVU16C, RVU16D.
July 1, 2015
RVU15C
$86.88changed to$87.31
- Conversion factor 35.7547 changed to 35.9335
Held through RVU15D.
January 1, 2015
RVU15A
$87.15changed to$86.88
- Conversion factor 35.8228 changed to 35.7547
- Practice expense RVU 1.39 changed to 1.38
- Malpractice RVU 0.08 changed to 0.09
- Malpractice GPCI 0.536 changed to 0.554
Held through RVU15B.
January 1, 2014
RVU14A
$88.51changed to$87.15
- Conversion factor 34.0230 changed to 35.8228
- Practice expense RVU 1.56 changed to 1.39
- Malpractice GPCI 0.517 changed to 0.536
Held through RVU14B, RVU14C, RVU14D.
January 1, 2013
RVU13AR
Earliest loaded release: $88.51
Held through RVU13B, RVU13C, RVU13D.
| Effective from | Office | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | $94.27 | $42.17 | RVU26D |
| 2026-07-01 | $94.27 | $42.17 | RVU26C |
| 2026-04-01 | $94.27 | $42.17 | RVU26B |
| 2026-01-01 | $94.27 | $42.17 | RVU26A |
| 2025-10-01 | $86.42 | $47.60 | RVU25D |
| 2025-07-01 | $86.42 | $47.60 | RVU25C |
| 2025-04-01 | $86.42 | $47.60 | RVU25B |
| 2025-01-01 | $86.42 | $47.60 | RVU25A |
| 2024-10-01 | $89.27 | $48.66 | RVU24D |
| 2024-07-01 | $89.27 | $48.66 | RVU24C |
| 2024-04-01 | $89.27 | $48.66 | RVU24B |
| 2024-03-09 | $89.27 | $48.66 | RVU24AR |
| 2024-01-01 | $87.81 | $47.86 | RVU24A |
| 2023-10-01 | $89.71 | $49.39 | RVU23D |
| 2023-07-01 | $89.71 | $49.39 | RVU23C |
| 2023-04-01 | $89.71 | $49.39 | RVU23B |
| 2023-01-01 | $89.71 | $49.39 | RVU23A |
| 2022-10-01 | $91.47 | $49.94 | RVU22D |
| 2022-07-01 | $91.47 | $49.94 | RVU22C |
| 2022-04-01 | $91.47 | $49.94 | RVU22B |
| 2022-01-01 | $91.47 | $49.94 | RVU22A |
| 2021-10-01 | $91.88 | $50.70 | RVU21D |
| 2021-07-01 | $91.88 | $50.70 | RVU21C |
| 2021-04-01 | $91.88 | $50.70 | RVU21B |
| 2021-01-01 | $91.88 | $50.70 | RVU21A |
| 2020-10-01 | $89.63 | $52.10 | RVU20D |
| 2020-07-01 | $89.63 | $52.10 | RVU20C |
| 2020-04-01 | $89.63 | $52.10 | RVU20B |
| 2020-01-01 | $89.63 | $52.10 | RVU20A |
| 2019-10-01 | $88.25 | $52.21 | RVU19D |
| 2019-07-01 | $88.25 | $52.21 | RVU19C |
| 2019-04-01 | $88.25 | $52.21 | RVU19B |
| 2019-01-01 | $88.25 | $52.21 | RVU19A |
| 2018-10-01 | $86.71 | $52.15 | RVU18D |
| 2018-07-01 | $86.71 | $52.15 | RVU18C |
| 2018-04-01 | $86.71 | $52.15 | RVU18B |
| 2018-01-01 | $86.71 | $52.15 | RVU18AR1 |
| 2017-10-01 | $86.11 | $52.01 | RVU17D |
| 2017-07-01 | $86.11 | $52.01 | RVU17C |
| 2017-04-01 | $86.11 | $52.01 | RVU17B |
| 2017-01-01 | $86.11 | $52.01 | RVU17A |
| 2016-10-01 | $87.00 | $52.27 | RVU16D |
| 2016-07-01 | $87.00 | $52.27 | RVU16C |
| 2016-04-01 | $87.00 | $52.27 | RVU16B |
| 2016-01-01 | $87.00 | $52.27 | RVU16A |
| 2015-10-01 | $87.31 | $52.46 | RVU15D |
| 2015-07-01 | $87.31 | $52.46 | RVU15C |
| 2015-04-01 | $86.88 | $52.20 | RVU15B |
| 2015-01-01 | $86.88 | $52.20 | RVU15A |
| 2014-10-01 | $87.15 | $52.40 | RVU14D |
| 2014-07-01 | $87.15 | $52.40 | RVU14C |
| 2014-04-01 | $87.15 | $52.40 | RVU14B |
| 2014-01-01 | $87.15 | $52.40 | RVU14A |
| 2013-10-01 | $88.51 | $51.08 | RVU13D |
| 2013-07-01 | $88.51 | $51.08 | RVU13C |
| 2013-04-01 | $88.51 | $51.08 | RVU13B |
| 2013-01-01 | $88.51 | $51.08 | RVU13AR |
Where the North Dakota rate applies
North Dakota is a Medicare payment area, not a city. Our Census mapping connects it to 406 cities and communities in North Dakota. Some span more than one payment area; confirm with the service ZIP.
- Abercrombie
- Adams
- Alamo
- Alexander
- Alice
- Almont
- Alsen
- Ambrose
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
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