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CMS RVU26D · Effective 2026-10-01

64520 in Manhattan

Office / nonfacility

$278.76

Base rate per service

Facility setting

$86.65

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.

Pain management

About 64520: Lumbar or thoracic sympathetic block

Reports an anesthetic injection to a lumbar or thoracic sympathetic chain, commonly used to evaluate or treat sympathetically maintained pain.

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.

CMS billing rules for 64520

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 RVU1.32 · 18%
  • Practice expense (office) RVU5.81 · 80%
  • Malpractice RVU0.12 · 2%

11.3K

Medicare services in 2024 · #1410 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.

64520 compared with similar codes

Office rates for Manhattan, from the same CMS release.

64510

Nerve block

Stellate ganglion

$176.59

Choose 64510 for an injection targeting the stellate ganglion. Code 64520 is for a lumbar or thoracic sympathetic-chain target.

64517

Plexus block

Hypogastric plexus

$231.38

Code 64517 identifies a hypogastric plexus injection; 64520 is selected when the documented target is the lumbar or thoracic sympathetic chain.

64530

Celiac plexus block

Anesthetic injection

$271.10

Code 64530 is for a celiac plexus injection. Use 64520 for the lumbar or thoracic sympathetic-chain target instead.

The same code, a different location

How does Manhattan compare?

In Nyc Suburbs/Long Island, the office rate for 64520 is $285.09—$6.33 higher than the $278.76 rate in Manhattan. Both use the same code, release and participation basis.

64520 across payment areas

Same release and payment basis · bars start at $0

  1. Manhattan · This locality

    $278.76

  2. Nyc Suburbs/Long Island

    $285.09

    $6.33 higher than Manhattan

  3. Poughkpsie/N Nyc Suburbs

    $263.42

    $15.34 lower than Manhattan

  4. Queens

    $282.07

    $3.31 higher than Manhattan

  5. Rest Of New York

    $231.26

    $47.50 lower than Manhattan

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

    $278.13

    $0.63 lower than Manhattan

  7. Dc + Md/Va Suburbs

    $279.53

    $0.77 higher than Manhattan

Other payment areas listed in New York 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, 64520 ranges from $212.85 in Arkansas to $330.92 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

  • Miami

    Florida · 64520

    Office

    $256.24

    Facility

    $84.13

    $22.52 lower than Manhattan for the office setting.

  • Chicago

    Illinois · 64520

    Office

    $248.63

    Facility

    $82.46

    $30.13 lower than Manhattan for the office setting.

  • Alaska*

    Alaska · 64520

    Office

    $275.02

    Facility

    $98.93

    $3.74 lower than Manhattan for the office setting.

  • Alabama

    Alabama · 64520

    Office

    $216.16

    Facility

    $71.49

    $62.60 lower than Manhattan for the office setting.

  • Arkansas

    Arkansas · 64520

    Office

    $212.85

    Facility

    $70.83

    $65.91 lower than Manhattan for the office setting.

  • Arizona

    Arizona · 64520

    Office

    $235.56

    Facility

    $75.35

    $43.20 lower than Manhattan for the office setting.

  • Bakersfield

    California · 64520

    Office

    $260.06

    Facility

    $78.85

    $18.70 lower than Manhattan for the office setting.

  • Chico

    California · 64520

    Office

    $259.68

    Facility

    $78.47

    $19.08 lower than Manhattan for the office setting.

  • El Centro

    California · 64520

    Office

    $259.70

    Facility

    $78.49

    $19.06 lower than Manhattan for the office setting.

  • Fresno

    California · 64520

    Office

    $259.68

    Facility

    $78.47

    $19.08 lower than Manhattan for the office setting.

  • Hanford-Corcoran

    California · 64520

    Office

    $259.68

    Facility

    $78.47

    $19.08 lower than Manhattan for the office setting.

  • Madera

    California · 64520

    Office

    $259.68

    Facility

    $78.47

    $19.08 lower than Manhattan for the office setting.

  • Merced

    California · 64520

    Office

    $259.68

    Facility

    $78.47

    $19.08 lower than Manhattan for the office setting.

  • Modesto

    California · 64520

    Office

    $259.68

    Facility

    $78.47

    $19.08 lower than Manhattan for the office setting.

  • Napa

    California · 64520

    Office

    $304.67

    Facility

    $86.76

    $25.91 higher than Manhattan for the office setting.

  • Oxnard-Thousand Oaks-Ventura

    California · 64520

    Office

    $277.20

    Facility

    $81.77

    $1.56 lower than Manhattan for the office setting.

  • Redding

    California · 64520

    Office

    $259.68

    Facility

    $78.47

    $19.08 lower than Manhattan for the office setting.

  • Rest Of California

    California · 64520

    Office

    $259.68

    Facility

    $78.47

    $19.08 lower than Manhattan for the office setting.

  • Riverside-San Bernardino-Ontario

    California · 64520

    Office

    $260.99

    Facility

    $79.78

    $17.77 lower than Manhattan for the office setting.

  • Sacramento-Roseville-Folsom

    California · 64520

    Office

    $273.52

    Facility

    $81.23

    $5.24 lower than Manhattan for the office setting.

  • Salinas

    California · 64520

    Office

    $272.52

    Facility

    $80.90

    $6.24 lower than Manhattan for the office setting.

  • San Diego-Chula Vista-Carlsbad

    California · 64520

    Office

    $279.68

    Facility

    $81.94

    $0.92 higher than Manhattan for the office setting.

  • San Francisco-Oakland-Berkeley (Marin Cnty)

    California · 64520

    Office

    $323.74

    Facility

    $90.62

    $44.98 higher than Manhattan for the office setting.

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

    California · 64520

    Office

    $323.60

    Facility

    $90.48

    $44.84 higher than Manhattan for the office setting.

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

    California · 64520

    Office

    $330.92

    Facility

    $92.51

    $52.16 higher than Manhattan for the office setting.

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

    California · 64520

    Office

    $330.36

    Facility

    $91.95

    $51.60 higher than Manhattan for the office setting.

  • San Luis Obispo-Paso Robles

    California · 64520

    Office

    $268.02

    Facility

    $79.70

    $10.74 lower than Manhattan for the office setting.

  • Santa Cruz-Watsonville

    California · 64520

    Office

    $282.95

    Facility

    $82.06

    $4.19 higher than Manhattan for the office setting.

  • Santa Maria-Santa Barbara

    California · 64520

    Office

    $273.75

    Facility

    $80.97

    $5.01 lower than Manhattan for the office setting.

  • Santa Rosa-Petaluma

    California · 64520

    Office

    $285.86

    Facility

    $82.83

    $7.10 higher than Manhattan for the office setting.

  • Stockton

    California · 64520

    Office

    $259.68

    Facility

    $78.47

    $19.08 lower than Manhattan for the office setting.

  • Vallejo

    California · 64520

    Office

    $304.48

    Facility

    $86.57

    $25.72 higher than Manhattan for the office setting.

  • Visalia

    California · 64520

    Office

    $259.68

    Facility

    $78.47

    $19.08 lower than Manhattan for the office setting.

  • Yuba City

    California · 64520

    Office

    $259.68

    Facility

    $78.47

    $19.08 lower than Manhattan for the office setting.

  • Colorado

    Colorado · 64520

    Office

    $254.23

    Facility

    $78.31

    $24.53 lower than Manhattan for the office setting.

  • Connecticut

    Connecticut · 64520

    Office

    $258.82

    Facility

    $80.76

    $19.94 lower than Manhattan for the office setting.

  • Delaware

    Delaware · 64520

    Office

    $239.64

    Facility

    $76.29

    $39.12 lower than Manhattan for the office setting.

  • Fort Lauderdale

    Florida · 64520

    Office

    $247.92

    Facility

    $80.43

    $30.84 lower than Manhattan for the office setting.

  • Rest Of Florida

    Florida · 64520

    Office

    $235.63

    Facility

    $77.57

    $43.13 lower than Manhattan for the office setting.

  • Atlanta

    Georgia · 64520

    Office

    $246.20

    Facility

    $78.22

    $32.56 lower than Manhattan for the office setting.

  • Rest Of Georgia

    Georgia · 64520

    Office

    $221.97

    Facility

    $74.49

    $56.79 lower than Manhattan for the office setting.

  • Hawaii, Guam

    Hawaii · 64520

    Office

    $267.06

    Facility

    $79.07

    $11.70 lower than Manhattan for the office setting.

  • Iowa

    Iowa · 64520

    Office

    $223.24

    Facility

    $71.96

    $55.52 lower than Manhattan for the office setting.

  • Idaho

    Idaho · 64520

    Office

    $224.52

    Facility

    $72.41

    $54.24 lower than Manhattan for the office setting.

  • East St. Louis

    Illinois · 64520

    Office

    $230.70

    Facility

    $78.59

    $48.06 lower than Manhattan for the office setting.

  • Rest Of Illinois

    Illinois · 64520

    Office

    $227.53

    Facility

    $76.58

    $51.23 lower than Manhattan for the office setting.

  • Suburban Chicago

    Illinois · 64520

    Office

    $250.80

    Facility

    $81.00

    $27.96 lower than Manhattan for the office setting.

  • Indiana

    Indiana · 64520

    Office

    $225.93

    Facility

    $72.66

    $52.83 lower than Manhattan for the office setting.

  • Kansas

    Kansas · 64520

    Office

    $221.54

    Facility

    $72.08

    $57.22 lower than Manhattan for the office setting.

  • Kentucky

    Kentucky · 64520

    Office

    $220.28

    Facility

    $73.29

    $58.48 lower than Manhattan for the office setting.

  • New Orleans

    Louisiana · 64520

    Office

    $231.25

    Facility

    $75.67

    $47.51 lower than Manhattan for the office setting.

  • Rest Of Louisiana

    Louisiana · 64520

    Office

    $219.67

    Facility

    $73.35

    $59.09 lower than Manhattan for the office setting.

  • Metropolitan Boston

    Massachusetts · 64520

    Office

    $281.17

    Facility

    $83.76

    $2.41 higher than Manhattan for the office setting.

  • Rest Of Massachusetts

    Massachusetts · 64520

    Office

    $252.33

    Facility

    $78.24

    $26.43 lower than Manhattan for the office setting.

  • Baltimore/Surr. Cntys

    Maryland · 64520

    Office

    $257.98

    Facility

    $80.57

    $20.78 lower than Manhattan for the office setting.

  • Rest Of Maryland

    Maryland · 64520

    Office

    $244.60

    Facility

    $77.28

    $34.16 lower than Manhattan for the office setting.

  • Rest Of Maine

    Maine · 64520

    Office

    $225.12

    Facility

    $73.01

    $53.64 lower than Manhattan for the office setting.

  • Southern Maine

    Maine · 64520

    Office

    $238.93

    Facility

    $75.08

    $39.83 lower than Manhattan for the office setting.

  • Detroit

    Michigan · 64520

    Office

    $238.11

    Facility

    $78.57

    $40.65 lower than Manhattan for the office setting.

  • Rest Of Michigan

    Michigan · 64520

    Office

    $225.79

    Facility

    $74.84

    $52.97 lower than Manhattan for the office setting.

  • Minnesota

    Minnesota · 64520

    Office

    $244.96

    Facility

    $74.83

    $33.80 lower than Manhattan for the office setting.

  • Metropolitan Kansas City

    Missouri · 64520

    Office

    $230.23

    Facility

    $74.98

    $48.53 lower than Manhattan for the office setting.

  • Metropolitan St. Louis

    Missouri · 64520

    Office

    $232.85

    Facility

    $75.45

    $45.91 lower than Manhattan for the office setting.

  • Rest Of Missouri

    Missouri · 64520

    Office

    $215.27

    Facility

    $72.75

    $63.49 lower than Manhattan for the office setting.

  • Mississippi

    Mississippi · 64520

    Office

    $214.14

    Facility

    $71.78

    $64.62 lower than Manhattan for the office setting.

  • Montana**

    Montana · 64520

    Office

    $242.15

    Facility

    $76.81

    $36.61 lower than Manhattan for the office setting.

  • North Carolina

    North Carolina · 64520

    Office

    $227.71

    Facility

    $73.45

    $51.05 lower than Manhattan for the office setting.

  • North Dakota**

    North Dakota · 64520

    Office

    $239.78

    Facility

    $74.44

    $38.98 lower than Manhattan for the office setting.

  • Nebraska

    Nebraska · 64520

    Office

    $224.72

    Facility

    $72.12

    $54.04 lower than Manhattan for the office setting.

  • New Hampshire

    New Hampshire · 64520

    Office

    $249.61

    Facility

    $77.50

    $29.15 lower than Manhattan for the office setting.

  • Northern Nj

    New Jersey · 64520

    Office

    $276.26

    Facility

    $84.47

    $2.50 lower than Manhattan for the office setting.

  • Rest Of New Jersey

    New Jersey · 64520

    Office

    $262.16

    Facility

    $81.62

    $16.60 lower than Manhattan for the office setting.

  • New Mexico

    New Mexico · 64520

    Office

    $226.86

    Facility

    $75.24

    $51.90 lower than Manhattan for the office setting.

  • Nevada**

    Nevada · 64520

    Office

    $241.68

    Facility

    $76.18

    $37.08 lower than Manhattan for the office setting.

  • Ohio

    Ohio · 64520

    Office

    $225.31

    Facility

    $74.36

    $53.45 lower than Manhattan for the office setting.

  • Oklahoma

    Oklahoma · 64520

    Office

    $220.50

    Facility

    $72.85

    $58.26 lower than Manhattan for the office setting.

  • Portland

    Oregon · 64520

    Office

    $263.38

    Facility

    $79.69

    $15.38 lower than Manhattan for the office setting.

  • Rest Of Oregon

    Oregon · 64520

    Office

    $240.19

    Facility

    $75.52

    $38.57 lower than Manhattan for the office setting.

  • Metropolitan Philadelphia

    Pennsylvania · 64520

    Office

    $251.68

    Facility

    $79.57

    $27.08 lower than Manhattan for the office setting.

  • Rest Of Pennsylvania

    Pennsylvania · 64520

    Office

    $226.02

    Facility

    $74.25

    $52.74 lower than Manhattan for the office setting.

  • Puerto Rico

    Puerto Rico · 64520

    Office

    $244.23

    Facility

    $77.08

    $34.53 lower than Manhattan for the office setting.

  • Rhode Island

    Rhode Island · 64520

    Office

    $248.97

    Facility

    $78.17

    $29.79 lower than Manhattan for the office setting.

  • South Carolina

    South Carolina · 64520

    Office

    $226.81

    Facility

    $74.04

    $51.95 lower than Manhattan for the office setting.

  • South Dakota**

    South Dakota · 64520

    Office

    $239.50

    Facility

    $74.16

    $39.26 lower than Manhattan for the office setting.

  • Tennessee

    Tennessee · 64520

    Office

    $222.64

    Facility

    $72.35

    $56.12 lower than Manhattan for the office setting.

  • Austin

    Texas · 64520

    Office

    $253.04

    Facility

    $78.12

    $25.72 lower than Manhattan for the office setting.

  • Beaumont

    Texas · 64520

    Office

    $224.41

    Facility

    $73.95

    $54.35 lower than Manhattan for the office setting.

  • Brazoria

    Texas · 64520

    Office

    $239.88

    Facility

    $76.03

    $38.88 lower than Manhattan for the office setting.

  • Dallas

    Texas · 64520

    Office

    $241.21

    Facility

    $76.53

    $37.55 lower than Manhattan for the office setting.

  • Fort Worth

    Texas · 64520

    Office

    $239.32

    Facility

    $76.30

    $39.44 lower than Manhattan for the office setting.

  • Galveston

    Texas · 64520

    Office

    $240.46

    Facility

    $76.28

    $38.30 lower than Manhattan for the office setting.

  • Houston

    Texas · 64520

    Office

    $242.66

    Facility

    $78.48

    $36.10 lower than Manhattan for the office setting.

  • Rest Of Texas

    Texas · 64520

    Office

    $231.87

    Facility

    $74.97

    $46.89 lower than Manhattan for the office setting.

  • Utah

    Utah · 64520

    Office

    $230.10

    Facility

    $74.69

    $48.66 lower than Manhattan for the office setting.

  • Virginia

    Virginia · 64520

    Office

    $237.68

    Facility

    $75.16

    $41.08 lower than Manhattan for the office setting.

  • Virgin Islands

    United States Virgin Islands · 64520

    Office

    $244.23

    Facility

    $77.08

    $34.53 lower than Manhattan for the office setting.

  • Vermont

    Vermont · 64520

    Office

    $238.24

    Facility

    $74.55

    $40.52 lower than Manhattan for the office setting.

  • Rest Of Washington

    Washington · 64520

    Office

    $252.06

    Facility

    $77.96

    $26.70 lower than Manhattan for the office setting.

  • Seattle (King Cnty)

    Washington · 64520

    Office

    $287.68

    Facility

    $84.81

    $8.92 higher than Manhattan for the office setting.

  • Wisconsin

    Wisconsin · 64520

    Office

    $231.23

    Facility

    $72.84

    $47.53 lower than Manhattan for the office setting.

  • West Virginia

    West Virginia · 64520

    Office

    $218.46

    Facility

    $74.79

    $60.30 lower than Manhattan for the office setting.

  • Wyoming**

    Wyoming · 64520

    Office

    $241.11

    Facility

    $75.78

    $37.65 lower than Manhattan for the office setting.

See how rates vary across the country

64520 · 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.

$212.85

$295.30

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

View all state and territory rates as a table
State / territoryRate rangeLocalities
AK$275.021
AL$216.161
AR$212.851
AZ$235.561
CA$259.68–$330.9229
CO$254.231
CT$258.821
DC$279.531
DE$239.641
FL$235.63–$256.243
GA$221.97–$246.202
GU$267.061
HI$267.061
IA$223.241
ID$224.521
IL$227.53–$250.804
IN$225.931
KS$221.541
KY$220.281
LA$219.67–$231.252
MA$252.33–$281.172
MD$244.60–$279.533
ME$225.12–$238.932
MI$225.79–$238.112
MN$244.961
MO$215.27–$232.853
MS$214.141
MT$242.151
NC$227.711
ND$239.781
NE$224.721
NH$249.611
NJ$262.16–$276.262
NM$226.861
NV$241.681
NY$231.26–$285.095
OH$225.311
OK$220.501
OR$240.19–$263.382
PA$226.02–$251.682
PR$244.231
RI$248.971
SC$226.811
SD$239.501
TN$222.641
TX$224.41–$253.048
UT$230.101
VA$237.68–$279.532
VI$244.231
VT$238.241
WA$252.06–$287.682
WI$231.231
WV$218.461
WY$241.111

Explore 64520 on the national rate map →

Where does this rate apply?

Manhattan is a Medicare payment area. Our Census mapping connects it to 1 cities and communities in New York, 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 New York →

Why are the office and facility amounts different?

For 64520 in Manhattan, the physician’s office rate is $278.76 and the facility-setting rate is $86.65: a difference of $192.11.

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 64520 in Manhattan. This uses the base rate on this page, so the locality and release stay consistent.

Reference amount per service

$306.64

$278.76 × 110% = $306.64

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.

Compare your contract offer →

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 64520 in Manhattan.

PPRRVU2026_Oct_nonQPP.csv

7,143

Code
64520
Physician work
1.32
Practice expense
5.81
Malpractice
0.12

GPCI2026.csv

78

Locality
Manhattan
Physician work
1.064
Practice expense
1.162
Malpractice
1.586
Office / nonfacility calculation for 64520 in Manhattan
ComponentRVULocality factorAdjusted
Physician work1.32× 1.0641.4045
Practice expense5.81× 1.1626.7512
Malpractice0.12× 1.5860.1903
Total RVUs8.3460
Conversion factor× 33.4009

Office / nonfacility rate, Manhattan$278.76

Open 64520 in the RVU calculator →

Explore RVUs, geographic factors and the full formula

Office / nonfacility

Office / nonfacility calculation inputs
ComponentRVULocal GPCI
Work1.321.064
Practice expense5.811.162
Malpractice0.121.586

(1.32 × 1.064 + 5.81 × 1.162 + 0.12 × 1.586) × $33.4009 = $278.76

Facility

Facility calculation inputs
ComponentRVULocal GPCI
Work1.321.064
Practice expense0.861.162
Malpractice0.121.586

(1.32 × 1.064 + 0.86 × 1.162 + 0.12 × 1.586) × $33.4009 = $86.65

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

64520 · Office / nonfacility

$278.76

Effective 2026-10-01

The base rate is $26.15 higher than on 2025-10-01, moving from $252.61 to $278.76 (10.4%).

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

    $252.61changed to$278.76

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 1.35 changed to 1.32
    • Practice expense RVU 5.28 changed to 5.81
    • Malpractice RVU 0.13 changed to 0.12
    • Work GPCI 1.065 changed to 1.064
    • Practice expense GPCI 1.166 changed to 1.162
    • Malpractice GPCI 1.656 changed to 1.586

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    Earliest loaded release: $252.61

    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$278.76$86.65RVU26D
2026-07-01$278.76$86.65RVU26C
2026-04-01$278.76$86.65RVU26B
2026-01-01$278.76$86.65RVU26A
2025-10-01$252.61$93.83RVU25D
2025-07-01$252.61$93.83RVU25C
2025-04-01$252.61$93.83RVU25B
2025-01-01$252.61$93.83RVU25A

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 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 64520PPRRVU2026_Oct_nonQPP.csv, line 7,143 (RVU26D)
Geographic factors for ManhattanGPCI2026.csv, line 78 (RVU26D)
Open CMS sourceHow this rate is calculatedBuild a fee sheet