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CMS RVU26D · Effective 2026-10-01

64461 in Wyoming**

Office / nonfacility

$148.25

Base rate per service

Facility setting

$70.42

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.

Anesthesia and pain

About 64461: Thoracic paravertebral single-site block

Reports a single-site thoracic paravertebral nerve block, commonly used to provide regional analgesia for thoracic or breast surgery.

This service is a single-injection thoracic paravertebral nerve block using anesthetic medication, with or without steroid, to reduce pain in the relevant thoracic distribution. Anesthesiologists and acute pain or pain-management clinicians commonly perform it around thoracic procedures, including thoracotomy, or breast surgery. Imaging guidance may be used to place the injection and is included in the service. The block may be performed in an operating room or another procedural setting.

Select this code for one thoracic paravertebral injection site; report 64462 for each additional site when applicable. Document the indication, laterality, site count, medication, and guidance used. Medicare assigns a 0-day global period, so same-day preoperative and postoperative care is included. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and the others at 50%. For bilateral performance, modifier 50 is paid at 150%. Medicare does not pay an assistant at surgery for this code; co-surgeons and team surgery are not permitted.

CMS billing rules for 64461

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 RVU1.71 · 38%
  • Practice expense (office) RVU2.61 · 58%
  • Malpractice RVU0.16 · 4%

5.8K

Medicare services in 2024 · #1777 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.

64461 compared with similar codes

Office rates for Wyoming**, from the same CMS release.

64462

Paravertebral block

Additional thoracic injection site

$77.46

64461 covers one thoracic paravertebral injection site. Use 64462 for each additional site, not as a substitute for the initial-site code.

64463

Paravertebral block

Thoracic continuous infusion

$262.81

64463 is for a thoracic paravertebral block delivered by continuous infusion; 64461 describes a single-injection service.

64466

Thoracic block

Unilateral injection

$140.74

64466 describes a unilateral thoracic fascial plane block. Choose it when the clinician performs that fascial plane technique rather than a paravertebral block.

64468

Thoracic block

Bilateral injection

$163.03

64468 describes a bilateral thoracic fascial plane block, not bilateral thoracic paravertebral injection sites.

The same code, a different location

How does Wyoming** compare?

64461 across payment areas

Same release and payment basis · bars start at $0

  1. Wyoming** · This locality

    $148.25

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

    $166.14

    $17.89 higher than Wyoming**

  3. Dc + Md/Va Suburbs

    $168.84

    $20.59 higher than Wyoming**

  4. Miami

    $161.38

    $13.13 higher than Wyoming**

  5. Chicago

    $157.39

    $9.14 higher than Wyoming**

  6. Manhattan

    $170.55

    $22.30 higher than Wyoming**

  7. Alaska*

    $181.46

    $33.21 higher than Wyoming**

Other payment areas listed in Wyoming 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, 64461 ranges from $134.75 in Arkansas to $191.97 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

  • Alabama

    Alabama · 64461

    Office

    $136.42

    Facility

    $68.32

    $11.83 lower than Wyoming** for the office setting.

  • Arkansas

    Arkansas · 64461

    Office

    $134.75

    Facility

    $67.90

    $13.50 lower than Wyoming** for the office setting.

  • Arizona

    Arizona · 64461

    Office

    $146.16

    Facility

    $70.75

    $2.09 lower than Wyoming** for the office setting.

  • Bakersfield

    California · 64461

    Office

    $157.00

    Facility

    $71.71

    $8.75 higher than Wyoming** for the office setting.

  • Chico

    California · 64461

    Office

    $156.50

    Facility

    $71.20

    $8.25 higher than Wyoming** for the office setting.

  • El Centro

    California · 64461

    Office

    $156.52

    Facility

    $71.23

    $8.27 higher than Wyoming** for the office setting.

  • Fresno

    California · 64461

    Office

    $156.50

    Facility

    $71.20

    $8.25 higher than Wyoming** for the office setting.

  • Hanford-Corcoran

    California · 64461

    Office

    $156.50

    Facility

    $71.20

    $8.25 higher than Wyoming** for the office setting.

  • Madera

    California · 64461

    Office

    $156.50

    Facility

    $71.20

    $8.25 higher than Wyoming** for the office setting.

  • Merced

    California · 64461

    Office

    $156.50

    Facility

    $71.20

    $8.25 higher than Wyoming** for the office setting.

  • Modesto

    California · 64461

    Office

    $156.50

    Facility

    $71.20

    $8.25 higher than Wyoming** for the office setting.

  • Napa

    California · 64461

    Office

    $178.33

    Facility

    $75.75

    $30.08 higher than Wyoming** for the office setting.

  • Oxnard-Thousand Oaks-Ventura

    California · 64461

    Office

    $165.09

    Facility

    $73.10

    $16.84 higher than Wyoming** for the office setting.

  • Redding

    California · 64461

    Office

    $156.50

    Facility

    $71.20

    $8.25 higher than Wyoming** for the office setting.

  • Rest Of California

    California · 64461

    Office

    $156.50

    Facility

    $71.20

    $8.25 higher than Wyoming** for the office setting.

  • Riverside-San Bernardino-Ontario

    California · 64461

    Office

    $158.25

    Facility

    $72.95

    $10.00 higher than Wyoming** for the office setting.

  • Sacramento-Roseville-Folsom

    California · 64461

    Office

    $163.42

    Facility

    $72.91

    $15.17 higher than Wyoming** for the office setting.

  • Salinas

    California · 64461

    Office

    $162.79

    Facility

    $72.59

    $14.54 higher than Wyoming** for the office setting.

  • San Diego-Chula Vista-Carlsbad

    California · 64461

    Office

    $165.99

    Facility

    $72.91

    $17.74 higher than Wyoming** for the office setting.

  • San Francisco-Oakland-Berkeley (Marin Cnty)

    California · 64461

    Office

    $187.91

    Facility

    $78.18

    $39.66 higher than Wyoming** for the office setting.

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

    California · 64461

    Office

    $187.73

    Facility

    $78.00

    $39.48 higher than Wyoming** for the office setting.

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

    California · 64461

    Office

    $191.97

    Facility

    $79.75

    $43.72 higher than Wyoming** for the office setting.

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

    California · 64461

    Office

    $191.23

    Facility

    $79.01

    $42.98 higher than Wyoming** for the office setting.

  • San Luis Obispo-Paso Robles

    California · 64461

    Office

    $160.24

    Facility

    $71.60

    $11.99 higher than Wyoming** for the office setting.

  • Santa Cruz-Watsonville

    California · 64461

    Office

    $167.10

    Facility

    $72.54

    $18.85 higher than Wyoming** for the office setting.

  • Santa Maria-Santa Barbara

    California · 64461

    Office

    $163.23

    Facility

    $72.48

    $14.98 higher than Wyoming** for the office setting.

  • Santa Rosa-Petaluma

    California · 64461

    Office

    $168.75

    Facility

    $73.18

    $20.50 higher than Wyoming** for the office setting.

  • Stockton

    California · 64461

    Office

    $156.50

    Facility

    $71.20

    $8.25 higher than Wyoming** for the office setting.

  • Vallejo

    California · 64461

    Office

    $178.07

    Facility

    $75.49

    $29.82 higher than Wyoming** for the office setting.

  • Visalia

    California · 64461

    Office

    $156.50

    Facility

    $71.20

    $8.25 higher than Wyoming** for the office setting.

  • Yuba City

    California · 64461

    Office

    $156.50

    Facility

    $71.20

    $8.25 higher than Wyoming** for the office setting.

  • Colorado

    Colorado · 64461

    Office

    $154.73

    Facility

    $71.93

    $6.48 higher than Wyoming** for the office setting.

  • Connecticut

    Connecticut · 64461

    Office

    $158.61

    Facility

    $74.80

    $10.36 higher than Wyoming** for the office setting.

  • Delaware

    Delaware · 64461

    Office

    $148.34

    Facility

    $71.45

    $0.09 higher than Wyoming** for the office setting.

  • Fort Lauderdale

    Florida · 64461

    Office

    $155.09

    Facility

    $76.25

    $6.84 higher than Wyoming** for the office setting.

  • Rest Of Florida

    Florida · 64461

    Office

    $148.49

    Facility

    $74.09

    $0.24 higher than Wyoming** for the office setting.

  • Atlanta

    Georgia · 64461

    Office

    $152.28

    Facility

    $73.21

    $4.03 higher than Wyoming** for the office setting.

  • Rest Of Georgia

    Georgia · 64461

    Office

    $141.25

    Facility

    $71.83

    $7.00 lower than Wyoming** for the office setting.

  • Hawaii, Guam

    Hawaii · 64461

    Office

    $159.33

    Facility

    $70.84

    $11.08 higher than Wyoming** for the office setting.

  • Iowa

    Iowa · 64461

    Office

    $139.00

    Facility

    $67.79

    $9.25 lower than Wyoming** for the office setting.

  • Idaho

    Idaho · 64461

    Office

    $139.85

    Facility

    $68.25

    $8.40 lower than Wyoming** for the office setting.

  • East St. Louis

    Illinois · 64461

    Office

    $148.08

    Facility

    $76.48

    $0.17 lower than Wyoming** for the office setting.

  • Rest Of Illinois

    Illinois · 64461

    Office

    $145.06

    Facility

    $74.01

    $3.19 lower than Wyoming** for the office setting.

  • Suburban Chicago

    Illinois · 64461

    Office

    $156.52

    Facility

    $76.59

    $8.27 higher than Wyoming** for the office setting.

  • Indiana

    Indiana · 64461

    Office

    $140.53

    Facility

    $68.38

    $7.72 lower than Wyoming** for the office setting.

  • Kansas

    Kansas · 64461

    Office

    $138.62

    Facility

    $68.26

    $9.63 lower than Wyoming** for the office setting.

  • Kentucky

    Kentucky · 64461

    Office

    $139.51

    Facility

    $70.32

    $8.74 lower than Wyoming** for the office setting.

  • New Orleans

    Louisiana · 64461

    Office

    $145.22

    Facility

    $71.99

    $3.03 lower than Wyoming** for the office setting.

  • Rest Of Louisiana

    Louisiana · 64461

    Office

    $139.39

    Facility

    $70.51

    $8.86 lower than Wyoming** for the office setting.

  • Metropolitan Boston

    Massachusetts · 64461

    Office

    $168.30

    Facility

    $75.38

    $20.05 higher than Wyoming** for the office setting.

  • Rest Of Massachusetts

    Massachusetts · 64461

    Office

    $154.09

    Facility

    $72.14

    $5.84 higher than Wyoming** for the office setting.

  • Baltimore/Surr. Cntys

    Maryland · 64461

    Office

    $158.18

    Facility

    $74.68

    $9.93 higher than Wyoming** for the office setting.

  • Rest Of Maryland

    Maryland · 64461

    Office

    $150.82

    Facility

    $72.06

    $2.57 higher than Wyoming** for the office setting.

  • Rest Of Maine

    Maine · 64461

    Office

    $140.64

    Facility

    $69.04

    $7.61 lower than Wyoming** for the office setting.

  • Southern Maine

    Maine · 64461

    Office

    $146.88

    Facility

    $69.76

    $1.37 lower than Wyoming** for the office setting.

  • Detroit

    Michigan · 64461

    Office

    $150.25

    Facility

    $75.15

    $2.00 higher than Wyoming** for the office setting.

  • Rest Of Michigan

    Michigan · 64461

    Office

    $142.74

    Facility

    $71.69

    $5.51 lower than Wyoming** for the office setting.

  • Minnesota

    Minnesota · 64461

    Office

    $148.40

    Facility

    $68.32

    $0.15 higher than Wyoming** for the office setting.

  • Metropolitan Kansas City

    Missouri · 64461

    Office

    $144.20

    Facility

    $71.12

    $4.05 lower than Wyoming** for the office setting.

  • Metropolitan St. Louis

    Missouri · 64461

    Office

    $145.46

    Facility

    $71.37

    $2.79 lower than Wyoming** for the office setting.

  • Rest Of Missouri

    Missouri · 64461

    Office

    $137.47

    Facility

    $70.38

    $10.78 lower than Wyoming** for the office setting.

  • Mississippi

    Mississippi · 64461

    Office

    $136.12

    Facility

    $69.12

    $12.13 lower than Wyoming** for the office setting.

  • Montana**

    Montana · 64461

    Office

    $149.63

    Facility

    $71.80

    $1.38 higher than Wyoming** for the office setting.

  • North Carolina

    North Carolina · 64461

    Office

    $141.87

    Facility

    $69.26

    $6.38 lower than Wyoming** for the office setting.

  • North Dakota**

    North Dakota · 64461

    Office

    $146.46

    Facility

    $68.64

    $1.79 lower than Wyoming** for the office setting.

  • Nebraska

    Nebraska · 64461

    Office

    $139.60

    Facility

    $67.77

    $8.65 lower than Wyoming** for the office setting.

  • New Hampshire

    New Hampshire · 64461

    Office

    $152.54

    Facility

    $71.53

    $4.29 higher than Wyoming** for the office setting.

  • Northern Nj

    New Jersey · 64461

    Office

    $167.55

    Facility

    $77.27

    $19.30 higher than Wyoming** for the office setting.

  • Rest Of New Jersey

    New Jersey · 64461

    Office

    $160.46

    Facility

    $75.48

    $12.21 higher than Wyoming** for the office setting.

  • New Mexico

    New Mexico · 64461

    Office

    $143.47

    Facility

    $72.11

    $4.78 lower than Wyoming** for the office setting.

  • Nevada**

    Nevada · 64461

    Office

    $148.83

    Facility

    $70.93

    $0.58 higher than Wyoming** for the office setting.

  • Nyc Suburbs/Long Island

    New York · 64461

    Office

    $174.35

    Facility

    $81.81

    $26.10 higher than Wyoming** for the office setting.

  • Poughkpsie/N Nyc Suburbs

    New York · 64461

    Office

    $161.61

    Facility

    $76.39

    $13.36 higher than Wyoming** for the office setting.

  • Queens

    New York · 64461

    Office

    $171.52

    Facility

    $79.53

    $23.27 higher than Wyoming** for the office setting.

  • Rest Of New York

    New York · 64461

    Office

    $143.69

    Facility

    $69.76

    $4.56 lower than Wyoming** for the office setting.

  • Ohio

    Ohio · 64461

    Office

    $142.09

    Facility

    $71.04

    $6.16 lower than Wyoming** for the office setting.

  • Oklahoma

    Oklahoma · 64461

    Office

    $139.12

    Facility

    $69.62

    $9.13 lower than Wyoming** for the office setting.

  • Portland

    Oregon · 64461

    Office

    $158.86

    Facility

    $72.40

    $10.61 higher than Wyoming** for the office setting.

  • Rest Of Oregon

    Oregon · 64461

    Office

    $147.70

    Facility

    $70.19

    $0.55 lower than Wyoming** for the office setting.

  • Metropolitan Philadelphia

    Pennsylvania · 64461

    Office

    $155.27

    Facility

    $74.25

    $7.02 higher than Wyoming** for the office setting.

  • Rest Of Pennsylvania

    Pennsylvania · 64461

    Office

    $142.19

    Facility

    $70.75

    $6.06 lower than Wyoming** for the office setting.

  • Puerto Rico

    Puerto Rico · 64461

    Office

    $150.51

    Facility

    $71.83

    $2.26 higher than Wyoming** for the office setting.

  • Rhode Island

    Rhode Island · 64461

    Office

    $153.02

    Facility

    $72.63

    $4.77 higher than Wyoming** for the office setting.

  • South Carolina

    South Carolina · 64461

    Office

    $142.21

    Facility

    $70.30

    $6.04 lower than Wyoming** for the office setting.

  • South Dakota**

    South Dakota · 64461

    Office

    $146.09

    Facility

    $68.26

    $2.16 lower than Wyoming** for the office setting.

  • Tennessee

    Tennessee · 64461

    Office

    $139.23

    Facility

    $68.49

    $9.02 lower than Wyoming** for the office setting.

  • Austin

    Texas · 64461

    Office

    $154.20

    Facility

    $71.86

    $5.95 higher than Wyoming** for the office setting.

  • Beaumont

    Texas · 64461

    Office

    $141.41

    Facility

    $70.59

    $6.84 lower than Wyoming** for the office setting.

  • Brazoria

    Texas · 64461

    Office

    $148.13

    Facility

    $71.01

    $0.12 lower than Wyoming** for the office setting.

  • Dallas

    Texas · 64461

    Office

    $149.04

    Facility

    $71.53

    $0.79 higher than Wyoming** for the office setting.

  • Fort Worth

    Texas · 64461

    Office

    $148.24

    Facility

    $71.51

    $0.01 lower than Wyoming** for the office setting.

  • Galveston

    Texas · 64461

    Office

    $148.56

    Facility

    $71.28

    $0.31 higher than Wyoming** for the office setting.

  • Houston

    Texas · 64461

    Office

    $151.49

    Facility

    $74.21

    $3.24 higher than Wyoming** for the office setting.

  • Rest Of Texas

    Texas · 64461

    Office

    $144.67

    Facility

    $70.82

    $3.58 lower than Wyoming** for the office setting.

  • Utah

    Utah · 64461

    Office

    $143.86

    Facility

    $70.71

    $4.39 lower than Wyoming** for the office setting.

  • Virginia

    Virginia · 64461

    Office

    $146.58

    Facility

    $70.08

    $1.67 lower than Wyoming** for the office setting.

  • Virgin Islands

    United States Virgin Islands · 64461

    Office

    $150.51

    Facility

    $71.83

    $2.26 higher than Wyoming** for the office setting.

  • Vermont

    Vermont · 64461

    Office

    $146.12

    Facility

    $69.08

    $2.13 lower than Wyoming** for the office setting.

  • Rest Of Washington

    Washington · 64461

    Office

    $153.72

    Facility

    $71.77

    $5.47 higher than Wyoming** for the office setting.

  • Seattle (King Cnty)

    Washington · 64461

    Office

    $171.30

    Facility

    $75.81

    $23.05 higher than Wyoming** for the office setting.

  • Wisconsin

    Wisconsin · 64461

    Office

    $142.28

    Facility

    $67.72

    $5.97 lower than Wyoming** for the office setting.

  • West Virginia

    West Virginia · 64461

    Office

    $140.52

    Facility

    $72.89

    $7.73 lower than Wyoming** for the office setting.

See how rates vary across the country

64461 · 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.

$134.75

$181.46

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

View all state and territory rates as a table
State / territoryRate rangeLocalities
AK$181.461
AL$136.421
AR$134.751
AZ$146.161
CA$156.50–$191.9729
CO$154.731
CT$158.611
DC$168.841
DE$148.341
FL$148.49–$161.383
GA$141.25–$152.282
GU$159.331
HI$159.331
IA$139.001
ID$139.851
IL$145.06–$157.394
IN$140.531
KS$138.621
KY$139.511
LA$139.39–$145.222
MA$154.09–$168.302
MD$150.82–$168.843
ME$140.64–$146.882
MI$142.74–$150.252
MN$148.401
MO$137.47–$145.463
MS$136.121
MT$149.631
NC$141.871
ND$146.461
NE$139.601
NH$152.541
NJ$160.46–$167.552
NM$143.471
NV$148.831
NY$143.69–$174.355
OH$142.091
OK$139.121
OR$147.70–$158.862
PA$142.19–$155.272
PR$150.511
RI$153.021
SC$142.211
SD$146.091
TN$139.231
TX$141.41–$154.208
UT$143.861
VA$146.58–$168.842
VI$150.511
VT$146.121
WA$153.72–$171.302
WI$142.281
WV$140.521
WY$148.251

Explore 64461 on the national rate map →

Where does this rate apply?

Wyoming** is a Medicare payment area. Our Census mapping connects it to 205 cities and communities in Wyoming, 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 Wyoming →

Why are the office and facility amounts different?

For 64461 in Wyoming**, the physician’s office rate is $148.25 and the facility-setting rate is $70.42: a difference of $77.83.

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 64461 in Wyoming**. This uses the base rate on this page, so the locality and release stay consistent.

Reference amount per service

$163.08

$148.25 × 110% = $163.08

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 64461 in Wyoming**.

PPRRVU2026_Oct_nonQPP.csv

7,117

Code
64461
Physician work
1.71
Practice expense
2.61
Malpractice
0.16

GPCI2026.csv

112

Locality
Wyoming**
Physician work
1.000
Practice expense
1.000
Malpractice
0.740
Office / nonfacility calculation for 64461 in Wyoming**
ComponentRVULocality factorAdjusted
Physician work1.71× 1.0001.7100
Practice expense2.61× 1.0002.6100
Malpractice0.16× 0.7400.1184
Total RVUs4.4384
Conversion factor× 33.4009

Office / nonfacility rate, Wyoming**$148.25

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

Open 64461 in the RVU calculator →

Explore RVUs, geographic factors and the full formula

Office / nonfacility

Office / nonfacility calculation inputs
ComponentRVULocal GPCI
Work1.711
Practice expense2.611
Malpractice0.160.74

(1.71 × 1 + 2.61 × 1 + 0.16 × 0.74) × $33.4009 = $148.25

Facility

Facility calculation inputs
ComponentRVULocal GPCI
Work1.711
Practice expense0.281
Malpractice0.160.74

(1.71 × 1 + 0.28 × 1 + 0.16 × 0.74) × $33.4009 = $70.42

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

64461 · Office / nonfacility

$148.25

Effective 2026-10-01

The base rate is $21.19 higher than on 2025-10-01, moving from $127.06 to $148.25 (16.7%).

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

    $127.06changed to$148.25

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 1.75 changed to 1.71
    • Practice expense RVU 2.06 changed to 2.61
    • Malpractice GPCI 0.739 changed to 0.740

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    Earliest loaded release: $127.06

    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$148.25$70.42RVU26D
2026-07-01$148.25$70.42RVU26C
2026-04-01$148.25$70.42RVU26B
2026-01-01$148.25$70.42RVU26A
2025-10-01$127.06$73.37RVU25D
2025-07-01$127.06$73.37RVU25C
2025-04-01$127.06$73.37RVU25B
2025-01-01$127.06$73.37RVU25A

64461 billing questions

When should 64462 be used instead?

Use 64461 for one thoracic paravertebral injection site. Code 64462 is the add-on for each additional site.

Can imaging guidance be billed separately?

Imaging guidance, when performed to place this block, is included in 64461 and should not be separately reported as guidance for the same service.

How is a bilateral block reported?

Report bilateral performance with modifier 50. CMS pays the bilateral procedure at 150%.

What should the procedure note support?

Document the thoracic paravertebral target, laterality, number of injection sites, medication, clinical indication, and imaging guidance if used.

Can an assistant or co-surgeon be billed?

Medicare does not pay an assistant at surgery for 64461. 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 64461PPRRVU2026_Oct_nonQPP.csv, line 7,117 (RVU26D)
Geographic factors for Wyoming**GPCI2026.csv, line 112 (RVU26D)
Open CMS sourceHow this rate is calculatedBuild a fee sheet