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CPT code 64495: Facet injection, third and additional levels2026 Medicare rate & RVUs in Washington, DC area

Image-guided lumbar or sacral facet joint injections at the third and subsequent levels are reported with the corresponding primary-level procedure.

CMS RVU26DEffective Oct 1, 2026One payment locality887 Medicare services in 2024

In Washington, DC area, Medicare pays $112.23 for 64495 in the office and $48.88 when it’s performed in a hospital or facility.

$112.23Office (non-facility)
$48.88Hospital or facility
+13.5%vs the national office rate ($98.87)

Check a contract rate as a % of Medicare · 64495 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 64495 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Washington, DC area
  2. What 64495 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 64495 covers

This code represents an image-guided injection of a diagnostic or therapeutic agent into lumbar or sacral facet joints, or the nerves that supply them, at the third and any additional treated level. Pain physicians, anesthesiologists, physiatrists, and other qualified clinicians commonly perform these procedures in outpatient procedure settings to evaluate or treat pain attributed to facet joints. Fluoroscopy or CT guidance is part of the service described by the code.

Select the code by the number of lumbar or sacral levels treated in the same session: report 64493 for the first level, 64494 for the second, and 64495 for the third and any additional level. The procedure note should identify the treated levels and side, injection target, agent, and imaging guidance. This is an add-on code and must be billed with a primary procedure; CMS pays it within that procedure’s global period. For a bilateral procedure reported with modifier 50, CMS pays 150% of the applicable amount.

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 64495

Across 109 of 109 payment localities, the office rate for 64495 runs from $88.62 in Arkansas to $129.28 in San Benito County, CA. Washington, DC area pays $112.23. The RVUs are the same everywhere; the geographic indexes change the dollars.

64495 in Washington, DC area vs other payment areas
  1. Washington, DC area · this page$112.23
  2. Los Angeles, CA · California$110.92−$1.31
  3. Miami, FL · Florida$105.55−$6.68
  4. Chicago, IL · Illinois$102.87−$9.36
  5. Manhattan, NY · New York$112.81+$0.58
  6. Alaska · Alaska$118.16+$5.93
  7. Alabama · Alabama$89.77−$22.46

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

Every other payment area

64495 in every other Medicare payment locality
Payment localityOfficeFacility
ArkansasArkansas$88.62$42.43
ArizonaArizona$96.51$44.41
Bakersfield, CACalifornia$104.54$45.60
Chico, CACalifornia$104.28$45.34
El Centro, CACalifornia$104.29$45.35
Fresno, CACalifornia$104.28$45.34
Hanford, CACalifornia$104.28$45.34
Madera, CACalifornia$104.28$45.34

64495 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.

$88.62

$118.16

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

View every state and territory as a table
64495 office rate range by state
State / territoryOffice rate rangeLocalities
AK$118.161
AL$89.771
AR$88.621
AZ$96.511
CA$104.28–$129.2829
CO$102.741
CT$104.971
DC$112.231
DE$98.001
FL$97.42–$105.553
GA$92.53–$100.522
GU$106.441
HI$106.441
IA$91.861
ID$92.381
IL$94.85–$102.874
IN$92.861
KS$91.451
KY$91.601
LA$91.46–$95.492
MA$102.21–$112.232
MD$99.74–$112.233
ME$92.78–$97.312
MI$93.69–$98.482
MN$98.831
MO$90.04–$95.833
MS$89.351
MT$98.861
NC$93.651
ND$97.281
NE$92.321
NH$101.131
NJ$106.27–$111.262
NM$94.141
NV$98.481
NY$94.90–$115.255
OH$93.371
OK$91.481
OR$97.82–$105.752
PA$93.52–$102.572
PR$99.521
RI$101.291
SC$93.641
SD$97.091
TN$91.851
TX$92.97–$102.318
UT$94.791
VA$97.00–$112.232
VI$99.521
VT$96.911
WA$102.02–$114.422
WI$94.351
WV$91.701
WY$98.171

See 64495 in every payment locality

How the 64495 rate is calculated

Each of 64495’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 · 64495

RVUs × geographic indexes × conversion factor

Office or facility?

Work0.98

0.98 RVUs× 1.000 GPCI

Practice expense1.90

1.90 RVUs× 1.000 GPCI

Malpractice0.08

0.08 RVUs× 1.000 GPCI

Adjusted RVUs

2.9600

Conversion factor

$33.4009

Medicare rate

$98.87

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

7,139

Code
64495
Physician work
0.98
Practice expense
1.90
Malpractice
0.08

GPCI2026.csv

39

Locality
Washington, DC area
Physician work
1.054
Practice expense
1.178
Malpractice
1.113
Office calculation for 64495 in Washington, DC area
ComponentRVULocality factorAdjusted
Physician work0.98× 1.0541.0329
Practice expense1.90× 1.1782.2382
Malpractice0.08× 1.1130.0890
Total RVUs3.3602
Conversion factor× 33.4009

Office rate, Washington, DC area$112.23

Office: (0.98 × 1.054 + 1.9 × 1.178 + 0.08 × 1.113) × $33.4009 = $112.23

Facility: (0.98 × 1.054 + 0.29 × 1.178 + 0.08 × 1.113) × $33.4009 = $48.88

Open 64495 in the RVU calculator

Payment rules and modifiers for 64495

The CMS indicators that decide how 64495 is paid alongside other services.

CMS payment indicators · 64495

Facet injection, third and additional levels

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

64495 without 50 · national office

$98.87

Facet injection, third and additional levels

64495-50 · Bilateral: 150%

$148.31

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 64495

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

Codes related to 64495
CodeHow it relatesOffice range, Washington, DC area
Primary code
64493Facet joint injection, lumbar or sacral, one levelPrimary lumbar or sacral facet injection code for the first level.$217.84
Same family
64494Facet joint injection, lumbar/sacral, second levelSame region and procedure family; reported for the second treated level.$108.69
64492Facet injection, third cervical/thoracic levelCorresponding third-and-additional-level facet injection code for the cervical or thoracic region.$115.52
Used instead
64483Transforaminal epidural injection, lumbar or sacral, first levelLumbar transforaminal epidural injection targets a different anatomic space.$303.98
64484Epidural injection, each additional lumbar or sacral levelAdditional-level code for lumbar transforaminal epidural injections, not facet injections.$134.27

How 64495 has changed in Washington, DC area

64495 · Office / nonfacility

$112.23

Effective 2026-10-01

The base rate is $12.94 higher than on 2025-10-01, moving from $99.29 to $112.23 (13.0%).

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

    $99.29changed to$112.23

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 1.00 changed to 0.98
    • Practice expense RVU 1.61 changed to 1.90
    • 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

    $103.75changed to$99.29

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 1.63 changed to 1.61
    • Malpractice RVU 0.10 changed to 0.08

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $102.06changed to$103.75

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $105.78changed to$102.06

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 1.60 changed to 1.63
    • 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

    $108.96changed to$105.78

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 1.59 changed to 1.60
    • 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

    $109.87changed to$108.96

    • Conversion factor 34.8931 changed to 34.6062

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $105.46changed to$109.87

    • 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
    • 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

    $102.55changed to$105.46

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 1.40 changed to 1.44
    • 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

    $100.70changed to$102.55

    • 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

    $100.53changed to$100.70

    • Conversion factor 35.8887 changed to 35.9996
    • 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

    $101.73changed to$100.53

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 1.39 changed to 1.36
    • 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

    $102.09changed to$101.73

    • Conversion factor 35.9335 changed to 35.8043

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $101.58changed to$102.09

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $101.35changed to$101.58

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 1.40 changed to 1.39
    • Malpractice RVU 0.08 changed to 0.09
    • 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

    $102.76changed to$101.35

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 1.57 changed to 1.40
    • 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: $102.76

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$112.23$48.88RVU26D
2026-07-01$112.23$48.88RVU26C
2026-04-01$112.23$48.88RVU26B
2026-01-01$112.23$48.88RVU26A
2025-10-01$99.29$54.56RVU25D
2025-07-01$99.29$54.56RVU25C
2025-04-01$99.29$54.56RVU25B
2025-01-01$99.29$54.56RVU25A
2024-10-01$103.75$56.53RVU24D
2024-07-01$103.75$56.53RVU24C
2024-04-01$103.75$56.53RVU24B
2024-03-09$103.75$56.53RVU24AR
2024-01-01$102.06$55.61RVU24A
2023-10-01$105.78$57.65RVU23D
2023-07-01$105.78$57.65RVU23C
2023-04-01$105.78$57.65RVU23B
2023-01-01$105.78$57.65RVU23A
2022-10-01$108.96$58.92RVU22D
2022-07-01$108.96$58.92RVU22C
2022-04-01$108.96$58.92RVU22B
2022-01-01$108.96$58.92RVU22A
2021-10-01$109.87$59.84RVU21D
2021-07-01$109.87$59.84RVU21C
2021-04-01$109.87$59.84RVU21B
2021-01-01$109.87$59.84RVU21A
2020-10-01$105.46$60.51RVU20D
2020-07-01$105.46$60.51RVU20C
2020-04-01$105.46$60.51RVU20B
2020-01-01$105.46$60.51RVU20A
2019-10-01$102.55$59.99RVU19D
2019-07-01$102.55$59.99RVU19C
2019-04-01$102.55$59.99RVU19B
2019-01-01$102.55$59.99RVU19A
2018-10-01$100.70$59.92RVU18D
2018-07-01$100.70$59.92RVU18C
2018-04-01$100.70$59.92RVU18B
2018-01-01$100.70$59.92RVU18AR1
2017-10-01$100.53$59.88RVU17D
2017-07-01$100.53$59.88RVU17C
2017-04-01$100.53$59.88RVU17B
2017-01-01$100.53$59.88RVU17A
2016-10-01$101.73$60.31RVU16D
2016-07-01$101.73$60.31RVU16C
2016-04-01$101.73$60.31RVU16B
2016-01-01$101.73$60.31RVU16A
2015-10-01$102.09$60.52RVU15D
2015-07-01$102.09$60.52RVU15C
2015-04-01$101.58$60.22RVU15B
2015-01-01$101.58$60.22RVU15A
2014-10-01$101.35$60.01RVU14D
2014-07-01$101.35$60.01RVU14C
2014-04-01$101.35$60.01RVU14B
2014-01-01$101.35$60.01RVU14A
2013-10-01$102.76$58.33RVU13D
2013-07-01$102.76$58.33RVU13C
2013-04-01$102.76$58.33RVU13B
2013-01-01$102.76$58.33RVU13AR

Price 64495 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

64495 billing questions

When is 64495 used instead of 64494?

Use 64494 for the second lumbar or sacral level and 64495 for the third and any additional level treated in the session.

Can 64495 be billed by itself?

No. It is an add-on code and must be reported with a primary procedure, such as 64493 for the first level.

Does the code include imaging guidance?

Yes. The service includes fluoroscopic or CT guidance for the facet joint or the nerves innervating it.

How is a bilateral procedure reported?

Report modifier 50 for the bilateral procedure. CMS pays the code at 150% when modifier 50 is used.

What documentation supports reporting 64495?

Document the lumbar or sacral levels treated, the injection target and agent, the side or sides, and the imaging guidance used.

How is this different from a lumbar transforaminal epidural injection?

64495 targets facet joints or their innervating nerves. A transforaminal epidural injection targets the epidural space through a neural foramen.

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 64495PPRRVU2026_Oct_nonQPP.csv, line 7,139 (RVU26D)
Geographic factors for Washington, DC areaGPCI2026.csv, line 39 (RVU26D)

Open CMS sourceHow we calculate rates

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