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

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 Ohio, Medicare pays $90.62 for 64494 in the office and $43.05 when it’s performed in a hospital or facility.

$90.62Office (non-facility)
$43.05Hospital or facility
−5.5%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 Ohio
  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 Ohio 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. Ohio pays $90.62. The RVUs are the same everywhere; the geographic indexes change the dollars.

64494 in Ohio vs other payment areas
  1. Ohio · this page$90.62
  2. Los Angeles, CA · California$107.37+$16.75
  3. Washington, DC area · District of Columbia$108.69+$18.07
  4. Miami, FL · Florida$102.42+$11.80
  5. Chicago, IL · Illinois$99.85+$9.23
  6. Manhattan, NY · New York$109.32+$18.70
  7. Alaska · Alaska$114.96+$24.34

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

Every other payment area

64494 in every other Medicare payment locality
Payment localityOfficeFacility
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

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 Ohio 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

85

Locality
Ohio
Physician work
1.000
Practice expense
0.913
Malpractice
1.008
Office calculation for 64494 in Ohio
ComponentRVULocality factorAdjusted
Physician work0.98× 1.0000.9800
Practice expense1.81× 0.9131.6525
Malpractice0.08× 1.0080.0806
Total RVUs2.7132
Conversion factor× 33.4009

Office rate, Ohio$90.62

Office: (0.98 × 1 + 1.81 × 0.913 + 0.08 × 1.008) × $33.4009 = $90.62

Facility: (0.98 × 1 + 0.25 × 0.913 + 0.08 × 1.008) × $33.4009 = $43.05

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, Ohio
Primary code
64493Facet joint injection, lumbar or sacral, one levelPrimary first-level lumbar/sacral facet service reported with this second-level add-on.$178.57
Same family
64495Facet injection, third and additional levelsRepresents the third lumbar/sacral facet level.$93.37
64491Facet injection, cervical/thoracic second levelRepresents a second facet level in the cervical or thoracic region.$96.64
64490Facet injection, cervical or thoracic, one levelRepresents the first facet level in the cervical or thoracic region.$192.92

How 64494 has changed in Ohio

64494 · Office / nonfacility

$90.62

Effective 2026-10-01

The base rate is $7.19 higher than on 2025-10-01, moving from $83.43 to $90.62 (8.6%).

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

    $83.43changed to$90.62

    • 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 0.911 changed to 0.913
    • Malpractice GPCI 1.033 changed to 1.008

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $86.16changed to$83.43

    • 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

    $84.75changed to$86.16

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $86.94changed to$84.75

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 1.60 changed to 1.63
    • Practice expense GPCI 0.912 changed to 0.911
    • Malpractice GPCI 1.063 changed to 1.033

  5. January 1, 2023

    RVU23A

    $88.94changed to$86.94

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense GPCI 0.913 changed to 0.912
    • Malpractice GPCI 1.094 changed to 1.063

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $89.36changed to$88.94

    • 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

    $87.05changed to$89.36

    • 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 0.915 changed to 0.913
    • Malpractice GPCI 1.049 changed to 1.094

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $85.57changed to$87.05

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 1.40 changed to 1.44
    • Practice expense GPCI 0.917 changed to 0.915
    • Malpractice GPCI 1.005 changed to 1.049

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $84.15changed to$85.57

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

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $83.59changed to$84.15

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 1.35 changed to 1.36
    • Practice expense GPCI 0.918 changed to 0.917
    • Malpractice GPCI 0.999 changed to 1.005

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $84.36changed to$83.59

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 1.38 changed to 1.35
    • Malpractice GPCI 0.993 changed to 0.999

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $84.67changed to$84.36

    • Conversion factor 35.9335 changed to 35.8043

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $84.25changed to$84.67

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $84.98changed to$84.25

    • 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
    • Practice expense GPCI 0.923 changed to 0.918
    • Malpractice GPCI 1.117 changed to 0.993

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $86.60changed to$84.98

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 1.56 changed to 1.39
    • Practice expense GPCI 0.927 changed to 0.923
    • Malpractice GPCI 1.240 changed to 1.117

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $86.60

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$90.62$43.05RVU26D
2026-07-01$90.62$43.05RVU26C
2026-04-01$90.62$43.05RVU26B
2026-01-01$90.62$43.05RVU26A
2025-10-01$83.43$48.06RVU25D
2025-07-01$83.43$48.06RVU25C
2025-04-01$83.43$48.06RVU25B
2025-01-01$83.43$48.06RVU25A
2024-10-01$86.16$49.16RVU24D
2024-07-01$86.16$49.16RVU24C
2024-04-01$86.16$49.16RVU24B
2024-03-09$86.16$49.16RVU24AR
2024-01-01$84.75$48.36RVU24A
2023-10-01$86.94$50.16RVU23D
2023-07-01$86.94$50.16RVU23C
2023-04-01$86.94$50.16RVU23B
2023-01-01$86.94$50.16RVU23A
2022-10-01$88.94$51.03RVU22D
2022-07-01$88.94$51.03RVU22C
2022-04-01$88.94$51.03RVU22B
2022-01-01$88.94$51.03RVU22A
2021-10-01$89.36$51.77RVU21D
2021-07-01$89.36$51.77RVU21C
2021-04-01$89.36$51.77RVU21B
2021-01-01$89.36$51.77RVU21A
2020-10-01$87.05$52.71RVU20D
2020-07-01$87.05$52.71RVU20C
2020-04-01$87.05$52.71RVU20B
2020-01-01$87.05$52.71RVU20A
2019-10-01$85.57$52.52RVU19D
2019-07-01$85.57$52.52RVU19C
2019-04-01$85.57$52.52RVU19B
2019-01-01$85.57$52.52RVU19A
2018-10-01$84.15$52.46RVU18D
2018-07-01$84.15$52.46RVU18C
2018-04-01$84.15$52.46RVU18B
2018-01-01$84.15$52.46RVU18AR1
2017-10-01$83.59$52.29RVU17D
2017-07-01$83.59$52.29RVU17C
2017-04-01$83.59$52.29RVU17B
2017-01-01$83.59$52.29RVU17A
2016-10-01$84.36$52.48RVU16D
2016-07-01$84.36$52.48RVU16C
2016-04-01$84.36$52.48RVU16B
2016-01-01$84.36$52.48RVU16A
2015-10-01$84.67$52.67RVU15D
2015-07-01$84.67$52.67RVU15C
2015-04-01$84.25$52.41RVU15B
2015-01-01$84.25$52.41RVU15A
2014-10-01$84.98$52.91RVU14D
2014-07-01$84.98$52.91RVU14C
2014-04-01$84.98$52.91RVU14B
2014-01-01$84.98$52.91RVU14A
2013-10-01$86.60$51.91RVU13D
2013-07-01$86.60$51.91RVU13C
2013-04-01$86.60$51.91RVU13B
2013-01-01$86.60$51.91RVU13AR

Price 64494 for an earlier date of service

Where the Ohio rate applies

Ohio is a Medicare payment area, not a city. Our Census mapping connects it to 1265 cities and communities in Ohio. Some span more than one payment area; confirm with the service ZIP.

  • Aberdeen
  • Ada
  • Adamsville
  • Addyston
  • Adelphi
  • Adena
  • Ai
  • Akron

Browse all communities in Ohio

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 OhioGPCI2026.csv, line 85 (RVU26D)

Open CMS sourceHow we calculate rates

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