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

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 Delaware, Medicare pays $98.00 for 64495 in the office and $44.87 when it’s performed in a hospital or facility.

$98.00Office (non-facility)
$44.87Hospital or facility
−0.9%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 Delaware
  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 Delaware 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. Delaware pays $98.00. The RVUs are the same everywhere; the geographic indexes change the dollars.

64495 in Delaware vs other payment areas
  1. Delaware · this page$98.00
  2. Los Angeles, CA · California$110.92+$12.92
  3. Washington, DC area · District of Columbia$112.23+$14.23
  4. Miami, FL · Florida$105.55+$7.55
  5. Chicago, IL · Illinois$102.87+$4.87
  6. Manhattan, NY · New York$112.81+$14.81
  7. Alaska · Alaska$118.16+$20.16

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

Every other payment area

64495 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$89.77$42.72
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

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 Delaware 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

40

Locality
Delaware
Physician work
1.005
Practice expense
0.988
Malpractice
0.899
Office calculation for 64495 in Delaware
ComponentRVULocality factorAdjusted
Physician work0.98× 1.0050.9849
Practice expense1.90× 0.9881.8772
Malpractice0.08× 0.8990.0719
Total RVUs2.9340
Conversion factor× 33.4009

Office rate, Delaware$98.00

Office: (0.98 × 1.005 + 1.9 × 0.988 + 0.08 × 0.899) × $33.4009 = $98.00

Facility: (0.98 × 1.005 + 0.29 × 0.988 + 0.08 × 0.899) × $33.4009 = $44.87

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, Delaware
Primary code
64493Facet joint injection, lumbar or sacral, one levelPrimary lumbar or sacral facet injection code for the first level.$188.52
Same family
64494Facet joint injection, lumbar/sacral, second levelSame region and procedure family; reported for the second treated level.$95.03
64492Facet injection, third cervical/thoracic levelCorresponding third-and-additional-level facet injection code for the cervical or thoracic region.$101.35
Used instead
64483Transforaminal epidural injection, lumbar or sacral, first levelLumbar transforaminal epidural injection targets a different anatomic space.$262.24
64484Epidural injection, each additional lumbar or sacral levelAdditional-level code for lumbar transforaminal epidural injections, not facet injections.$116.48

How 64495 has changed in Delaware

64495 · Office / nonfacility

$98.00

Effective 2026-10-01

The base rate is $11.25 higher than on 2025-10-01, moving from $86.75 to $98.00 (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

    $86.75changed to$98.00

    • 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 1.009 changed to 1.005
    • Practice expense GPCI 0.992 changed to 0.988
    • Malpractice GPCI 0.949 changed to 0.899

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $90.57changed to$86.75

    • 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

    $89.09changed to$90.57

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $91.90changed to$89.09

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 1.60 changed to 1.63
    • Work GPCI 1.007 changed to 1.009
    • Practice expense GPCI 1.007 changed to 0.992
    • Malpractice GPCI 0.938 changed to 0.949

  5. January 1, 2023

    RVU23A

    $94.22changed to$91.90

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 1.59 changed to 1.60
    • Work GPCI 1.005 changed to 1.007
    • Practice expense GPCI 1.022 changed to 1.007
    • Malpractice GPCI 0.927 changed to 0.938

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $95.00changed to$94.22

    • Conversion factor 34.8931 changed to 34.6062

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $92.69changed to$95.00

    • 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 1.006 changed to 1.005
    • Practice expense GPCI 1.021 changed to 1.022
    • Malpractice GPCI 1.023 changed to 0.927

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $91.33changed to$92.69

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 1.40 changed to 1.44
    • Work GPCI 1.007 changed to 1.006
    • Practice expense GPCI 1.019 changed to 1.021
    • Malpractice GPCI 1.119 changed to 1.023

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $89.77changed to$91.33

    • 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

    $89.83changed to$89.77

    • Conversion factor 35.8887 changed to 35.9996
    • Work GPCI 1.010 changed to 1.007
    • Practice expense GPCI 1.025 changed to 1.019
    • Malpractice GPCI 1.101 changed to 1.119

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $91.03changed to$89.83

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 1.39 changed to 1.36
    • Work GPCI 1.012 changed to 1.010
    • Practice expense GPCI 1.031 changed to 1.025
    • Malpractice GPCI 1.083 changed to 1.101

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $91.36changed to$91.03

    • Conversion factor 35.9335 changed to 35.8043

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $90.91changed to$91.36

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $90.83changed to$90.91

    • 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
    • Practice expense GPCI 1.038 changed to 1.031
    • Malpractice GPCI 0.878 changed to 1.083

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $92.03changed to$90.83

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 1.57 changed to 1.40
    • Practice expense GPCI 1.044 changed to 1.038
    • Malpractice GPCI 0.672 changed to 0.878

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $92.03

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$98.00$44.87RVU26D
2026-07-01$98.00$44.87RVU26C
2026-04-01$98.00$44.87RVU26B
2026-01-01$98.00$44.87RVU26A
2025-10-01$86.75$49.53RVU25D
2025-07-01$86.75$49.53RVU25C
2025-04-01$86.75$49.53RVU25B
2025-01-01$86.75$49.53RVU25A
2024-10-01$90.57$51.28RVU24D
2024-07-01$90.57$51.28RVU24C
2024-04-01$90.57$51.28RVU24B
2024-03-09$90.57$51.28RVU24AR
2024-01-01$89.09$50.44RVU24A
2023-10-01$91.90$51.98RVU23D
2023-07-01$91.90$51.98RVU23C
2023-04-01$91.90$51.98RVU23B
2023-01-01$91.90$51.98RVU23A
2022-10-01$94.22$52.84RVU22D
2022-07-01$94.22$52.84RVU22C
2022-04-01$94.22$52.84RVU22B
2022-01-01$94.22$52.84RVU22A
2021-10-01$95.00$53.64RVU21D
2021-07-01$95.00$53.64RVU21C
2021-04-01$95.00$53.64RVU21B
2021-01-01$95.00$53.64RVU21A
2020-10-01$92.69$55.10RVU20D
2020-07-01$92.69$55.10RVU20C
2020-04-01$92.69$55.10RVU20B
2020-01-01$92.69$55.10RVU20A
2019-10-01$91.33$55.34RVU19D
2019-07-01$91.33$55.34RVU19C
2019-04-01$91.33$55.34RVU19B
2019-01-01$91.33$55.34RVU19A
2018-10-01$89.77$55.28RVU18D
2018-07-01$89.77$55.28RVU18C
2018-04-01$89.77$55.28RVU18B
2018-01-01$89.77$55.28RVU18AR1
2017-10-01$89.83$55.25RVU17D
2017-07-01$89.83$55.25RVU17C
2017-04-01$89.83$55.25RVU17B
2017-01-01$89.83$55.25RVU17A
2016-10-01$91.03$55.60RVU16D
2016-07-01$91.03$55.60RVU16C
2016-04-01$91.03$55.60RVU16B
2016-01-01$91.03$55.60RVU16A
2015-10-01$91.36$55.80RVU15D
2015-07-01$91.36$55.80RVU15C
2015-04-01$90.91$55.52RVU15B
2015-01-01$90.91$55.52RVU15A
2014-10-01$90.83$55.13RVU14D
2014-07-01$90.83$55.13RVU14C
2014-04-01$90.83$55.13RVU14B
2014-01-01$90.83$55.13RVU14A
2013-10-01$92.03$53.31RVU13D
2013-07-01$92.03$53.31RVU13C
2013-04-01$92.03$53.31RVU13B
2013-01-01$92.03$53.31RVU13AR

Price 64495 for an earlier date of service

Where the Delaware rate applies

Delaware is a Medicare payment area, not a city. Our Census mapping connects it to 79 cities and communities in Delaware. Some span more than one payment area; confirm with the service ZIP.

  • Arden
  • Ardencroft
  • Ardentown
  • Bear
  • Bellefonte
  • Bethany Beach
  • Bethel
  • Blades

Browse all communities in Delaware

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 DelawareGPCI2026.csv, line 40 (RVU26D)

Open CMS sourceHow we calculate rates

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