Billing code 64405: Occipital nerve blockMedicare rate & RVUs
Report this injection for a greater occipital nerve block, commonly performed for occipital neuralgia or headache involving the occipital nerve distribution.
Medicare pays $78.83 for 64405 nationally in the office and $46.09 in a hospital or facility. Local office rates run $69.63–$97.11.
Medicare rate · 64405
Occipital nerve block
Swap in your local Medicare rate.
- Work RVUs
- 0.92
- Total RVUs
- 2.36
- Global days
- 000
National rate · 2026
$78.83
Office setting, before claim adjustments.
See every locality for 64405 → · Billed by an NP, PA or therapist? →
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 10 sections
What 64405 covers
This service injects anesthetic, steroid, or both around the greater occipital nerve to interrupt pain signals. Pain medicine physicians, anesthesiologists, neurologists, and other qualified clinicians commonly perform the block in an office or outpatient facility for occipital neuralgia or headache symptoms involving the back of the head. Documentation should identify the nerve and side treated, the clinical indication, and the injection performed.
Select this code for the greater occipital nerve rather than another named nerve or an unspecified peripheral nerve branch. CMS assigns a 0-day global period, so same-day preoperative and postoperative care is included. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and the others at 50%. For bilateral treatment, modifier 50 is paid at 150%. Assistant-at-surgery payment is restricted; co-surgeons and team surgery are not permitted.
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.
Where 64405 pays more and less
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
109 payment localities
$69.63 to $97.11
109 of 109 payment localities
64405 rates by state
Office rate range in each state. Select a state to see its payment localities.
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Local rates. Clear comparisons.
Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.
$69.63
$93.71
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 | $93.71 | 1 |
| AL | $70.65 | 1 |
| AR | $69.63 | 1 |
| AZ | $76.54 | 1 |
| CA | $80.04–$97.11 | 29 |
| CO | $80.29 | 1 |
| CT | $84.08 | 1 |
| DC | $88.59 | 1 |
| DE | $77.78 | 1 |
| FL | $80.55–$91.24 | 3 |
| GA | $75.74–$80.99 | 2 |
| GU | $81.50 | 1 |
| HI | $81.50 | 1 |
| IA | $71.10 | 1 |
| ID | $71.84 | 1 |
| IL | $79.20–$88.33 | 4 |
| IN | $72.22 | 1 |
| KS | $71.40 | 1 |
| KY | $73.67 | 1 |
| LA | $73.81–$77.36 | 2 |
| MA | $80.07–$87.28 | 2 |
| MD | $79.05–$88.59 | 3 |
| ME | $72.89–$75.87 | 2 |
| MI | $76.16–$82.20 | 2 |
| MN | $75.08 | 1 |
| MO | $72.97–$76.87 | 3 |
| MS | $71.28 | 1 |
| MT | $78.81 | 1 |
| NC | $73.54 | 1 |
| ND | $74.66 | 1 |
| NE | $71.30 | 1 |
| NH | $79.63 | 1 |
| NJ | $84.52–$87.81 | 2 |
| NM | $76.83 | 1 |
| NV | $77.70 | 1 |
| NY | $74.69–$94.57 | 5 |
| OH | $75.31 | 1 |
| OK | $72.87 | 1 |
| OR | $76.58–$82.08 | 2 |
| PA | $75.07–$82.42 | 2 |
| PR | $79.17 | 1 |
| RI | $80.01 | 1 |
| SC | $74.65 | 1 |
| SD | $74.17 | 1 |
| TN | $71.84 | 1 |
| TX | $74.63–$81.42 | 8 |
| UT | $75.65 | 1 |
| VA | $76.07–$88.59 | 2 |
| VI | $79.17 | 1 |
| VT | $74.95 | 1 |
| WA | $79.73–$88.40 | 2 |
| WI | $72.25 | 1 |
| WV | $76.47 | 1 |
| WY | $77.00 | 1 |
How the 64405 rate is calculated
Each of 64405’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 · 64405
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 0.92Practice expense 1.23Malpractice 0.21
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 64405
The CMS indicators that decide how 64405 is paid alongside other services.
CMS payment indicators · 64405
Occipital nerve block
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 000 | Same-day global: pre- and post-op care on the day of the procedure is included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 1 | Bilateral with modifier 50 pays 150% of the fee schedule amount. |
| Assistant at surgery (80/81/82/AS) | 1 | Not paid (statutory restriction). |
| 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
64405 without 50 · national office
$78.83
Occipital nerve block
64405-50 · Bilateral: 150%
$118.25
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).
64405 compared with similar codes
Compare codes
64405 vs 64400 vs 64450 vs 64418: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 64400Nerve block
- 64405 targets the greater occipital nerve; 64400 targets the trigeminal nerve. Choose by the nerve actually injected, not simply by a headache diagnosis.
- 64450Nerve block
- Use 64405 when the greater occipital nerve is the target. Code 64450 is for another peripheral nerve or branch when a more specific code does not describe the target.
- 64418Nerve injection
- 64418 targets the suprascapular nerve in the shoulder region. It is not the code for a greater occipital nerve block.
64405 billing questions
When should this code be chosen instead of 64400?
Use 64405 for the greater occipital nerve. Code 64400 describes an injection targeting the trigeminal nerve, a different nerve and distribution.
How is bilateral treatment reported?
CMS identifies this as a bilateral procedure; modifier 50 is paid at 150%. Document treatment of both greater occipital nerves.
Is same-day evaluation and postoperative care separately included?
CMS assigns a 0-day global period, with same-day preoperative and postoperative care included in the procedure.
What happens when another procedure is performed in the same session?
Under the standard multiple procedure reduction, the highest-valued procedure is paid in full and the other procedures are paid at 50%.
What documentation supports reporting this code?
Record the greater occipital nerve treated, laterality, clinical indication, and details of the injection. The documentation should distinguish this nerve from other named nerves treated.
Can an assistant or surgical team be reported for this procedure?
CMS does not pay an assistant at surgery for this code, and co-surgeons and team surgery are not permitted.
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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