$31.86–$43.63
64420 represents the first single intercostal nerve treated; 64421 reports each additional intercostal nerve in the same session.
On this page
CMS RVU26D · Effective 2026-10-01
64420 Intercostal block Medicare reimbursement rates
Reports injection of anesthetic, with or without steroid, near one intercostal nerve to relieve localized chest-wall pain or neuralgia. Compare 64420 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 64420?
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
$94.86–$138.31
109 of 109 localities have a supported rate.
Lowest: Arkansas
Highest: San Jose-Sunnyvale-Santa Clara (San Benito Cnty)
A spread of $43.45 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 64420 pays more and less
109 payment localities
$94.86 to $138.31
Pain management
About 64420: Single intercostal nerve block
Reports injection of anesthetic, with or without steroid, near one intercostal nerve to relieve localized chest-wall pain or neuralgia.
An intercostal nerve block places local anesthetic, with or without steroid, near one nerve running beneath a rib to interrupt chest-wall pain. Anesthesiologists, pain physicians, and surgeons may perform it for localized pain after rib injury or thoracic surgery, or for intercostal neuralgia, in an office, procedure suite, or hospital.
Report 64420 for one targeted intercostal nerve; when additional intercostal nerves are blocked in the same session, report 64421 for each additional nerve. The record should identify the side and nerve or level treated, clinical indication, medication, technique, and response. CMS assigns a 0-day global period, so same-day preoperative and postoperative care is included. For bilateral treatment, modifier 50 is paid at 150%. When procedures are performed in the same session, the highest-valued procedure is paid in full and the others receive the standard multiple-procedure reduction. Assistant-at-surgery payment is statutorily restricted; co-surgeons and team surgery are not permitted.
CMS billing rules for 64420
- 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 RVU1.05 · 33%
- Practice expense (office) RVU2.03 · 64%
- Malpractice RVU0.09 · 3%
22.3K
Medicare services in 2024 · #1104 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.
64420 compared with similar codes
Office rate ranges across all CMS payment localities, from the same CMS release.
$134.75–$191.97
64461 is a thoracic paravertebral block at one injection site. Use 64420 when the injection targets a specific intercostal nerve.
$127.21–$184.27
64466 describes a thoracic fascial plane block, not an injection directed at one intercostal nerve.
See how rates vary across the country
64420 · 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.
$94.86
$126.47
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 | $126.47 | 1 |
| AL | $96.10 | 1 |
| AR | $94.86 | 1 |
| AZ | $103.35 | 1 |
| CA | $111.59–$138.31 | 29 |
| CO | $109.98 | 1 |
| CT | $112.43 | 1 |
| DC | $120.18 | 1 |
| DE | $104.94 | 1 |
| FL | $104.41–$113.26 | 3 |
| GA | $99.14–$107.68 | 2 |
| GU | $113.90 | 1 |
| HI | $113.90 | 1 |
| IA | $98.30 | 1 |
| ID | $98.87 | 1 |
| IL | $101.67–$110.36 | 4 |
| IN | $99.39 | 1 |
| KS | $97.88 | 1 |
| KY | $98.10 | 1 |
| LA | $97.96–$102.29 | 2 |
| MA | $109.43–$120.14 | 2 |
| MD | $106.80–$120.18 | 3 |
| ME | $99.32–$104.16 | 2 |
| MI | $100.37–$105.57 | 2 |
| MN | $105.73 | 1 |
| MO | $96.45–$102.63 | 3 |
| MS | $95.67 | 1 |
| MT | $105.87 | 1 |
| NC | $100.25 | 1 |
| ND | $104.10 | 1 |
| NE | $98.79 | 1 |
| NH | $108.29 | 1 |
| NJ | $113.81–$119.14 | 2 |
| NM | $100.86 | 1 |
| NV | $105.45 | 1 |
| NY | $101.60–$123.52 | 5 |
| OH | $100.01 | 1 |
| OK | $97.96 | 1 |
| OR | $104.72–$113.20 | 2 |
| PA | $100.16–$109.87 | 2 |
| PR | $106.58 | 1 |
| RI | $108.46 | 1 |
| SC | $100.28 | 1 |
| SD | $103.88 | 1 |
| TN | $98.32 | 1 |
| TX | $99.57–$109.54 | 8 |
| UT | $101.51 | 1 |
| VA | $103.84–$120.18 | 2 |
| VI | $106.58 | 1 |
| VT | $103.72 | 1 |
| WA | $109.21–$122.48 | 2 |
| WI | $100.95 | 1 |
| WV | $98.29 | 1 |
| WY | $105.10 | 1 |
Compare 64420 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 $96.10 | Facility $49.34 |
| Alaska* | Office $126.47 | Facility $69.56 |
| Arizona | Office $103.35 | Facility $51.56 |
| Arkansas | Office $94.86 | Facility $48.96 |
| Atlanta | Office $107.68 | Facility $53.38 |
| Austin | Office $109.54 | Facility $53.00 |
| Bakersfield | Office $111.88 | Facility $53.31 |
| Baltimore/Surr. Cntys | Office $112.10 | Facility $54.76 |
| Beaumont | Office $99.57 | Facility $50.93 |
| Brazoria | Office $104.89 | Facility $51.93 |
| Chicago | Office $110.36 | Facility $56.65 |
| Chico | Office $111.59 | Facility $53.02 |
| Colorado | Office $109.98 | Facility $53.12 |
| Connecticut | Office $112.43 | Facility $54.88 |
| Dallas | Office $105.50 | Facility $52.27 |
| Dc + Md/Va Suburbs | Office $120.18 | Facility $57.23 |
| Delaware | Office $104.94 | Facility $52.14 |
| Detroit | Office $105.57 | Facility $54.00 |
| East St. Louis | Office $103.50 | Facility $54.34 |
| El Centro | Office $111.61 | Facility $53.03 |
| Fort Lauderdale | Office $109.19 | Facility $55.06 |
| Fort Worth | Office $104.86 | Facility $52.17 |
| Fresno | Office $111.59 | Facility $53.02 |
| Galveston | Office $105.17 | Facility $52.10 |
| Hanford-Corcoran | Office $111.59 | Facility $53.02 |
| Hawaii, Guam | Office $113.90 | Facility $53.14 |
| Houston | Office $106.82 | Facility $53.75 |
| Idaho | Office $98.87 | Facility $49.71 |
| Indiana | Office $99.39 | Facility $49.85 |
| Iowa | Office $98.30 | Facility $49.41 |
| Kansas | Office $97.88 | Facility $49.57 |
| Kentucky | Office $98.10 | Facility $50.59 |
| Los Angeles-Long Beach-Anaheim (Los Angeles/Orange Cnty) | Office $118.72 | Facility $55.50 |
| Madera | Office $111.59 | Facility $53.02 |
| Manhattan | Office $120.87 | Facility $58.77 |
| Merced | Office $111.59 | Facility $53.02 |
| Metropolitan Boston | Office $120.14 | Facility $56.33 |
| Metropolitan Kansas City | Office $101.68 | Facility $51.49 |
| Metropolitan Philadelphia | Office $109.87 | Facility $54.24 |
| Metropolitan St. Louis | Office $102.63 | Facility $51.76 |
| Miami | Office $113.26 | Facility $57.62 |
| Minnesota | Office $105.73 | Facility $50.74 |
| Mississippi | Office $95.67 | Facility $49.66 |
| Modesto | Office $111.59 | Facility $53.02 |
| Montana** | Office $105.87 | Facility $52.43 |
| Napa | Office $128.17 | Facility $57.74 |
| Nebraska | Office $98.79 | Facility $49.46 |
| Nevada** | Office $105.45 | Facility $51.95 |
| New Hampshire | Office $108.29 | Facility $52.65 |
| New Mexico | Office $100.86 | Facility $51.85 |
| New Orleans | Office $102.29 | Facility $52.00 |
| North Carolina | Office $100.25 | Facility $50.39 |
| North Dakota** | Office $104.10 | Facility $50.65 |
| Northern Nj | Office $119.14 | Facility $57.15 |
| Nyc Suburbs/Long Island | Office $123.52 | Facility $59.97 |
| Ohio | Office $100.01 | Facility $51.21 |
| Oklahoma | Office $97.96 | Facility $50.23 |
| Oxnard-Thousand Oaks-Ventura | Office $118.07 | Facility $54.90 |
| Portland | Office $113.20 | Facility $53.83 |
| Poughkpsie/N Nyc Suburbs | Office $114.53 | Facility $56.01 |
| Puerto Rico | Office $106.58 | Facility $52.55 |
| Queens | Office $121.79 | Facility $58.63 |
| Redding | Office $111.59 | Facility $53.02 |
| Rest Of California | Office $111.59 | Facility $53.02 |
| Rest Of Florida | Office $104.41 | Facility $53.32 |
| Rest Of Georgia | Office $99.14 | Facility $51.47 |
| Rest Of Illinois | Office $101.67 | Facility $52.88 |
| Rest Of Louisiana | Office $97.96 | Facility $50.66 |
| Rest Of Maine | Office $99.32 | Facility $50.15 |
| Rest Of Maryland | Office $106.80 | Facility $52.72 |
| Rest Of Massachusetts | Office $109.43 | Facility $53.15 |
| Rest Of Michigan | Office $100.37 | Facility $51.58 |
| Rest Of Missouri | Office $96.45 | Facility $50.38 |
| Rest Of New Jersey | Office $113.81 | Facility $55.46 |
| Rest Of New York | Office $101.60 | Facility $50.83 |
| Rest Of Oregon | Office $104.72 | Facility $51.49 |
| Rest Of Pennsylvania | Office $100.16 | Facility $51.10 |
| Rest Of Texas | Office $102.13 | Facility $51.42 |
| Rest Of Washington | Office $109.21 | Facility $52.94 |
| Rhode Island | Office $108.46 | Facility $53.26 |
| Riverside-San Bernardino-Ontario | Office $112.58 | Facility $54.01 |
| Sacramento-Roseville-Folsom | Office $116.80 | Facility $54.65 |
| Salinas | Office $116.35 | Facility $54.42 |
| San Diego-Chula Vista-Carlsbad | Office $118.85 | Facility $54.93 |
| San Francisco-Oakland-Berkeley (Marin Cnty) | Office $135.39 | Facility $60.03 |
| San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty) | Office $135.28 | Facility $59.93 |
| San Jose-Sunnyvale-Santa Clara (San Benito Cnty) | Office $138.31 | Facility $61.25 |
| San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty) | Office $137.90 | Facility $60.83 |
| San Luis Obispo-Paso Robles | Office $114.51 | Facility $53.64 |
| Santa Cruz-Watsonville | Office $119.80 | Facility $54.87 |
| Santa Maria-Santa Barbara | Office $116.72 | Facility $54.41 |
| Santa Rosa-Petaluma | Office $121.00 | Facility $55.37 |
| Seattle (King Cnty) | Office $122.48 | Facility $56.90 |
| South Carolina | Office $100.28 | Facility $50.90 |
| South Dakota** | Office $103.88 | Facility $50.44 |
| Southern Maine | Office $104.16 | Facility $51.20 |
| Stockton | Office $111.59 | Facility $53.02 |
| Suburban Chicago | Office $110.28 | Facility $55.39 |
| Tennessee | Office $98.32 | Facility $49.74 |
| Utah | Office $101.51 | Facility $51.27 |
| Vallejo | Office $128.03 | Facility $57.59 |
| Vermont | Office $103.72 | Facility $50.81 |
| Virgin Islands | Office $106.58 | Facility $52.55 |
| Virginia | Office $103.84 | Facility $51.31 |
| Visalia | Office $111.59 | Facility $53.02 |
| West Virginia | Office $98.29 | Facility $51.85 |
| Wisconsin | Office $100.95 | Facility $49.76 |
| Wyoming** | Office $105.10 | Facility $51.66 |
| Yuba City | Office $111.59 | Facility $53.02 |
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64420 billing questions
When should I use 64420 instead of 64421?
Use 64420 for the first, single intercostal nerve treated. Report 64421 for each additional intercostal nerve blocked in the same session.
How is bilateral treatment reported?
For bilateral treatment, report modifier 50. CMS pays the bilateral procedure at 150%.
What documentation supports 64420?
Document the indication, side and intercostal nerve or level treated, medication and technique, and the patient's response.
Is same-day postoperative care included?
Yes. The 0-day global period includes same-day preoperative and postoperative care.
How does the multiple-procedure reduction affect 64420?
When it is performed with other procedures in the same session, the highest-valued procedure is paid in full and the others receive the standard 50% 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.
7,10064416,,Njx aa&/strd brch pl nfs img,A,,1.76,0.26,NA,0.26,,0.15,2.17,2.17,0,000,0.00,0.00,0.00,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,10164417,,Njx aa&/strd ax nerve img,A,,1.28,4.16,,0.43,,0.13,5.57,1.84,0,000,0.00,0.00,0.00,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,10264418,,Njx aa&/strd sprscap nrv,A,,1.07,1.51,,0.26,,0.11,2.69,1.44,0,000,0.00,0.00,0.00,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,10364420,,Njx aa&/strd ntrcost nrv 1,A,,1.05,2.03,,0.43,,0.09,3.17,1.57,0,000,0.00,0.00,0.00,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,10464421,,Njx aa&/strd ntrcost nrv ea,A,,0.49,0.51,,0.11,,0.05,1.05,0.65,0,ZZZ,0.00,0.00,0.00,0,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,10564425,,Njx aa&/strd ii ih nerves,A,,0.98,2.55,,0.42,,0.09,3.62,1.49,0,000,0.00,0.00,0.00,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,10664430,,Njx aa&/strd pudendal nerve,A,,0.98,1.78,,0.37,,0.11,2.87,1.46,0,000,0.00,0.00,0.00,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00