$69.63–$97.11
64405 targets the greater occipital nerve. Use 64400 for a trigeminal division or branch.
On this page
CMS RVU26D · Effective 2026-10-01
64400 Nerve block Medicare reimbursement rates
Reports an injection around a trigeminal nerve division or branch, commonly for facial pain or trigeminal neuralgia treatment or diagnostic evaluation. Compare 64400 office and facility rates across CMS payment localities.
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
What does Medicare pay for 64400?
The service location and office or facility setting determine which base rate applies. These are the supported base rates for the 109 payment areas shown below, using the same CMS release.
Office / nonfacility
$105.75–$161.35
109 of 109 localities have a supported rate.
Lowest: Arkansas
Highest: San Jose-Sunnyvale-Santa Clara (San Benito Cnty)
A spread of $55.60 per service.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Where 64400 pays more and less
109 payment localities
$105.75 to $161.35
Pain management
About 64400: Trigeminal nerve injection or block
Reports an injection around a trigeminal nerve division or branch, commonly for facial pain or trigeminal neuralgia treatment or diagnostic evaluation.
This service places an anesthetic, with or without a steroid, around a trigeminal nerve division or branch to evaluate or relieve facial pain. Pain medicine physicians and anesthesiologists commonly perform it in an office, pain clinic, or outpatient facility. Typical situations include a diagnostic block or treatment directed at trigeminal neuralgia or another facial pain condition. The documented target must be part of the trigeminal nerve, not another cranial or peripheral nerve.
Report the service when the clinician performs the trigeminal injection; document the indication, targeted division or branch, side, and injectate. CMS assigns a 0-day global period, so same-day preoperative and postoperative care is included. For bilateral service, modifier 50 is paid at 150%. When multiple procedures occur in one session, the highest-valued procedure is paid in full and the others at 50%. Assistant-at-surgery services are not paid; co-surgeons and team surgery are not permitted.
CMS billing rules for 64400
- Global period
- Minor procedure with a 0-day global period: same-day preoperative and postoperative care is included.
- Multiple procedures
- Standard multiple procedure reduction: the highest-valued procedure is paid in full and others at 50% when performed in the same session.
- Bilateral procedures
- Bilateral procedure with modifier 50 is paid at 150%.
- Assistant at surgery
- Statutory restriction: assistant at surgery is not paid.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU0.73 · 20%
- Practice expense (office) RVU2.71 · 74%
- Malpractice RVU0.21 · 6%
25.4K
Medicare services in 2024 · #1044 by national volume
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.
64400 compared with similar codes
Office rate ranges across all CMS payment localities, from the same CMS release.
$70.75–$103.69
64408 targets the vagus nerve; it is not the code for a trigeminal nerve injection.
$72.07–$106.34
64450 describes an injection of another peripheral nerve or branch. Use 64400 when the documented target is trigeminal.
See how rates vary across the country
64400 · Office / nonfacility · Non-QP. Choose a state to explore its payment localities. A range means the amount varies within that state.
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.
$105.75
$144.56
Color shows the midpoint of each state’s locality range.
View all state and territory rates as a table
| State / territory | Rate range | Localities |
|---|---|---|
| AK | $136.84 | 1 |
| AL | $107.55 | 1 |
| AR | $105.75 | 1 |
| AZ | $118.10 | 1 |
| CA | $127.76–$161.35 | 29 |
| CO | $126.46 | 1 |
| CT | $130.84 | 1 |
| DC | $140.13 | 1 |
| DE | $120.24 | 1 |
| FL | $121.46–$136.35 | 3 |
| GA | $113.48–$124.84 | 2 |
| GU | $131.36 | 1 |
| HI | $131.36 | 1 |
| IA | $109.99 | 1 |
| ID | $110.98 | 1 |
| IL | $117.99–$131.62 | 4 |
| IN | $111.70 | 1 |
| KS | $109.74 | 1 |
| KY | $111.27 | 1 |
| LA | $111.21–$117.53 | 2 |
| MA | $125.68–$139.70 | 2 |
| MD | $122.67–$140.13 | 3 |
| ME | $112.02–$118.51 | 2 |
| MI | $114.94–$123.56 | 2 |
| MN | $119.60 | 1 |
| MO | $109.24–$117.58 | 3 |
| MS | $107.50 | 1 |
| MT | $121.90 | 1 |
| NC | $113.32 | 1 |
| ND | $117.75 | 1 |
| NE | $110.58 | 1 |
| NH | $124.75 | 1 |
| NJ | $131.90–$138.41 | 2 |
| NM | $115.81 | 1 |
| NV | $120.83 | 1 |
| NY | $115.30–$146.59 | 5 |
| OH | $114.09 | 1 |
| OK | $110.66 | 1 |
| OR | $119.47–$130.56 | 2 |
| PA | $114.11–$127.42 | 2 |
| PR | $122.80 | 1 |
| RI | $124.61 | 1 |
| SC | $113.98 | 1 |
| SD | $117.26 | 1 |
| TN | $110.43 | 1 |
| TX | $113.27–$126.41 | 8 |
| UT | $115.77 | 1 |
| VA | $118.31–$140.13 | 2 |
| VI | $122.80 | 1 |
| VT | $117.54 | 1 |
| WA | $125.35–$142.40 | 2 |
| WI | $113.26 | 1 |
| WV | $113.08 | 1 |
| WY | $120.09 | 1 |
Compare 64400 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
109 of 109 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Alabama | Office $107.55 | Facility $42.38 |
| Alaska* | Office $136.84 | Facility $57.51 |
| Arizona | Office $118.10 | Facility $45.92 |
| Arkansas | Office $105.75 | Facility $41.77 |
| Atlanta | Office $124.84 | Facility $49.17 |
| Austin | Office $126.41 | Facility $47.61 |
| Bakersfield | Office $128.32 | Facility $46.69 |
| Baltimore/Surr. Cntys | Office $130.57 | Facility $50.65 |
| Beaumont | Office $113.27 | Facility $45.49 |
| Brazoria | Office $119.75 | Facility $45.94 |
| Chicago | Office $131.62 | Facility $56.76 |
| Chico | Office $127.76 | Facility $46.13 |
| Colorado | Office $126.46 | Facility $47.21 |
| Connecticut | Office $130.84 | Facility $50.62 |
| Dallas | Office $120.77 | Facility $46.59 |
| Dc + Md/Va Suburbs | Office $140.13 | Facility $52.39 |
| Delaware | Office $120.24 | Facility $46.65 |
| Detroit | Office $123.56 | Facility $51.68 |
| East St. Louis | Office $121.78 | Facility $53.26 |
| El Centro | Office $127.80 | Facility $46.16 |
| Fort Lauderdale | Office $128.76 | Facility $53.31 |
| Fort Worth | Office $119.96 | Facility $46.52 |
| Fresno | Office $127.76 | Facility $46.13 |
| Galveston | Office $120.27 | Facility $46.31 |
| Hanford-Corcoran | Office $127.76 | Facility $46.13 |
| Hawaii, Guam | Office $131.36 | Facility $46.67 |
| Houston | Office $124.11 | Facility $50.15 |
| Idaho | Office $110.98 | Facility $42.45 |
| Indiana | Office $111.70 | Facility $42.65 |
| Iowa | Office $109.99 | Facility $41.84 |
| Kansas | Office $109.74 | Facility $42.41 |
| Kentucky | Office $111.27 | Facility $45.05 |
| Los Angeles-Long Beach-Anaheim (Los Angeles/Orange Cnty) | Office $137.12 | Facility $49.01 |
| Madera | Office $127.76 | Facility $46.13 |
| Manhattan | Office $142.25 | Facility $55.70 |
| Merced | Office $127.76 | Facility $46.13 |
| Metropolitan Boston | Office $139.70 | Facility $50.77 |
| Metropolitan Kansas City | Office $116.23 | Facility $46.29 |
| Metropolitan Philadelphia | Office $127.42 | Facility $49.88 |
| Metropolitan St. Louis | Office $117.58 | Facility $46.67 |
| Miami | Office $136.35 | Facility $58.81 |
| Minnesota | Office $119.60 | Facility $42.96 |
| Mississippi | Office $107.50 | Facility $43.37 |
| Modesto | Office $127.76 | Facility $46.13 |
| Montana** | Office $121.90 | Facility $47.42 |
| Napa | Office $148.78 | Facility $50.61 |
| Nebraska | Office $110.58 | Facility $41.83 |
| Nevada** | Office $120.83 | Facility $46.27 |
| New Hampshire | Office $124.75 | Facility $47.21 |
| New Mexico | Office $115.81 | Facility $47.51 |
| New Orleans | Office $117.53 | Facility $47.44 |
| North Carolina | Office $113.32 | Facility $43.82 |
| North Dakota** | Office $117.75 | Facility $43.26 |
| Northern Nj | Office $138.41 | Facility $52.01 |
| Nyc Suburbs/Long Island | Office $146.59 | Facility $58.03 |
| Ohio | Office $114.09 | Facility $46.09 |
| Oklahoma | Office $110.66 | Facility $44.15 |
| Oxnard-Thousand Oaks-Ventura | Office $136.43 | Facility $48.39 |
| Portland | Office $130.56 | Facility $47.80 |
| Poughkpsie/N Nyc Suburbs | Office $133.08 | Facility $51.52 |
| Puerto Rico | Office $122.80 | Facility $47.50 |
| Queens | Office $143.05 | Facility $55.01 |
| Redding | Office $127.76 | Facility $46.13 |
| Rest Of California | Office $127.76 | Facility $46.13 |
| Rest Of Florida | Office $121.46 | Facility $50.25 |
| Rest Of Georgia | Office $113.48 | Facility $47.04 |
| Rest Of Illinois | Office $117.99 | Facility $49.98 |
| Rest Of Louisiana | Office $111.21 | Facility $45.29 |
| Rest Of Maine | Office $112.02 | Facility $43.50 |
| Rest Of Maryland | Office $122.67 | Facility $47.29 |
| Rest Of Massachusetts | Office $125.68 | Facility $47.25 |
| Rest Of Michigan | Office $114.94 | Facility $46.94 |
| Rest Of Missouri | Office $109.24 | Facility $45.03 |
| Rest Of New Jersey | Office $131.90 | Facility $50.56 |
| Rest Of New York | Office $115.30 | Facility $44.54 |
| Rest Of Oregon | Office $119.47 | Facility $45.28 |
| Rest Of Pennsylvania | Office $114.11 | Facility $45.73 |
| Rest Of Texas | Office $116.62 | Facility $45.93 |
| Rest Of Washington | Office $125.35 | Facility $46.92 |
| Rhode Island | Office $124.61 | Facility $47.66 |
| Riverside-San Bernardino-Ontario | Office $130.01 | Facility $48.38 |
| Sacramento-Roseville-Folsom | Office $134.29 | Facility $47.67 |
| Salinas | Office $133.81 | Facility $47.48 |
| San Diego-Chula Vista-Carlsbad | Office $137.17 | Facility $48.09 |
| San Francisco-Oakland-Berkeley (Marin Cnty) | Office $157.55 | Facility $52.52 |
| San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty) | Office $157.31 | Facility $52.29 |
| San Jose-Sunnyvale-Santa Clara (San Benito Cnty) | Office $161.35 | Facility $53.94 |
| San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty) | Office $160.37 | Facility $52.97 |
| San Luis Obispo-Paso Robles | Office $131.65 | Facility $46.82 |
| Santa Cruz-Watsonville | Office $138.63 | Facility $48.13 |
| Santa Maria-Santa Barbara | Office $134.37 | Facility $47.52 |
| Santa Rosa-Petaluma | Office $140.03 | Facility $48.56 |
| Seattle (King Cnty) | Office $142.40 | Facility $51.00 |
| South Carolina | Office $113.98 | Facility $45.16 |
| South Dakota** | Office $117.26 | Facility $42.77 |
| Southern Maine | Office $118.51 | Facility $44.70 |
| Stockton | Office $127.76 | Facility $46.13 |
| Suburban Chicago | Office $129.94 | Facility $53.45 |
| Tennessee | Office $110.43 | Facility $42.72 |
| Utah | Office $115.77 | Facility $45.75 |
| Vallejo | Office $148.44 | Facility $50.27 |
| Vermont | Office $117.54 | Facility $43.80 |
| Virgin Islands | Office $122.80 | Facility $47.50 |
| Virginia | Office $118.31 | Facility $45.09 |
| Visalia | Office $127.76 | Facility $46.13 |
| West Virginia | Office $113.08 | Facility $48.35 |
| Wisconsin | Office $113.26 | Facility $41.90 |
| Wyoming** | Office $120.09 | Facility $45.61 |
| Yuba City | Office $127.76 | Facility $46.13 |
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64400 billing questions
When should 64400 be selected instead of a general peripheral nerve block code?
Use 64400 when the documented target is a trigeminal nerve division or branch. A different peripheral nerve target calls for the code specific to that nerve, when available.
Does the code identify the facial pain diagnosis by itself?
No. The record should support the indication for the injection and identify the trigeminal division or branch treated.
How is a bilateral trigeminal injection reported for Medicare payment?
Use modifier 50 for a bilateral procedure; CMS pays it at 150%.
Is same-day pre- and postoperative care separately included?
The code has a 0-day global period, and same-day preoperative and postoperative care is included.
Can an assistant, co-surgeon, or surgical team be reported for this service?
CMS does not pay an assistant at surgery for this code. Co-surgeons and team surgery are not permitted.
What happens when another procedure is performed in the same session?
CMS pays the highest-valued procedure in full and the other procedures at 50% under the standard multiple procedure reduction.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense, and malpractice RVUs, adjusted by each locality’s geographic indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
7,09363741,,Install spinal shunt,A,,8.89,9.11,NA,9.11,,3.35,21.35,21.35,0,090,0.11,0.76,0.13,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,09463744,,Revision of spinal shunt,A,,8.72,9.65,NA,9.65,,3.67,22.04,22.04,0,090,0.11,0.76,0.13,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,09563746,,Removal of spinal shunt,A,,7.15,9.10,NA,9.10,,3.01,19.26,19.26,0,090,0.11,0.76,0.13,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,09664400,,Njx aa&/strd trigeminal nrv,A,,0.73,2.71,,0.48,,0.21,3.65,1.42,0,000,0.00,0.00,0.00,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,09764405,,Njx aa&/strd gr ocpl nrv,A,,0.92,1.23,,0.25,,0.21,2.36,1.38,0,000,0.00,0.00,0.00,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,09864408,,Njx aa&/strd vagus nrv,A,,0.73,1.55,,0.32,,0.11,2.39,1.16,0,000,0.00,0.00,0.00,2,1,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,09964415,,Njx aa&/strd brch plxs img,A,,1.46,3.06,,0.41,,0.12,4.64,1.99,0,000,0.00,0.00,0.00,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00