Billing code 64435: Nerve blockMedicare rate & RVUs
Reports injection around a paracervical uterine nerve to provide regional anesthesia or pain relief during cervical or uterine care.
Medicare pays $75.15 for 64435 nationally in the office and $38.75 in a hospital or facility. Local office rates run $66.50–$96.34.
Medicare rate · 64435
Nerve block
Swap in your local Medicare rate.
- Work RVUs
- 0.73
- Total RVUs
- 2.25
- Global days
- 000
National rate · 2026
$75.15
Office setting, before claim adjustments.
See every locality for 64435 → · 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 64435 covers
This service places anesthetic, with or without steroid, around a paracervical (uterine) nerve to create a regional block. Gynecologists, anesthesiologists, and pain physicians may perform it in an office, procedure room, or hospital. A typical setting is pain control for a cervical or uterine procedure; the code is selected for the paracervical nerve target, not simply because an injection is near the pelvis.
Document the nerve targeted, side, clinical reason, and procedure performed. The code has a 0-day global period, so same-day preoperative and postoperative care is included. For bilateral reporting, modifier 50 is paid at 150%. When multiple procedures occur in one session, the highest-valued procedure is paid in full and other procedures are paid at 50%. An assistant at surgery is not paid; 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 64435 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
$66.50 to $96.34
109 of 109 payment localities
64435 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.
$66.50
$88.41
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 | $88.41 | 1 |
| AL | $67.46 | 1 |
| AR | $66.50 | 1 |
| AZ | $73.09 | 1 |
| CA | $78.01–$96.34 | 29 |
| CO | $77.47 | 1 |
| CT | $80.13 | 1 |
| DC | $85.22 | 1 |
| DE | $74.28 | 1 |
| FL | $75.29–$83.69 | 3 |
| GA | $70.97–$76.84 | 2 |
| GU | $79.68 | 1 |
| HI | $79.68 | 1 |
| IA | $68.59 | 1 |
| ID | $69.15 | 1 |
| IL | $73.56–$81.18 | 4 |
| IN | $69.53 | 1 |
| KS | $68.54 | 1 |
| KY | $69.63 | 1 |
| LA | $69.63–$73.00 | 2 |
| MA | $77.12–$84.68 | 2 |
| MD | $75.60–$85.22 | 3 |
| ME | $69.80–$73.13 | 2 |
| MI | $71.67–$76.51 | 2 |
| MN | $73.44 | 1 |
| MO | $68.63–$72.93 | 3 |
| MS | $67.57 | 1 |
| MT | $75.14 | 1 |
| NC | $70.47 | 1 |
| ND | $72.57 | 1 |
| NE | $68.88 | 1 |
| NH | $76.51 | 1 |
| NJ | $80.82–$84.41 | 2 |
| NM | $72.17 | 1 |
| NV | $74.47 | 1 |
| NY | $71.54–$89.21 | 5 |
| OH | $71.15 | 1 |
| OK | $69.22 | 1 |
| OR | $73.68–$79.58 | 2 |
| PA | $71.11–$78.33 | 2 |
| PR | $75.60 | 1 |
| RI | $76.68 | 1 |
| SC | $70.97 | 1 |
| SD | $72.27 | 1 |
| TN | $68.92 | 1 |
| TX | $70.67–$77.40 | 8 |
| UT | $71.92 | 1 |
| VA | $73.09–$85.22 | 2 |
| VI | $75.60 | 1 |
| VT | $72.54 | 1 |
| WA | $76.89–$86.12 | 2 |
| WI | $70.20 | 1 |
| WV | $70.94 | 1 |
| WY | $74.02 | 1 |
How the 64435 rate is calculated
Each of 64435’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 · 64435
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 0.73Practice expense 1.39Malpractice 0.13
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 64435
The CMS indicators that decide how 64435 is paid alongside other services.
CMS payment indicators · 64435
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
64435 without 50 · national office
$75.15
Nerve block
64435-50 · Bilateral: 150%
$112.73
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).
64435 compared with similar codes
Compare codes
64435 vs 64430 vs 64425 vs 64450: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 64430Nerve block
- 64435 targets the paracervical (uterine) nerve; 64430 is for a pudendal nerve injection. Choose based on the documented nerve targeted.
- 64425Nerve block
- 64425 describes injection of the ilioinguinal or iliohypogastric nerves. It is not selected for a paracervical nerve block.
- 64450Nerve block
- 64450 is for an eligible peripheral nerve or branch without a more specific code. Use 64435 when the documented target is the paracervical nerve.
64435 billing questions
How is this different from a pudendal nerve block?
This code is for injection at the paracervical (uterine) nerve. Use the pudendal nerve code, 64430, when the documented target is the pudendal nerve.
When should modifier 50 be reported?
When the paracervical nerve injection is performed bilaterally, report modifier 50. CMS pays the bilateral procedure at 150%.
What does the 0-day global period include?
Same-day preoperative and postoperative care is included in the procedure. The global period is 0 days.
What documentation supports reporting this code?
Document the paracervical nerve target, laterality, reason for the block, and the injection performed. The record should distinguish this target from another pelvic nerve.
How does CMS handle this with another procedure in the same session?
The highest-valued procedure is paid in full, and other procedures in the session are paid 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 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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