Billing code 64640: Nerve treatmentMedicare rate & RVUs
Reports neurolytic treatment directed at a peripheral nerve or branch when the target is not covered by a more specifically named nerve code.
Medicare pays $267.54 for 64640 nationally in the office and $111.56 in a hospital or facility. Local office rates run $236.38–$357.73.
Medicare rate · 64640
Nerve treatment
Swap in your local Medicare rate.
- Work RVUs
- 1.93
- Total RVUs
- 8.01
- Global days
- 010
National rate · 2026
$267.54
Office setting, before claim adjustments.
See every locality for 64640 → · 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 64640 covers
This service involves intentionally disabling a targeted peripheral nerve or branch to reduce pain, commonly by injecting a neurolytic agent. Interventional pain physicians and other qualified clinicians may perform it for selected cases of persistent neuralgia or nerve pain, including pain associated with an injured nerve or neuroma. The specific nerve and treatment approach distinguish this service from codes assigned to particular nerves or nerve groups.
Select the code based on the nerve treated and the documented procedure, not simply the presence of an injection or nerve block. The record should identify the target nerve or branch, the condition treated, and the neurolytic method. Related postoperative visits are included in the 10-day global period. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and the others at 50%. For bilateral treatment, modifier 50 is paid at 150%. Medicare does not pay an assistant at surgery for this service; 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 64640 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
$236.38 to $357.73
109 of 109 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Alabama | $239.89 | $103.40 |
| Alaska* | $309.20 | $143.08 |
| Arizona | $260.42 | $109.27 |
| Arkansas | $236.38 | $102.39 |
| Atlanta | $272.34 | $113.87 |
| Austin | $278.18 | $113.16 |
| Bakersfield | $284.68 | $113.73 |
| Baltimore/Surr. Cntys | $284.60 | $117.23 |
| Beaumont | $249.40 | $107.46 |
| Brazoria | $264.68 | $110.10 |
| Chicago | $278.49 | $121.72 |
| Chico | $284.02 | $113.06 |
| Colorado | $279.23 | $113.27 |
| Connecticut | $285.44 | $117.45 |
| Dallas | $266.30 | $110.94 |
| Dc + Md/Va Suburbs | $306.69 | $122.95 |
| Delaware | $264.77 | $110.66 |
| Detroit | $265.73 | $115.21 |
| East St. Louis | $259.33 | $115.83 |
| El Centro | $284.05 | $113.10 |
| Fort Lauderdale | $276.02 | $118.01 |
| Fort Worth | $264.43 | $110.63 |
| Fresno | $284.02 | $113.06 |
| Galveston | $265.42 | $110.53 |
| Hanford-Corcoran | $284.02 | $113.06 |
| Hawaii, Guam | $291.26 | $113.91 |
| Houston | $269.45 | $114.56 |
| Idaho | $248.01 | $104.51 |
| Indiana | $249.48 | $104.88 |
| Iowa | $246.47 | $103.75 |
| Kansas | $245.11 | $104.10 |
| Kentucky | $245.19 | $106.52 |
| Los Angeles-Long Beach-Anaheim (Los Angeles/Orange Cnty) | $303.53 | $119.01 |
| Madera | $284.02 | $113.06 |
| Manhattan | $307.68 | $126.43 |
| Merced | $284.02 | $113.06 |
| Metropolitan Boston | $307.35 | $121.10 |
| Metropolitan Kansas City | $255.43 | $108.97 |
| Metropolitan Philadelphia | $278.14 | $115.77 |
| Metropolitan St. Louis | $258.16 | $109.67 |
| Miami | $286.80 | $124.42 |
| Minnesota | $268.04 | $107.54 |
| Mississippi | $238.42 | $104.12 |
| Modesto | $284.02 | $113.06 |
| Montana** | $267.53 | $111.54 |
| Napa | $330.23 | $124.64 |
| Nebraska | $247.90 | $103.93 |
| Nevada** | $266.51 | $110.37 |
| New Hampshire | $274.65 | $112.27 |
| New Mexico | $252.77 | $109.74 |
| New Orleans | $256.99 | $110.21 |
| North Carolina | $251.77 | $106.24 |
| North Dakota** | $263.18 | $107.19 |
| Northern Nj | $303.42 | $122.48 |
| Nyc Suburbs/Long Island | $314.96 | $129.49 |
| Ohio | $250.57 | $108.16 |
| Oklahoma | $244.96 | $105.67 |
| Oxnard-Thousand Oaks-Ventura | $302.20 | $117.83 |
| Portland | $288.42 | $115.12 |
| Poughkpsie/N Nyc Suburbs | $290.58 | $119.78 |
| Puerto Rico | $269.58 | $111.89 |
| Queens | $310.54 | $126.17 |
| Redding | $284.02 | $113.06 |
| Rest Of California | $284.02 | $113.06 |
| Rest Of Florida | $262.63 | $113.51 |
| Rest Of Georgia | $247.81 | $108.68 |
| Rest Of Illinois | $254.65 | $112.24 |
| Rest Of Louisiana | $244.72 | $106.68 |
| Rest Of Maine | $249.11 | $105.60 |
| Rest Of Maryland | $269.93 | $112.08 |
| Rest Of Massachusetts | $277.45 | $113.21 |
| Rest Of Michigan | $251.46 | $109.05 |
| Rest Of Missouri | $240.34 | $105.88 |
| Rest Of New Jersey | $288.84 | $118.51 |
| Rest Of New York | $255.57 | $107.39 |
| Rest Of Oregon | $264.58 | $109.22 |
| Rest Of Pennsylvania | $251.09 | $107.90 |
| Rest Of Texas | $256.85 | $108.82 |
| Rest Of Washington | $277.00 | $112.75 |
| Rhode Island | $274.43 | $113.30 |
| Riverside-San Bernardino-Ontario | $286.41 | $115.45 |
| Sacramento-Roseville-Folsom | $298.36 | $116.95 |
| Salinas | $297.25 | $116.47 |
| San Diego-Chula Vista-Carlsbad | $304.47 | $117.92 |
| San Francisco-Oakland-Berkeley (Marin Cnty) | $349.94 | $130.00 |
| San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty) | $349.69 | $129.75 |
| San Jose-Sunnyvale-Santa Clara (San Benito Cnty) | $357.73 | $132.81 |
| San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty) | $356.71 | $131.79 |
| San Luis Obispo-Paso Robles | $292.43 | $114.77 |
| Santa Cruz-Watsonville | $307.57 | $118.05 |
| Santa Maria-Santa Barbara | $298.43 | $116.55 |
| Santa Rosa-Petaluma | $310.69 | $119.15 |
| Seattle (King Cnty) | $313.85 | $122.46 |
| South Carolina | $251.56 | $107.44 |
| South Dakota** | $262.66 | $106.68 |
| Southern Maine | $263.07 | $108.49 |
| Stockton | $284.02 | $113.06 |
| Suburban Chicago | $278.95 | $118.76 |
| Tennessee | $246.33 | $104.54 |
| Utah | $255.05 | $108.42 |
| Vallejo | $329.87 | $124.28 |
| Vermont | $261.95 | $107.53 |
| Virgin Islands | $269.58 | $111.89 |
| Virginia | $262.05 | $108.72 |
| Visalia | $284.02 | $113.06 |
| West Virginia | $245.07 | $109.52 |
| Wisconsin | $254.24 | $104.80 |
| Wyoming** | $265.63 | $109.65 |
| Yuba City | $284.02 | $113.06 |
64640 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.
$236.38
$320.88
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 | $309.20 | 1 |
| AL | $239.89 | 1 |
| AR | $236.38 | 1 |
| AZ | $260.42 | 1 |
| CA | $284.02–$357.73 | 29 |
| CO | $279.23 | 1 |
| CT | $285.44 | 1 |
| DC | $306.69 | 1 |
| DE | $264.77 | 1 |
| FL | $262.63–$286.80 | 3 |
| GA | $247.81–$272.34 | 2 |
| GU | $291.26 | 1 |
| HI | $291.26 | 1 |
| IA | $246.47 | 1 |
| ID | $248.01 | 1 |
| IL | $254.65–$278.95 | 4 |
| IN | $249.48 | 1 |
| KS | $245.11 | 1 |
| KY | $245.19 | 1 |
| LA | $244.72–$256.99 | 2 |
| MA | $277.45–$307.35 | 2 |
| MD | $269.93–$306.69 | 3 |
| ME | $249.11–$263.07 | 2 |
| MI | $251.46–$265.73 | 2 |
| MN | $268.04 | 1 |
| MO | $240.34–$258.16 | 3 |
| MS | $238.42 | 1 |
| MT | $267.53 | 1 |
| NC | $251.77 | 1 |
| ND | $263.18 | 1 |
| NE | $247.90 | 1 |
| NH | $274.65 | 1 |
| NJ | $288.84–$303.42 | 2 |
| NM | $252.77 | 1 |
| NV | $266.51 | 1 |
| NY | $255.57–$314.96 | 5 |
| OH | $250.57 | 1 |
| OK | $244.96 | 1 |
| OR | $264.58–$288.42 | 2 |
| PA | $251.09–$278.14 | 2 |
| PR | $269.58 | 1 |
| RI | $274.43 | 1 |
| SC | $251.56 | 1 |
| SD | $262.66 | 1 |
| TN | $246.33 | 1 |
| TX | $249.40–$278.18 | 8 |
| UT | $255.05 | 1 |
| VA | $262.05–$306.69 | 2 |
| VI | $269.58 | 1 |
| VT | $261.95 | 1 |
| WA | $277.00–$313.85 | 2 |
| WI | $254.24 | 1 |
| WV | $245.07 | 1 |
| WY | $265.63 | 1 |
How the 64640 rate is calculated
Each of 64640’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 · 64640
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 1.93Practice expense 5.86Malpractice 0.22
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 64640
64640 has a 10-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 64640
Nerve treatment
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 010 | Minor procedure: the day of the procedure plus 10 days after are 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. |
| Split (54/55/56) | 0.10/0.80/0.10 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 64640
Nerve treatment
10-day global period ends
Oct 11, 2026
Covers Oct 1, 2026 through Oct 11, 2026 (11 days).
Visit on Oct 31, 2026
After the global period ends: visits and procedures are billed normally.
What modifiers do to the payment
Modifier 50 · payment effect
With and without the modifier
64640 without 50 · national office
$267.54
Nerve treatment
64640-50 · Bilateral: 150%
$401.31
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).
64640 compared with similar codes
Compare codes
64640 vs 64630 vs 64632 vs 64624: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 64630Nerve neurolysis
- Choose 64630 for neurolytic treatment of the pudendal nerve. Code 64640 is for another peripheral nerve or branch.
- 64632Nerve destruction
- Choose 64632 for treatment of a common digital nerve. Code 64640 covers other peripheral nerves or branches.
- 64624Genicular nerve ablation
- Choose 64624 for the specified genicular nerve treatment; 64640 is the broader code for other peripheral nerve targets.
64640 billing questions
When should 64640 be selected instead of a nerve-specific code?
Use 64640 for neurolytic treatment of another peripheral nerve or branch. Use a more specific code when the treated nerve is named in a separate code, such as the pudendal or common digital nerve.
Does an ordinary nerve block support 64640?
A diagnostic or therapeutic nerve block alone is not the neurolytic treatment reported by this code. The documentation should support intentional neurolytic treatment of the identified nerve or branch.
What should the procedure note identify?
Document the nerve or branch treated, the clinical condition, and the neurolytic method. The note should distinguish the treatment from a temporary anesthetic block.
How is bilateral treatment reported?
For bilateral treatment, report modifier 50; CMS pays the bilateral procedure at 150%.
How are multiple procedures in one session paid?
CMS pays the highest-valued procedure in full and the other procedures at 50% when performed in the same session.
Are related postoperative visits separately included?
Related postoperative visits during the 10-day global period are included in this procedure's payment.
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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