CPT code 64495: Facet injection, third and additional levels2026 Medicare rate & RVUs in Virginia
Image-guided lumbar or sacral facet joint injections at the third and subsequent levels are reported with the corresponding primary-level procedure.
In Virginia, Medicare pays $97.00 for 64495 in the office and $44.14 when it’s performed in a hospital or facility.
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.
On this page 11 sections
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 Virginia 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. Virginia pays $97.00. The RVUs are the same everywhere; the geographic indexes change the dollars.
- Virginia · this page$97.00
- Los Angeles, CA · California$110.92+$13.92
- Washington, DC area · District of Columbia$112.23+$15.23
- Miami, FL · Florida$105.55+$8.55
- Chicago, IL · Illinois$102.87+$5.87
- Manhattan, NY · New York$112.81+$15.81
- Alaska · Alaska$118.16+$21.16
Other areas in Virginia first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| 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 |
| Madera, CACalifornia | $104.28 | $45.34 |
| Merced, CACalifornia | $104.28 | $45.34 |
| Modesto, CACalifornia | $104.28 | $45.34 |
| Napa, CACalifornia | $119.79 | $48.92 |
| Oxnard, CACalifornia | $110.33 | $46.76 |
| Redding, CACalifornia | $104.28 | $45.34 |
| Rest of CaliforniaCalifornia | $104.28 | $45.34 |
| Riverside, CACalifornia | $105.16 | $46.22 |
| Sacramento, CACalifornia | $109.15 | $46.61 |
| Salinas, CACalifornia | $108.73 | $46.41 |
| San Diego, CACalifornia | $111.06 | $46.75 |
| Marin County, CACalifornia | $126.55 | $50.73 |
| San Francisco, CACalifornia | $126.46 | $50.64 |
| San Benito County, CACalifornia | $129.28 | $51.73 |
| Santa Clara County, CACalifornia | $128.91 | $51.36 |
| San Luis Obispo, CACalifornia | $107.00 | $45.75 |
| Santa Cruz, CACalifornia | $111.96 | $46.62 |
| Santa Maria, CACalifornia | $109.08 | $46.38 |
| Santa Rosa, CACalifornia | $113.08 | $47.04 |
| Stockton, CACalifornia | $104.28 | $45.34 |
| Vallejo, CACalifornia | $119.66 | $48.79 |
| Visalia, CACalifornia | $104.28 | $45.34 |
| Yuba City, CACalifornia | $104.28 | $45.34 |
| ColoradoColorado | $102.74 | $45.52 |
| ConnecticutConnecticut | $104.97 | $47.05 |
| DelawareDelaware | $98.00 | $44.87 |
| Fort Lauderdale, FLFlorida | $101.85 | $47.38 |
| Rest of FloridaFlorida | $97.42 | $46.01 |
| Atlanta, GAGeorgia | $100.52 | $45.88 |
| Rest of GeorgiaGeorgia | $92.53 | $44.56 |
| Hawaii, Guam, HIHawaii | $106.44 | $45.29 |
| IowaIowa | $91.86 | $42.66 |
| IdahoIdaho | $92.38 | $42.91 |
| East St. Louis, ILIllinois | $96.50 | $47.03 |
| Rest of IllinoisIllinois | $94.85 | $45.75 |
| Suburban Chicago, ILIllinois | $102.87 | $47.64 |
| IndianaIndiana | $92.86 | $43.01 |
| KansasKansas | $91.45 | $42.84 |
| KentuckyKentucky | $91.60 | $43.79 |
| New Orleans, LALouisiana | $95.49 | $44.88 |
| Rest of LouisianaLouisiana | $91.46 | $43.87 |
| Metropolitan Boston, MAMassachusetts | $112.23 | $48.02 |
| Rest of MassachusettsMassachusetts | $102.21 | $45.59 |
| Baltimore area, MDMaryland | $104.66 | $46.96 |
| Rest of MarylandMaryland | $99.74 | $45.32 |
| Rest of MaineMaine | $92.78 | $43.31 |
| Southern Maine, MEMaine | $97.31 | $44.02 |
| Detroit, MIMichigan | $98.48 | $46.59 |
| Rest of MichiganMichigan | $93.69 | $44.59 |
| MinnesotaMinnesota | $98.83 | $43.49 |
| Metropolitan Kansas City, MOMissouri | $94.93 | $44.44 |
| Metropolitan St. Louis, MOMissouri | $95.83 | $44.63 |
| Rest of MissouriMissouri | $90.04 | $43.69 |
| MississippiMississippi | $89.35 | $43.05 |
| MontanaMontana | $98.86 | $45.09 |
| North CarolinaNorth Carolina | $93.65 | $43.48 |
| North DakotaNorth Dakota | $97.28 | $43.50 |
| NebraskaNebraska | $92.32 | $42.68 |
| New HampshireNew Hampshire | $101.13 | $45.15 |
| Northern New JerseyNew Jersey | $111.26 | $48.88 |
| Rest of New JerseyNew Jersey | $106.27 | $47.55 |
| New MexicoNew Mexico | $94.14 | $44.82 |
| NevadaNevada | $98.48 | $44.65 |
| NYC suburbs and Long Island, NYNew York | $115.25 | $51.31 |
| Poughkeepsie and northern NYC suburbs, NYNew York | $106.93 | $48.05 |
| Queens, NYNew York | $113.69 | $50.13 |
| Rest of New YorkNew York | $94.90 | $43.81 |
| OhioOhio | $93.37 | $44.27 |
| OklahomaOklahoma | $91.48 | $43.46 |
| Portland, OROregon | $105.75 | $46.01 |
| Rest of OregonOregon | $97.82 | $44.26 |
| Metropolitan Philadelphia, PAPennsylvania | $102.57 | $46.59 |
| Rest of PennsylvaniaPennsylvania | $93.52 | $44.15 |
| Puerto RicoPuerto Rico | $99.52 | $45.16 |
| Rhode IslandRhode Island | $101.29 | $45.74 |
| South CarolinaSouth Carolina | $93.64 | $43.95 |
| South DakotaSouth Dakota | $97.09 | $43.32 |
| TennesseeTennessee | $91.85 | $42.97 |
| Austin, TXTexas | $102.31 | $45.41 |
| Beaumont, TXTexas | $92.97 | $44.03 |
| Brazoria, TXTexas | $97.97 | $44.68 |
| Dallas, TXTexas | $98.53 | $44.97 |
| Fort Worth, TXTexas | $97.93 | $44.91 |
| Galveston, TXTexas | $98.22 | $44.83 |
| Houston, TXTexas | $99.69 | $46.29 |
| Rest of TexasTexas | $95.37 | $44.34 |
| UtahUtah | $94.79 | $44.24 |
| Virgin Islands, VIUnited States Virgin Islands | $99.52 | $45.16 |
| VermontVermont | $96.91 | $43.67 |
| Rest of WashingtonWashington | $102.02 | $45.39 |
| King County, WAWashington | $114.42 | $48.44 |
| WisconsinWisconsin | $94.35 | $42.84 |
| West VirginiaWest Virginia | $91.70 | $44.97 |
| WyomingWyoming | $98.17 | $44.40 |
64495 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.
$88.62
$118.16
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 | $118.16 | 1 |
| AL | $89.77 | 1 |
| AR | $88.62 | 1 |
| AZ | $96.51 | 1 |
| CA | $104.28–$129.28 | 29 |
| CO | $102.74 | 1 |
| CT | $104.97 | 1 |
| DC | $112.23 | 1 |
| DE | $98.00 | 1 |
| FL | $97.42–$105.55 | 3 |
| GA | $92.53–$100.52 | 2 |
| GU | $106.44 | 1 |
| HI | $106.44 | 1 |
| IA | $91.86 | 1 |
| ID | $92.38 | 1 |
| IL | $94.85–$102.87 | 4 |
| IN | $92.86 | 1 |
| KS | $91.45 | 1 |
| KY | $91.60 | 1 |
| LA | $91.46–$95.49 | 2 |
| MA | $102.21–$112.23 | 2 |
| MD | $99.74–$112.23 | 3 |
| ME | $92.78–$97.31 | 2 |
| MI | $93.69–$98.48 | 2 |
| MN | $98.83 | 1 |
| MO | $90.04–$95.83 | 3 |
| MS | $89.35 | 1 |
| MT | $98.86 | 1 |
| NC | $93.65 | 1 |
| ND | $97.28 | 1 |
| NE | $92.32 | 1 |
| NH | $101.13 | 1 |
| NJ | $106.27–$111.26 | 2 |
| NM | $94.14 | 1 |
| NV | $98.48 | 1 |
| NY | $94.90–$115.25 | 5 |
| OH | $93.37 | 1 |
| OK | $91.48 | 1 |
| OR | $97.82–$105.75 | 2 |
| PA | $93.52–$102.57 | 2 |
| PR | $99.52 | 1 |
| RI | $101.29 | 1 |
| SC | $93.64 | 1 |
| SD | $97.09 | 1 |
| TN | $91.85 | 1 |
| TX | $92.97–$102.31 | 8 |
| UT | $94.79 | 1 |
| VA | $97.00–$112.23 | 2 |
| VI | $99.52 | 1 |
| VT | $96.91 | 1 |
| WA | $102.02–$114.42 | 2 |
| WI | $94.35 | 1 |
| WV | $91.70 | 1 |
| WY | $98.17 | 1 |
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
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 Virginia 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
106
- Locality
- Virginia
- Physician work
- 1.000
- Practice expense
- 0.983
- Malpractice
- 0.706
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 0.98 | × 1.000 | 0.9800 |
| Practice expense | 1.90 | × 0.983 | 1.8677 |
| Malpractice | 0.08 | × 0.706 | 0.0565 |
| Total RVUs | 2.9042 | ||
| Conversion factor | × 33.4009 | ||
Office rate, Virginia$97.00
Office: (0.98 × 1 + 1.9 × 0.983 + 0.08 × 0.706) × $33.4009 = $97.00
Facility: (0.98 × 1 + 0.29 × 0.983 + 0.08 × 0.706) × $33.4009 = $44.14
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
| 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
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).
How 64495 has changed in Virginia
64495 · Office / nonfacility
$97.00
Effective 2026-10-01
The base rate is $11.39 higher than on 2025-10-01, moving from $85.61 to $97.00 (13.3%).
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
$85.61changed to$97.00
- 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 1.002 changed to 1.000
- Practice expense GPCI 0.984 changed to 0.983
- Malpractice GPCI 0.755 changed to 0.706
Held through RVU26B, RVU26C, RVU26D.
January 1, 2025
RVU25A
$89.26changed to$85.61
- 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.
March 9, 2024
RVU24AR
$87.80changed to$89.26
- Conversion factor 32.7442 changed to 33.2875
Held through RVU24B, RVU24C, RVU24D.
January 1, 2024
RVU24A
$90.36changed to$87.80
- Conversion factor 33.8872 changed to 32.7442
- Practice expense RVU 1.60 changed to 1.63
- Work GPCI 1.000 changed to 1.002
- Practice expense GPCI 0.990 changed to 0.984
- Malpractice GPCI 0.826 changed to 0.755
January 1, 2023
RVU23A
$92.46changed to$90.36
- Conversion factor 34.6062 changed to 33.8872
- Practice expense RVU 1.59 changed to 1.60
- Practice expense GPCI 0.995 changed to 0.990
- Malpractice GPCI 0.897 changed to 0.826
Held through RVU23B, RVU23C, RVU23D.
January 1, 2022
RVU22A
$93.23changed to$92.46
- Conversion factor 34.8931 changed to 34.6062
Held through RVU22B, RVU22C, RVU22D.
January 1, 2021
RVU21A
$90.52changed to$93.23
- 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 0.991 changed to 0.995
- Malpractice GPCI 0.903 changed to 0.897
Held through RVU21B, RVU21C, RVU21D.
January 1, 2020
RVU20A
$88.73changed to$90.52
- Conversion factor 36.0391 changed to 36.0896
- Practice expense RVU 1.40 changed to 1.44
- Practice expense GPCI 0.986 changed to 0.991
- Malpractice GPCI 0.908 changed to 0.903
Held through RVU20B, RVU20C, RVU20D.
January 1, 2019
RVU19A
$87.22changed to$88.73
- 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
$86.76changed to$87.22
- Conversion factor 35.8887 changed to 35.9996
- Practice expense GPCI 0.985 changed to 0.986
- Malpractice GPCI 0.866 changed to 0.908
Held through RVU18B, RVU18C, RVU18D.
January 1, 2017
RVU17A
$87.38changed to$86.76
- Conversion factor 35.8043 changed to 35.8887
- Practice expense RVU 1.39 changed to 1.36
- Practice expense GPCI 0.983 changed to 0.985
- Malpractice GPCI 0.824 changed to 0.866
Held through RVU17B, RVU17C, RVU17D.
January 1, 2016
RVU16A
$87.70changed to$87.38
- Conversion factor 35.9335 changed to 35.8043
Held through RVU16B, RVU16C, RVU16D.
July 1, 2015
RVU15C
$87.26changed to$87.70
- Conversion factor 35.7547 changed to 35.9335
Held through RVU15D.
January 1, 2015
RVU15A
$87.20changed to$87.26
- 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 0.980 changed to 0.983
- Malpractice GPCI 0.778 changed to 0.824
Held through RVU15B.
January 1, 2014
RVU14A
$88.20changed to$87.20
- Conversion factor 34.0230 changed to 35.8228
- Practice expense RVU 1.57 changed to 1.40
- Practice expense GPCI 0.977 changed to 0.980
- Malpractice GPCI 0.731 changed to 0.778
Held through RVU14B, RVU14C, RVU14D.
January 1, 2013
RVU13AR
Earliest loaded release: $88.20
Held through RVU13B, RVU13C, RVU13D.
| Effective from | Office | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | $97.00 | $44.14 | RVU26D |
| 2026-07-01 | $97.00 | $44.14 | RVU26C |
| 2026-04-01 | $97.00 | $44.14 | RVU26B |
| 2026-01-01 | $97.00 | $44.14 | RVU26A |
| 2025-10-01 | $85.61 | $48.69 | RVU25D |
| 2025-07-01 | $85.61 | $48.69 | RVU25C |
| 2025-04-01 | $85.61 | $48.69 | RVU25B |
| 2025-01-01 | $85.61 | $48.69 | RVU25A |
| 2024-10-01 | $89.26 | $50.28 | RVU24D |
| 2024-07-01 | $89.26 | $50.28 | RVU24C |
| 2024-04-01 | $89.26 | $50.28 | RVU24B |
| 2024-03-09 | $89.26 | $50.28 | RVU24AR |
| 2024-01-01 | $87.80 | $49.46 | RVU24A |
| 2023-10-01 | $90.36 | $51.11 | RVU23D |
| 2023-07-01 | $90.36 | $51.11 | RVU23C |
| 2023-04-01 | $90.36 | $51.11 | RVU23B |
| 2023-01-01 | $90.36 | $51.11 | RVU23A |
| 2022-10-01 | $92.46 | $52.17 | RVU22D |
| 2022-07-01 | $92.46 | $52.17 | RVU22C |
| 2022-04-01 | $92.46 | $52.17 | RVU22B |
| 2022-01-01 | $92.46 | $52.17 | RVU22A |
| 2021-10-01 | $93.23 | $52.95 | RVU21D |
| 2021-07-01 | $93.23 | $52.95 | RVU21C |
| 2021-04-01 | $93.23 | $52.95 | RVU21B |
| 2021-01-01 | $93.23 | $52.95 | RVU21A |
| 2020-10-01 | $90.52 | $54.04 | RVU20D |
| 2020-07-01 | $90.52 | $54.04 | RVU20C |
| 2020-04-01 | $90.52 | $54.04 | RVU20B |
| 2020-01-01 | $90.52 | $54.04 | RVU20A |
| 2019-10-01 | $88.73 | $53.91 | RVU19D |
| 2019-07-01 | $88.73 | $53.91 | RVU19C |
| 2019-04-01 | $88.73 | $53.91 | RVU19B |
| 2019-01-01 | $88.73 | $53.91 | RVU19A |
| 2018-10-01 | $87.22 | $53.85 | RVU18D |
| 2018-07-01 | $87.22 | $53.85 | RVU18C |
| 2018-04-01 | $87.22 | $53.85 | RVU18B |
| 2018-01-01 | $87.22 | $53.85 | RVU18AR1 |
| 2017-10-01 | $86.76 | $53.53 | RVU17D |
| 2017-07-01 | $86.76 | $53.53 | RVU17C |
| 2017-04-01 | $86.76 | $53.53 | RVU17B |
| 2017-01-01 | $86.76 | $53.53 | RVU17A |
| 2016-10-01 | $87.38 | $53.59 | RVU16D |
| 2016-07-01 | $87.38 | $53.59 | RVU16C |
| 2016-04-01 | $87.38 | $53.59 | RVU16B |
| 2016-01-01 | $87.38 | $53.59 | RVU16A |
| 2015-10-01 | $87.70 | $53.79 | RVU15D |
| 2015-07-01 | $87.70 | $53.79 | RVU15C |
| 2015-04-01 | $87.26 | $53.52 | RVU15B |
| 2015-01-01 | $87.26 | $53.52 | RVU15A |
| 2014-10-01 | $87.20 | $53.50 | RVU14D |
| 2014-07-01 | $87.20 | $53.50 | RVU14C |
| 2014-04-01 | $87.20 | $53.50 | RVU14B |
| 2014-01-01 | $87.20 | $53.50 | RVU14A |
| 2013-10-01 | $88.20 | $51.97 | RVU13D |
| 2013-07-01 | $88.20 | $51.97 | RVU13C |
| 2013-04-01 | $88.20 | $51.97 | RVU13B |
| 2013-01-01 | $88.20 | $51.97 | RVU13AR |
Where the Virginia rate applies
Virginia is a Medicare payment area, not a city. Our Census mapping connects it to 628 cities and communities in Virginia. Some span more than one payment area; confirm with the service ZIP.
- Abbs Valley
- Abingdon
- Accomac
- Adwolf
- Afton
- Alberta
- Aldie
- Allison Gap
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
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