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CMS RVU26D · Effective 2026-10-01

64435 in Madera

Office / nonfacility

$78.01

Base rate per service

Facility setting

$38.11

Base rate per service

Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.

Nerve blocks

About 64435: Paracervical nerve injection

Reports injection around a paracervical uterine nerve to provide regional anesthesia or pain relief during cervical or uterine care.

This service places anesthetic, with or without steroid, around a paracervical (uterine) nerve to create a regional block. Gynecologists, anesthesiologists, and pain physicians may perform it in an office, procedure room, or hospital. A typical setting is pain control for a cervical or uterine procedure; the code is selected for the paracervical nerve target, not simply because an injection is near the pelvis.

Document the nerve targeted, side, clinical reason, and procedure performed. The code has a 0-day global period, so same-day preoperative and postoperative care is included. For bilateral reporting, modifier 50 is paid at 150%. When multiple procedures occur in one session, the highest-valued procedure is paid in full and other procedures are paid at 50%. An assistant at surgery is not paid; co-surgeons and team surgery are not permitted.

CMS billing rules for 64435

Global period
Minor procedure with a 0-day global period: same-day preoperative and postoperative care is included.
Multiple procedures
Standard multiple procedure reduction: the highest-valued procedure is paid in full and others at 50% when performed in the same session.
Bilateral procedures
Bilateral procedure with modifier 50 is paid at 150%.
Assistant at surgery
Statutory restriction: assistant at surgery is not paid.
Co-surgeons
Co-surgeons not permitted.
Team surgery
Team surgery not permitted.

Where the value comes from

  • Work RVU0.73 · 32%
  • Practice expense (office) RVU1.39 · 62%
  • Malpractice RVU0.13 · 6%

60

Medicare services in 2024 · #5244 by national volume

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.

64435 compared with similar codes

Office rates for Madera, from the same CMS release.

64430

Nerve block

Pudendal nerve

$100.42

64435 targets the paracervical (uterine) nerve; 64430 is for a pudendal nerve injection. Choose based on the documented nerve targeted.

64425

Nerve block

Ilioinguinal and iliohypogastric

$128.25

64425 describes injection of the ilioinguinal or iliohypogastric nerves. It is not selected for a paracervical nerve block.

64450

Nerve block

Other peripheral nerve or branch

$85.35

64450 is for an eligible peripheral nerve or branch without a more specific code. Use 64435 when the documented target is the paracervical nerve.

The same code, a different location

How does Madera compare?

In Bakersfield, the office rate for 64435 is $78.37—$0.36 higher than the $78.01 rate in Madera. Both use the same code, release and participation basis.

64435 across payment areas

Same release and payment basis · bars start at $0

  1. Madera · This locality

    $78.01

  2. Bakersfield

    $78.37

    $0.36 higher than Madera

  3. Chico

    $78.01

    The same base rate than Madera

  4. El Centro

    $78.03

    $0.02 higher than Madera

  5. Fresno

    $78.01

    The same base rate than Madera

  6. Hanford-Corcoran

    $78.01

    The same base rate than Madera

  7. Los Angeles-Long Beach-Anaheim (Los Angeles/Orange Cnty)

    $83.19

    $5.18 higher than Madera

Other payment areas listed in California appear first, followed by selected cross-country examples. The chart compares amounts, not distance.

Across 109 of 109 CMS payment localities with a supported office rate, 64435 ranges from $66.50 in Arkansas to $96.34 in San Jose-Sunnyvale-Santa Clara (San Benito Cnty). This is a geographic range, not an average.

The code’s RVUs stay the same in these comparisons. Geographic adjustments to work, practice expense and malpractice change the dollar amount. A city name alone may not identify the payment area for a service address.

Compare all 108 other payment areas

  • Merced

    California · 64435

    Office

    $78.01

    Facility

    $38.11

    The same base rate than Madera for the office setting.

  • Modesto

    California · 64435

    Office

    $78.01

    Facility

    $38.11

    The same base rate than Madera for the office setting.

  • Napa

    California · 64435

    Office

    $89.32

    Facility

    $41.33

    $11.31 higher than Madera for the office setting.

  • Oxnard-Thousand Oaks-Ventura

    California · 64435

    Office

    $82.65

    Facility

    $39.61

    $4.64 higher than Madera for the office setting.

  • Redding

    California · 64435

    Office

    $78.01

    Facility

    $38.11

    The same base rate than Madera for the office setting.

  • Rest Of California

    California · 64435

    Office

    $78.01

    Facility

    $38.11

    The same base rate than Madera for the office setting.

  • Riverside-San Bernardino-Ontario

    California · 64435

    Office

    $79.41

    Facility

    $39.51

    $1.40 higher than Madera for the office setting.

  • Sacramento-Roseville-Folsom

    California · 64435

    Office

    $81.58

    Facility

    $39.24

    $3.57 higher than Madera for the office setting.

  • Salinas

    California · 64435

    Office

    $81.28

    Facility

    $39.08

    $3.27 higher than Madera for the office setting.

  • San Diego-Chula Vista-Carlsbad

    California · 64435

    Office

    $82.99

    Facility

    $39.45

    $4.98 higher than Madera for the office setting.

  • San Francisco-Oakland-Berkeley (Marin Cnty)

    California · 64435

    Office

    $94.15

    Facility

    $42.82

    $16.14 higher than Madera for the office setting.

  • San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty)

    California · 64435

    Office

    $94.01

    Facility

    $42.67

    $16.00 higher than Madera for the office setting.

  • San Jose-Sunnyvale-Santa Clara (San Benito Cnty)

    California · 64435

    Office

    $96.34

    Facility

    $43.84

    $18.33 higher than Madera for the office setting.

  • San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty)

    California · 64435

    Office

    $95.74

    Facility

    $43.24

    $17.73 higher than Madera for the office setting.

  • San Luis Obispo-Paso Robles

    California · 64435

    Office

    $80.01

    Facility

    $38.54

    $2.00 higher than Madera for the office setting.

  • Santa Cruz-Watsonville

    California · 64435

    Office

    $83.63

    Facility

    $39.40

    $5.62 higher than Madera for the office setting.

  • Santa Maria-Santa Barbara

    California · 64435

    Office

    $81.53

    Facility

    $39.08

    $3.52 higher than Madera for the office setting.

  • Santa Rosa-Petaluma

    California · 64435

    Office

    $84.45

    Facility

    $39.75

    $6.44 higher than Madera for the office setting.

  • Stockton

    California · 64435

    Office

    $78.01

    Facility

    $38.11

    The same base rate than Madera for the office setting.

  • Vallejo

    California · 64435

    Office

    $89.10

    Facility

    $41.12

    $11.09 higher than Madera for the office setting.

  • Visalia

    California · 64435

    Office

    $78.01

    Facility

    $38.11

    The same base rate than Madera for the office setting.

  • Yuba City

    California · 64435

    Office

    $78.01

    Facility

    $38.11

    The same base rate than Madera for the office setting.

  • Dc + Md/Va Suburbs

    District of Columbia · 64435

    Office

    $85.22

    Facility

    $42.34

    $7.21 higher than Madera for the office setting.

  • Miami

    Florida · 64435

    Office

    $83.69

    Facility

    $45.79

    $5.68 higher than Madera for the office setting.

  • Chicago

    Illinois · 64435

    Office

    $81.18

    Facility

    $44.59

    $3.17 higher than Madera for the office setting.

  • Manhattan

    New York · 64435

    Office

    $86.78

    Facility

    $44.47

    $8.77 higher than Madera for the office setting.

  • Alaska*

    Alaska · 64435

    Office

    $88.41

    Facility

    $49.64

    $10.40 higher than Madera for the office setting.

  • Alabama

    Alabama · 64435

    Office

    $67.46

    Facility

    $35.61

    $10.55 lower than Madera for the office setting.

  • Arkansas

    Arkansas · 64435

    Office

    $66.50

    Facility

    $35.23

    $11.51 lower than Madera for the office setting.

  • Arizona

    Arizona · 64435

    Office

    $73.09

    Facility

    $37.81

    $4.92 lower than Madera for the office setting.

  • Colorado

    Colorado · 64435

    Office

    $77.47

    Facility

    $38.73

    $0.54 lower than Madera for the office setting.

  • Connecticut

    Connecticut · 64435

    Office

    $80.13

    Facility

    $40.92

    $2.12 higher than Madera for the office setting.

  • Delaware

    Delaware · 64435

    Office

    $74.28

    Facility

    $38.31

    $3.73 lower than Madera for the office setting.

  • Fort Lauderdale

    Florida · 64435

    Office

    $79.26

    Facility

    $42.38

    $1.25 higher than Madera for the office setting.

  • Rest Of Florida

    Florida · 64435

    Office

    $75.29

    Facility

    $40.49

    $2.72 lower than Madera for the office setting.

  • Atlanta

    Georgia · 64435

    Office

    $76.84

    Facility

    $39.85

    $1.17 lower than Madera for the office setting.

  • Rest Of Georgia

    Georgia · 64435

    Office

    $70.97

    Facility

    $38.50

    $7.04 lower than Madera for the office setting.

  • Hawaii, Guam

    Hawaii · 64435

    Office

    $79.68

    Facility

    $38.29

    $1.67 higher than Madera for the office setting.

  • Iowa

    Iowa · 64435

    Office

    $68.59

    Facility

    $35.28

    $9.42 lower than Madera for the office setting.

  • Idaho

    Idaho · 64435

    Office

    $69.15

    Facility

    $35.66

    $8.86 lower than Madera for the office setting.

  • East St. Louis

    Illinois · 64435

    Office

    $75.84

    Facility

    $42.35

    $2.17 lower than Madera for the office setting.

  • Rest Of Illinois

    Illinois · 64435

    Office

    $73.56

    Facility

    $40.32

    $4.45 lower than Madera for the office setting.

  • Suburban Chicago

    Illinois · 64435

    Office

    $79.93

    Facility

    $42.54

    $1.92 higher than Madera for the office setting.

  • Indiana

    Indiana · 64435

    Office

    $69.53

    Facility

    $35.78

    $8.48 lower than Madera for the office setting.

  • Kansas

    Kansas · 64435

    Office

    $68.54

    Facility

    $35.63

    $9.47 lower than Madera for the office setting.

  • Kentucky

    Kentucky · 64435

    Office

    $69.63

    Facility

    $37.26

    $8.38 lower than Madera for the office setting.

  • New Orleans

    Louisiana · 64435

    Office

    $73.00

    Facility

    $38.74

    $5.01 lower than Madera for the office setting.

  • Rest Of Louisiana

    Louisiana · 64435

    Office

    $69.63

    Facility

    $37.41

    $8.38 lower than Madera for the office setting.

  • Metropolitan Boston

    Massachusetts · 64435

    Office

    $84.68

    Facility

    $41.21

    $6.67 higher than Madera for the office setting.

  • Rest Of Massachusetts

    Massachusetts · 64435

    Office

    $77.12

    Facility

    $38.78

    $0.89 lower than Madera for the office setting.

  • Baltimore/Surr. Cntys

    Maryland · 64435

    Office

    $79.96

    Facility

    $40.90

    $1.95 higher than Madera for the office setting.

  • Rest Of Maryland

    Maryland · 64435

    Office

    $75.60

    Facility

    $38.75

    $2.41 lower than Madera for the office setting.

  • Rest Of Maine

    Maine · 64435

    Office

    $69.80

    Facility

    $36.30

    $8.21 lower than Madera for the office setting.

  • Southern Maine

    Maine · 64435

    Office

    $73.13

    Facility

    $37.05

    $4.88 lower than Madera for the office setting.

  • Detroit

    Michigan · 64435

    Office

    $76.51

    Facility

    $41.37

    $1.50 lower than Madera for the office setting.

  • Rest Of Michigan

    Michigan · 64435

    Office

    $71.67

    Facility

    $38.43

    $6.34 lower than Madera for the office setting.

  • Minnesota

    Minnesota · 64435

    Office

    $73.44

    Facility

    $35.98

    $4.57 lower than Madera for the office setting.

  • Metropolitan Kansas City

    Missouri · 64435

    Office

    $72.22

    Facility

    $38.03

    $5.79 lower than Madera for the office setting.

  • Metropolitan St. Louis

    Missouri · 64435

    Office

    $72.93

    Facility

    $38.27

    $5.08 lower than Madera for the office setting.

  • Rest Of Missouri

    Missouri · 64435

    Office

    $68.63

    Facility

    $37.25

    $9.38 lower than Madera for the office setting.

  • Mississippi

    Mississippi · 64435

    Office

    $67.57

    Facility

    $36.22

    $10.44 lower than Madera for the office setting.

  • Montana**

    Montana · 64435

    Office

    $75.14

    Facility

    $38.74

    $2.87 lower than Madera for the office setting.

  • North Carolina

    North Carolina · 64435

    Office

    $70.47

    Facility

    $36.51

    $7.54 lower than Madera for the office setting.

  • North Dakota**

    North Dakota · 64435

    Office

    $72.57

    Facility

    $36.17

    $5.44 lower than Madera for the office setting.

  • Nebraska

    Nebraska · 64435

    Office

    $68.88

    Facility

    $35.27

    $9.13 lower than Madera for the office setting.

  • New Hampshire

    New Hampshire · 64435

    Office

    $76.51

    Facility

    $38.61

    $1.50 lower than Madera for the office setting.

  • Northern Nj

    New Jersey · 64435

    Office

    $84.41

    Facility

    $42.18

    $6.40 higher than Madera for the office setting.

  • Rest Of New Jersey

    New Jersey · 64435

    Office

    $80.82

    Facility

    $41.06

    $2.81 higher than Madera for the office setting.

  • New Mexico

    New Mexico · 64435

    Office

    $72.17

    Facility

    $38.79

    $5.84 lower than Madera for the office setting.

  • Nevada**

    Nevada · 64435

    Office

    $74.47

    Facility

    $38.03

    $3.54 lower than Madera for the office setting.

  • Nyc Suburbs/Long Island

    New York · 64435

    Office

    $89.21

    Facility

    $45.92

    $11.20 higher than Madera for the office setting.

  • Poughkpsie/N Nyc Suburbs

    New York · 64435

    Office

    $81.57

    Facility

    $41.71

    $3.56 higher than Madera for the office setting.

  • Queens

    New York · 64435

    Office

    $87.08

    Facility

    $44.05

    $9.07 higher than Madera for the office setting.

  • Rest Of New York

    New York · 64435

    Office

    $71.54

    Facility

    $36.95

    $6.47 lower than Madera for the office setting.

  • Ohio

    Ohio · 64435

    Office

    $71.15

    Facility

    $37.91

    $6.86 lower than Madera for the office setting.

  • Oklahoma

    Oklahoma · 64435

    Office

    $69.22

    Facility

    $36.70

    $8.79 lower than Madera for the office setting.

  • Portland

    Oregon · 64435

    Office

    $79.58

    Facility

    $39.14

    $1.57 higher than Madera for the office setting.

  • Rest Of Oregon

    Oregon · 64435

    Office

    $73.68

    Facility

    $37.42

    $4.33 lower than Madera for the office setting.

  • Metropolitan Philadelphia

    Pennsylvania · 64435

    Office

    $78.33

    Facility

    $40.43

    $0.32 higher than Madera for the office setting.

  • Rest Of Pennsylvania

    Pennsylvania · 64435

    Office

    $71.11

    Facility

    $37.68

    $6.90 lower than Madera for the office setting.

  • Puerto Rico

    Puerto Rico · 64435

    Office

    $75.60

    Facility

    $38.79

    $2.41 lower than Madera for the office setting.

  • Rhode Island

    Rhode Island · 64435

    Office

    $76.68

    Facility

    $39.07

    $1.33 lower than Madera for the office setting.

  • South Carolina

    South Carolina · 64435

    Office

    $70.97

    Facility

    $37.33

    $7.04 lower than Madera for the office setting.

  • South Dakota**

    South Dakota · 64435

    Office

    $72.27

    Facility

    $35.86

    $5.74 lower than Madera for the office setting.

  • Tennessee

    Tennessee · 64435

    Office

    $68.92

    Facility

    $35.82

    $9.09 lower than Madera for the office setting.

  • Austin

    Texas · 64435

    Office

    $77.40

    Facility

    $38.88

    $0.61 lower than Madera for the office setting.

  • Beaumont

    Texas · 64435

    Office

    $70.67

    Facility

    $37.53

    $7.34 lower than Madera for the office setting.

  • Brazoria

    Texas · 64435

    Office

    $73.97

    Facility

    $37.89

    $4.04 lower than Madera for the office setting.

  • Dallas

    Texas · 64435

    Office

    $74.57

    Facility

    $38.31

    $3.44 lower than Madera for the office setting.

  • Fort Worth

    Texas · 64435

    Office

    $74.16

    Facility

    $38.26

    $3.85 lower than Madera for the office setting.

  • Galveston

    Texas · 64435

    Office

    $74.28

    Facility

    $38.12

    $3.73 lower than Madera for the office setting.

  • Houston

    Texas · 64435

    Office

    $76.65

    Facility

    $40.50

    $1.36 lower than Madera for the office setting.

  • Rest Of Texas

    Texas · 64435

    Office

    $72.36

    Facility

    $37.81

    $5.65 lower than Madera for the office setting.

  • Utah

    Utah · 64435

    Office

    $71.92

    Facility

    $37.70

    $6.09 lower than Madera for the office setting.

  • Virginia

    Virginia · 64435

    Office

    $73.09

    Facility

    $37.30

    $4.92 lower than Madera for the office setting.

  • Virgin Islands

    United States Virgin Islands · 64435

    Office

    $75.60

    Facility

    $38.79

    $2.41 lower than Madera for the office setting.

  • Vermont

    Vermont · 64435

    Office

    $72.54

    Facility

    $36.50

    $5.47 lower than Madera for the office setting.

  • Rest Of Washington

    Washington · 64435

    Office

    $76.89

    Facility

    $38.56

    $1.12 lower than Madera for the office setting.

  • Seattle (King Cnty)

    Washington · 64435

    Office

    $86.12

    Facility

    $41.44

    $8.11 higher than Madera for the office setting.

  • Wisconsin

    Wisconsin · 64435

    Office

    $70.20

    Facility

    $35.32

    $7.81 lower than Madera for the office setting.

  • West Virginia

    West Virginia · 64435

    Office

    $70.94

    Facility

    $39.30

    $7.07 lower than Madera for the office setting.

  • Wyoming**

    Wyoming · 64435

    Office

    $74.02

    Facility

    $37.62

    $3.99 lower than Madera for the office setting.

See how rates vary across the country

64435 · Office / nonfacility · Non-QP. Choose a state to explore its payment localities. A range means the amount varies within that state.

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

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.

$66.50

$88.41

Color shows the midpoint of each state’s locality range.

View all state and territory rates as a table
State / territoryRate rangeLocalities
AK$88.411
AL$67.461
AR$66.501
AZ$73.091
CA$78.01–$96.3429
CO$77.471
CT$80.131
DC$85.221
DE$74.281
FL$75.29–$83.693
GA$70.97–$76.842
GU$79.681
HI$79.681
IA$68.591
ID$69.151
IL$73.56–$81.184
IN$69.531
KS$68.541
KY$69.631
LA$69.63–$73.002
MA$77.12–$84.682
MD$75.60–$85.223
ME$69.80–$73.132
MI$71.67–$76.512
MN$73.441
MO$68.63–$72.933
MS$67.571
MT$75.141
NC$70.471
ND$72.571
NE$68.881
NH$76.511
NJ$80.82–$84.412
NM$72.171
NV$74.471
NY$71.54–$89.215
OH$71.151
OK$69.221
OR$73.68–$79.582
PA$71.11–$78.332
PR$75.601
RI$76.681
SC$70.971
SD$72.271
TN$68.921
TX$70.67–$77.408
UT$71.921
VA$73.09–$85.222
VI$75.601
VT$72.541
WA$76.89–$86.122
WI$70.201
WV$70.941
WY$74.021

Explore 64435 on the national rate map →

Where does this rate apply?

Madera is a Medicare payment area. Our Census mapping connects it to 17 cities and communities in California, including the examples shown here.

Some communities span more than one payment area. Follow a city link to compare all of its mapped areas, or check the service-location ZIP above for an address-level starting point.

Browse all communities in California →

Why are the office and facility amounts different?

For 64435 in Madera, the physician’s office rate is $78.01 and the facility-setting rate is $38.11: a difference of $39.90.

The calculation uses a different practice-expense RVU for each setting. Both amounts here are physician fee-schedule amounts. The facility figure does not include a hospital’s separate charges, so this comparison does not tell you the total cost of receiving care in each setting.

See the inputs behind this difference →

Use this rate

What is a percentage of Medicare worth?

Turn a percentage into dollars for 64435 in Madera. This uses the base rate on this page, so the locality and release stay consistent.

Reference amount per service

$85.81

$78.01 × 110% = $85.81

A contract may specify another Medicare year or additional adjustments. This is percentage arithmetic on the displayed base rate, not a claim adjudication.

Working with a whole code list?

Compare an offer across your annual code mix, including an older Medicare schedule or flat per-code rates.

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How this local rate is calculated

Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 64435 in Madera.

PPRRVU2026_Oct_nonQPP.csv

7,107

Code
64435
Physician work
0.73
Practice expense
1.39
Malpractice
0.13

GPCI2026.csv

14

Locality
Madera
Physician work
1.017
Practice expense
1.096
Malpractice
0.536
Office / nonfacility calculation for 64435 in Madera
ComponentRVULocality factorAdjusted
Physician work0.73× 1.0170.7424
Practice expense1.39× 1.0961.5234
Malpractice0.13× 0.5360.0697
Total RVUs2.3355
Conversion factor× 33.4009

Office / nonfacility rate, Madera$78.01

Values as parsed from CMS release RVU26D, effective 2026-10-01. The amount is rounded to the nearest cent only at the end.

Open 64435 in the RVU calculator →

Explore RVUs, geographic factors and the full formula

Office / nonfacility

Office / nonfacility calculation inputs
ComponentRVULocal GPCI
Work0.731.017
Practice expense1.391.096
Malpractice0.130.536

(0.73 × 1.017 + 1.39 × 1.096 + 0.13 × 0.536) × $33.4009 = $78.01

Facility

Facility calculation inputs
ComponentRVULocal GPCI
Work0.731.017
Practice expense0.31.096
Malpractice0.130.536

(0.73 × 1.017 + 0.3 × 1.096 + 0.13 × 0.536) × $33.4009 = $38.11

The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.

How this rate has changed

64435 · Office / nonfacility

$78.01

Effective 2026-10-01

The base rate is $1.98 lower than on 2025-10-01, moving from $79.99 to $78.01 (2.5%).

It is unchanged from the immediately preceding available release, effective 2026-07-01.

Base rate by release · bars start at $0 · select a bar to compare

One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.

What changed, release by release

  1. January 1, 2026

    RVU26A

    $79.99changed to$78.01

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 0.75 changed to 0.73
    • Practice expense RVU 1.50 changed to 1.39
    • Work GPCI 1.014 changed to 1.017
    • Practice expense GPCI 1.093 changed to 1.096
    • Malpractice GPCI 0.560 changed to 0.536

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    Earliest loaded release: $79.99

    Held through RVU25B, RVU25C, RVU25D.

Explore release dates and calculate this code in an earlier period →

Each row uses the accepted CMS release effective on that date and the same contractor and locality identifiers. Missing rates stay visible. Historical boundaries may differ; verify the service address for an older claim.

Inspect every release and its CMS source
Effective fromOffice / nonfacilityFacilityCMS release
2026-10-01$78.01$38.11RVU26D
2026-07-01$78.01$38.11RVU26C
2026-04-01$78.01$38.11RVU26B
2026-01-01$78.01$38.11RVU26A
2025-10-01$79.99$42.16RVU25D
2025-07-01$79.99$42.16RVU25C
2025-04-01$79.99$42.16RVU25B
2025-01-01$79.99$42.16RVU25A

64435 billing questions

How is this different from a pudendal nerve block?

This code is for injection at the paracervical (uterine) nerve. Use the pudendal nerve code, 64430, when the documented target is the pudendal nerve.

When should modifier 50 be reported?

When the paracervical nerve injection is performed bilaterally, report modifier 50. CMS pays the bilateral procedure at 150%.

What does the 0-day global period include?

Same-day preoperative and postoperative care is included in the procedure. The global period is 0 days.

What documentation supports reporting this code?

Document the paracervical nerve target, laterality, reason for the block, and the injection performed. The record should distinguish this target from another pelvic nerve.

How does CMS handle this with another procedure in the same session?

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

Where these rates come from

FeeBase calculates base physician payments from CMS work, practice-expense, and malpractice RVUs, adjusted by each locality’s geographic indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.

Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.

RVUs for 64435PPRRVU2026_Oct_nonQPP.csv, line 7,107 (RVU26D)
Geographic factors for MaderaGPCI2026.csv, line 14 (RVU26D)
Open CMS sourceHow this rate is calculatedBuild a fee sheet