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Billing code 64446: Sciatic nerve blockMedicare rate & RVUs

Reports a sciatic nerve block delivered through a catheter for continuous infusion, commonly for ongoing lower-extremity analgesia after surgery.

CMS RVU26DEffective Oct 1, 2026109 payment localities3.3K Medicare services in 2024

Medicare pays $70.81 for 64446 nationally in a facility.

Medicare rate · 64446

Sciatic nerve block

Swap in your local Medicare rate.

Work RVUs
1.71
Total RVUs
2.12
Global days
000

National rate · 2026

$70.81

Facility setting, before claim adjustments.

See every locality for 64446 → · 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
  1. Medicare rate
  2. What 64446 covers
  3. By payment locality
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Similar codes
  8. Related codes
  9. Billing questions
  10. Sources

What 64446 covers

This service covers delivery of anesthetic through a catheter placed at the sciatic nerve for continuous regional analgesia. Anesthesiologists and pain physicians commonly provide it around lower-extremity surgery, such as procedures involving the foot, ankle, or lower leg. Imaging guidance, when used, is included in the service. The catheter allows medication delivery to continue beyond a single injection.

Choose this code for a continuous sciatic catheter service rather than a single-injection sciatic block. Documentation should identify the nerve and side, catheter placement, the continuous infusion plan, and any imaging used. CMS assigns a 0-day global period, so same-day preoperative and postoperative care is included. When multiple procedures occur in one session, the highest-valued procedure is paid in full and others at 50%. Bilateral reporting with 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 64446 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

64446 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$67.55
Alaska*Unavailable$97.68
ArizonaUnavailable$69.82
ArkansasUnavailable$67.16
AtlantaUnavailable$72.13
AustinUnavailable$70.86
BakersfieldUnavailable$70.77
Baltimore/Surr. CntysUnavailable$73.55
BeaumontUnavailable$69.67
BrazoriaUnavailable$70.09

64446 rates by state

Office rate range in each state. Select a state to see its payment localities.

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

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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.

View every state and territory as a table
64446 office rate range by state
State / territoryOffice rate rangeLocalities
AKNo published base rate1
ALNo published base rate1
ARNo published base rate1
AZNo published base rate1
CANo published base rate29
CONo published base rate1
CTNo published base rate1
DCNo published base rate1
DENo published base rate1
FLNo published base rate3
GANo published base rate2
GUNo published base rate1
HINo published base rate1
IANo published base rate1
IDNo published base rate1
ILNo published base rate4
INNo published base rate1
KSNo published base rate1
KYNo published base rate1
LANo published base rate2
MANo published base rate2
MDNo published base rate3
MENo published base rate2
MINo published base rate2
MNNo published base rate1
MONo published base rate3
MSNo published base rate1
MTNo published base rate1
NCNo published base rate1
NDNo published base rate1
NENo published base rate1
NHNo published base rate1
NJNo published base rate2
NMNo published base rate1
NVNo published base rate1
NYNo published base rate5
OHNo published base rate1
OKNo published base rate1
ORNo published base rate2
PANo published base rate2
PRNo published base rate1
RINo published base rate1
SCNo published base rate1
SDNo published base rate1
TNNo published base rate1
TXNo published base rate8
UTNo published base rate1
VANo published base rate2
VINo published base rate1
VTNo published base rate1
WANo published base rate2
WINo published base rate1
WVNo published base rate1
WYNo published base rate1

How the 64446 rate is calculated

Each of 64446’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 · 64446

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 1.71Practice expense 0.26Malpractice 0.15

2.1200 adjusted RVUs×$33.4009 conversion factor=$70.81

All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.

Payment rules and modifiers for 64446

The CMS indicators that decide how 64446 is paid alongside other services.

CMS payment indicators · 64446

Sciatic nerve block

RuleCMS valueWhat it means
Global period000Same-day global: pre- and post-op care on the day of the procedure is included.
Multiple procedures2Standard reduction: highest-valued procedure at 100%, others at 50%.
Bilateral (modifier 50)1Bilateral with modifier 50 pays 150% of the fee schedule amount.
Assistant at surgery (80/81/82/AS)1Not paid (statutory restriction).
Co-surgeons (62)0Not permitted.
Team surgery (66)0Not permitted.
Professional/technical0Physician service: no professional/technical split.

What modifiers do to the payment

Modifier 50 · payment effect

With and without the modifier

64446 without 50 · national facility

$70.81

Sciatic nerve block

64446-50 · Bilateral: 150%

$106.22

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).

When to use modifier 50

64446 compared with similar codes

Compare codes

64446 vs 64445 vs 64448 vs 64449: national Medicare rates

Swap in your local Medicare rate.

  • 64446
    Sciatic nerve block · 1.71 wRVU
    —
  • 64445
    Sciatic nerve block · 1.36 wRVU
    $173.35
  • 64448
    Femoral nerve block · 1.64 wRVU
    —
  • 64449
    Lumbar plexus block · 1.24 wRVU
    —

How to choose

64445Sciatic nerve block
Choose 64446 for continuous delivery through a sciatic catheter; 64445 describes a single-injection sciatic block.
64448Femoral nerve block
Both describe continuous catheter blocks, but 64448 targets the femoral nerve rather than the sciatic nerve.
64449Lumbar plexus block
64449 targets the lumbar plexus for continuous delivery; 64446 is specific to the sciatic nerve.

Codes related to 64446

Related codes aren’t interchangeable: bill the code that matches the service performed.

Codes related to 64446
CodeHow it relatesNational office range
Used instead
64445Sciatic nerve blockSingle-injection sciatic block rather than continuous catheter delivery.$153.59–$230.35
64448Femoral nerve blockContinuous catheter block targeting the femoral nerve instead.No office rate
64449Lumbar plexus blockContinuous catheter block targeting the lumbar plexus instead.No office rate

64446 billing questions

How does 64446 differ from 64445?

64446 is for continuous anesthetic delivery through a sciatic nerve catheter. Use 64445 for a single-injection sciatic nerve block.

Can imaging guidance be reported separately?

Imaging guidance, when performed for this block, is included in 64446.

What should the procedure note identify?

Document the sciatic nerve and side, catheter placement, the continuous infusion plan, and imaging used.

How is bilateral reporting handled?

For bilateral performance, CMS specifies modifier 50, with payment at 150%.

How does CMS handle other procedures in the same session?

The highest-valued procedure is paid in full, and other procedures in the same session are paid at 50%.

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
RVUs for 64446PPRRVU2026_Oct_nonQPP.csv, line 7,109 (RVU26D)

Open CMS sourceHow we calculate rates

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