Billing code 64461: Paravertebral blockMedicare rate & RVUs
Reports a single-site thoracic paravertebral nerve block, commonly used to provide regional analgesia for thoracic or breast surgery.
Medicare pays $149.64 for 64461 nationally in the office and $71.81 in a hospital or facility. Local office rates run $134.75–$191.97.
Medicare rate · 64461
Paravertebral block
Swap in your local Medicare rate.
- Work RVUs
- 1.71
- Total RVUs
- 4.48
- Global days
- 000
National rate · 2026
$149.64
Office setting, before claim adjustments.
See every locality for 64461 → · 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 64461 covers
This service is a single-injection thoracic paravertebral nerve block using anesthetic medication, with or without steroid, to reduce pain in the relevant thoracic distribution. Anesthesiologists and acute pain or pain-management clinicians commonly perform it around thoracic procedures, including thoracotomy, or breast surgery. Imaging guidance may be used to place the injection and is included in the service. The block may be performed in an operating room or another procedural setting.
Select this code for one thoracic paravertebral injection site; report 64462 for each additional site when applicable. Document the indication, laterality, site count, medication, and guidance used. Medicare 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 performance, modifier 50 is paid at 150%. Medicare does not pay an assistant at surgery for this code; 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 64461 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
$134.75 to $191.97
109 of 109 payment localities
64461 rates by state
Office rate range in each state. Select a state to see its payment localities.
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.
$134.75
$181.46
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 | $181.46 | 1 |
| AL | $136.42 | 1 |
| AR | $134.75 | 1 |
| AZ | $146.16 | 1 |
| CA | $156.50–$191.97 | 29 |
| CO | $154.73 | 1 |
| CT | $158.61 | 1 |
| DC | $168.84 | 1 |
| DE | $148.34 | 1 |
| FL | $148.49–$161.38 | 3 |
| GA | $141.25–$152.28 | 2 |
| GU | $159.33 | 1 |
| HI | $159.33 | 1 |
| IA | $139.00 | 1 |
| ID | $139.85 | 1 |
| IL | $145.06–$157.39 | 4 |
| IN | $140.53 | 1 |
| KS | $138.62 | 1 |
| KY | $139.51 | 1 |
| LA | $139.39–$145.22 | 2 |
| MA | $154.09–$168.30 | 2 |
| MD | $150.82–$168.84 | 3 |
| ME | $140.64–$146.88 | 2 |
| MI | $142.74–$150.25 | 2 |
| MN | $148.40 | 1 |
| MO | $137.47–$145.46 | 3 |
| MS | $136.12 | 1 |
| MT | $149.63 | 1 |
| NC | $141.87 | 1 |
| ND | $146.46 | 1 |
| NE | $139.60 | 1 |
| NH | $152.54 | 1 |
| NJ | $160.46–$167.55 | 2 |
| NM | $143.47 | 1 |
| NV | $148.83 | 1 |
| NY | $143.69–$174.35 | 5 |
| OH | $142.09 | 1 |
| OK | $139.12 | 1 |
| OR | $147.70–$158.86 | 2 |
| PA | $142.19–$155.27 | 2 |
| PR | $150.51 | 1 |
| RI | $153.02 | 1 |
| SC | $142.21 | 1 |
| SD | $146.09 | 1 |
| TN | $139.23 | 1 |
| TX | $141.41–$154.20 | 8 |
| UT | $143.86 | 1 |
| VA | $146.58–$168.84 | 2 |
| VI | $150.51 | 1 |
| VT | $146.12 | 1 |
| WA | $153.72–$171.30 | 2 |
| WI | $142.28 | 1 |
| WV | $140.52 | 1 |
| WY | $148.25 | 1 |
How the 64461 rate is calculated
Each of 64461’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 · 64461
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 1.71Practice expense 2.61Malpractice 0.16
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 64461
The CMS indicators that decide how 64461 is paid alongside other services.
CMS payment indicators · 64461
Paravertebral 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
64461 without 50 · national office
$149.64
Paravertebral block
64461-50 · Bilateral: 150%
$224.46
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).
64461 compared with similar codes
Compare codes
64461 vs 64462 vs 64463 vs 64466 vs 64468: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 64462Paravertebral block
- 64461 covers one thoracic paravertebral injection site. Use 64462 for each additional site, not as a substitute for the initial-site code.
- 64463Paravertebral block
- 64463 is for a thoracic paravertebral block delivered by continuous infusion; 64461 describes a single-injection service.
- 64466Thoracic block
- 64466 describes a unilateral thoracic fascial plane block. Choose it when the clinician performs that fascial plane technique rather than a paravertebral block.
- 64468Thoracic block
- 64468 describes a bilateral thoracic fascial plane block, not bilateral thoracic paravertebral injection sites.
64461 billing questions
When should 64462 be used instead?
Use 64461 for one thoracic paravertebral injection site. Code 64462 is the add-on for each additional site.
Can imaging guidance be billed separately?
Imaging guidance, when performed to place this block, is included in 64461 and should not be separately reported as guidance for the same service.
How is a bilateral block reported?
Report bilateral performance with modifier 50. CMS pays the bilateral procedure at 150%.
What should the procedure note support?
Document the thoracic paravertebral target, laterality, number of injection sites, medication, clinical indication, and imaging guidance if used.
Can an assistant or co-surgeon be billed?
Medicare does not pay an assistant at surgery for 64461. 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
Fee sheets
Put 64461 and the rest of your codes on one sheet
Build a fee sheet from your own code list at your locality, put your payer contracts beside Medicare, and see what changed each quarter.
Build my fee sheetOr price your code list free →