Billing code 64520: Sympathetic blockMedicare rate & RVUs
Reports an anesthetic injection to a lumbar or thoracic sympathetic chain, commonly used to evaluate or treat sympathetically maintained pain.
Medicare pays $242.16 for 64520 nationally in the office and $76.82 in a hospital or facility. Local office rates run $212.85–$330.92.
Medicare rate · 64520
Sympathetic block
Swap in your local Medicare rate.
- Work RVUs
- 1.32
- Total RVUs
- 7.25
- Global days
- 000
National rate · 2026
$242.16
Office setting, before claim adjustments.
See every locality for 64520 → · 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 64520 covers
This service places an anesthetic injection near a lumbar or thoracic sympathetic chain to interrupt sympathetic nerve activity. Pain medicine physicians and anesthesiologists commonly perform it for diagnostic or therapeutic management of sympathetically maintained pain, including pain associated with complex regional pain syndrome. The block may be performed in an office or facility setting, with the target selected according to the clinical problem and anatomy.
Report the code for the lumbar or thoracic sympathetic target, not for a block of a different plexus or ganglion. Documentation should identify the indication, treated side and target, injection performed, and relevant response when assessed. The code has a 0-day global period, so same-day preoperative and postoperative care is included. When multiple procedures are performed in one session, Medicare pays the highest-valued procedure in full and applies a 50% reduction to the others. 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 64520 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
$212.85 to $330.92
109 of 109 payment localities
64520 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.
$212.85
$295.30
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 | $275.02 | 1 |
| AL | $216.16 | 1 |
| AR | $212.85 | 1 |
| AZ | $235.56 | 1 |
| CA | $259.68–$330.92 | 29 |
| CO | $254.23 | 1 |
| CT | $258.82 | 1 |
| DC | $279.53 | 1 |
| DE | $239.64 | 1 |
| FL | $235.63–$256.24 | 3 |
| GA | $221.97–$246.20 | 2 |
| GU | $267.06 | 1 |
| HI | $267.06 | 1 |
| IA | $223.24 | 1 |
| ID | $224.52 | 1 |
| IL | $227.53–$250.80 | 4 |
| IN | $225.93 | 1 |
| KS | $221.54 | 1 |
| KY | $220.28 | 1 |
| LA | $219.67–$231.25 | 2 |
| MA | $252.33–$281.17 | 2 |
| MD | $244.60–$279.53 | 3 |
| ME | $225.12–$238.93 | 2 |
| MI | $225.79–$238.11 | 2 |
| MN | $244.96 | 1 |
| MO | $215.27–$232.85 | 3 |
| MS | $214.14 | 1 |
| MT | $242.15 | 1 |
| NC | $227.71 | 1 |
| ND | $239.78 | 1 |
| NE | $224.72 | 1 |
| NH | $249.61 | 1 |
| NJ | $262.16–$276.26 | 2 |
| NM | $226.86 | 1 |
| NV | $241.68 | 1 |
| NY | $231.26–$285.09 | 5 |
| OH | $225.31 | 1 |
| OK | $220.50 | 1 |
| OR | $240.19–$263.38 | 2 |
| PA | $226.02–$251.68 | 2 |
| PR | $244.23 | 1 |
| RI | $248.97 | 1 |
| SC | $226.81 | 1 |
| SD | $239.50 | 1 |
| TN | $222.64 | 1 |
| TX | $224.41–$253.04 | 8 |
| UT | $230.10 | 1 |
| VA | $237.68–$279.53 | 2 |
| VI | $244.23 | 1 |
| VT | $238.24 | 1 |
| WA | $252.06–$287.68 | 2 |
| WI | $231.23 | 1 |
| WV | $218.46 | 1 |
| WY | $241.11 | 1 |
How the 64520 rate is calculated
Each of 64520’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 · 64520
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 1.32Practice expense 5.81Malpractice 0.12
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 64520
The CMS indicators that decide how 64520 is paid alongside other services.
CMS payment indicators · 64520
Sympathetic 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
64520 without 50 · national office
$242.16
Sympathetic block
64520-50 · Bilateral: 150%
$363.24
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).
64520 compared with similar codes
Compare codes
64520 vs 64510 vs 64517 vs 64530: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 64510Nerve block
- Choose 64510 for an injection targeting the stellate ganglion. Code 64520 is for a lumbar or thoracic sympathetic-chain target.
- 64517Plexus block
- Code 64517 identifies a hypogastric plexus injection; 64520 is selected when the documented target is the lumbar or thoracic sympathetic chain.
- 64530Celiac plexus block
- Code 64530 is for a celiac plexus injection. Use 64520 for the lumbar or thoracic sympathetic-chain target instead.
64520 billing questions
How is this code different from a stellate ganglion block?
This code is for a lumbar or thoracic sympathetic-chain target. Use the stellate ganglion code, 64510, when the injection targets the stellate ganglion.
Can the code be reported bilaterally?
Yes. CMS specifies modifier 50 for bilateral reporting, with payment at 150%.
What does the 0-day global period include?
Same-day preoperative and postoperative care is included in the procedure payment.
How are other same-session procedures paid?
Under the standard multiple-procedure reduction, the highest-valued procedure is paid in full and the other procedures are paid at 50%.
Can an assistant, co-surgeon, or surgical team be reported?
Medicare does not pay an assistant at surgery for this code. 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
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