Billing code 64484: Epidural injectionMedicare rate & RVUs
Reports an image-guided transforaminal epidural injection at each additional lumbar or sacral level treated during the same procedure.
Medicare pays $117.57 for 64484 nationally in the office and $43.76 in a hospital or facility. Local office rates run $104.69–$156.25.
Medicare rate · 64484
Epidural injection
Swap in your local Medicare rate.
- Work RVUs
- 0.98
- Total RVUs
- 3.52
- Global days
- ZZZ
National rate · 2026
$117.57
Office setting, before claim adjustments.
See every locality for 64484 → · 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 64484 covers
This add-on reports an injection into the epidural space through a lumbar or sacral neural foramen at an additional spinal level. The clinician typically uses imaging guidance to position the needle near the affected nerve root and deliver medication for radicular pain, such as pain associated with disc disease or spinal stenosis. Pain specialists, anesthesiologists, and other clinicians who perform image-guided spine procedures commonly provide this service in an office or facility setting.
Report 64484 for each additional lumbar or sacral level treated after the first level, with 64483 for the initial level. The procedure note should identify the levels treated and support the additional injection. Imaging guidance is included in the injection service and is not separately reported for the same procedure. CMS treats this as an add-on code: it must be billed with its primary procedure and is paid within that procedure’s global period. When performed bilaterally and reported with modifier 50, CMS pays the bilateral procedure at 150%.
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 64484 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
$104.69 to $156.25
109 of 109 payment localities
64484 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.
$104.69
$140.52
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 | $138.08 | 1 |
| AL | $106.14 | 1 |
| AR | $104.69 | 1 |
| AZ | $114.64 | 1 |
| CA | $124.78–$156.25 | 29 |
| CO | $122.64 | 1 |
| CT | $125.11 | 1 |
| DC | $134.27 | 1 |
| DE | $116.48 | 1 |
| FL | $115.30–$125.03 | 3 |
| GA | $109.21–$119.52 | 2 |
| GU | $127.70 | 1 |
| HI | $127.70 | 1 |
| IA | $108.98 | 1 |
| ID | $109.59 | 1 |
| IL | $111.93–$122.08 | 4 |
| IN | $110.20 | 1 |
| KS | $108.36 | 1 |
| KY | $108.22 | 1 |
| LA | $108.01–$113.09 | 2 |
| MA | $121.91–$134.56 | 2 |
| MD | $118.67–$134.27 | 3 |
| ME | $109.99–$115.85 | 2 |
| MI | $110.77–$116.53 | 2 |
| MN | $118.07 | 1 |
| MO | $106.16–$113.63 | 3 |
| MS | $105.45 | 1 |
| MT | $117.57 | 1 |
| NC | $111.10 | 1 |
| ND | $115.98 | 1 |
| NE | $109.58 | 1 |
| NH | $120.61 | 1 |
| NJ | $126.70–$132.96 | 2 |
| NM | $111.29 | 1 |
| NV | $117.21 | 1 |
| NY | $112.67–$137.49 | 5 |
| OH | $110.44 | 1 |
| OK | $108.18 | 1 |
| OR | $116.45–$126.53 | 2 |
| PA | $110.69–$122.04 | 2 |
| PR | $118.43 | 1 |
| RI | $120.62 | 1 |
| SC | $110.93 | 1 |
| SD | $115.80 | 1 |
| TN | $108.86 | 1 |
| TX | $109.99–$122.10 | 8 |
| UT | $112.37 | 1 |
| VA | $115.39–$134.27 | 2 |
| VI | $118.43 | 1 |
| VT | $115.43 | 1 |
| WA | $121.71–$137.37 | 2 |
| WI | $112.27 | 1 |
| WV | $107.96 | 1 |
| WY | $116.88 | 1 |
How the 64484 rate is calculated
Each of 64484’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 · 64484
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 0.98Practice expense 2.46Malpractice 0.08
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 64484
The CMS indicators that decide how 64484 is paid alongside other services.
CMS payment indicators · 64484
Epidural injection
| Rule | CMS value | What it means |
|---|---|---|
| Global period | ZZZ | Add-on code: falls within the primary procedure’s global period. |
| Multiple procedures | 0 | No multiple-procedure reduction. |
| 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
64484 without 50 · national office
$117.57
Epidural injection
64484-50 · Bilateral: 150%
$176.36
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).
64484 compared with similar codes
Compare codes
64484 vs 64483 vs 64480 vs 64493: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 64483Transforaminal epidural injection
- 64483 reports the first lumbar or sacral transforaminal epidural level; 64484 reports each additional level and is not reported alone.
- 64480Epidural injection
- 64480 is the additional-level code for cervical or thoracic transforaminal epidural injections. Use 64484 for additional lumbar or sacral levels.
- 64493Facet joint injection
- 64493 describes an injection targeting a lumbar or sacral paravertebral facet joint, not medication delivered through a neural foramen into the epidural space.
64484 billing questions
When should 64484 be reported instead of 64483?
Use 64483 for the first lumbar or sacral transforaminal epidural level. Report 64484 for each additional level treated in the same procedure.
Can 64484 be billed by itself?
No. It is an add-on code and must be reported with the primary procedure, 64483.
Can imaging guidance be billed separately?
Imaging guidance is included in this injection service. Do not separately report guidance for the same injection.
How many units of 64484 should be reported?
Report one unit for each additional lumbar or sacral level treated beyond the first. Document the specific levels injected.
How is a bilateral procedure paid?
When the procedure is bilateral and reported with modifier 50, CMS pays it at 150%.
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 64484 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 →