$100.42–$124.03
64435 targets the paracervical (uterine) nerve; 64430 is for a pudendal nerve injection. Choose based on the documented nerve targeted.
On this page
CMS RVU26D · Effective 2026-10-01
64435 Nerve block Medicare reimbursement rates in California
Reports injection around a paracervical uterine nerve to provide regional anesthesia or pain relief during cervical or uterine care. Compare 64435 office and facility rates across CMS payment localities in California.
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.
What does Medicare pay for 64435 in California?
California has 29 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 29 payment areas shown below, using the same CMS release.
Office / nonfacility
$78.01–$96.34
29 of 29 localities have a supported rate.
Lowest: Chico
Highest: San Jose-Sunnyvale-Santa Clara (San Benito Cnty)
A spread of $18.33 per service.
Facility setting
$38.11–$43.84
29 of 29 localities have a supported rate.
Lowest: Chico
Highest: San Jose-Sunnyvale-Santa Clara (San Benito Cnty)
A spread of $5.73 per service.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Where 64435 pays more and less in California
29 payment localities
$78.01 to $96.34
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 California, from the same CMS release.
$128.25–$160.76
64425 describes injection of the ilioinguinal or iliohypogastric nerves. It is not selected for a paracervical nerve block.
$85.35–$106.34
64450 is for an eligible peripheral nerve or branch without a more specific code. Use 64435 when the documented target is the paracervical nerve.
Compare 64435 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
29 of 29 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Bakersfield | Office $78.37 | Facility $38.47 |
| Chico | Office $78.01 | Facility $38.11 |
| El Centro | Office $78.03 | Facility $38.13 |
| Fresno | Office $78.01 | Facility $38.11 |
| Hanford-Corcoran | Office $78.01 | Facility $38.11 |
| Los Angeles-Long Beach-Anaheim (Los Angeles/Orange Cnty) | Office $83.19 | Facility $40.12 |
| Madera | Office $78.01 | Facility $38.11 |
| Merced | Office $78.01 | Facility $38.11 |
| Modesto | Office $78.01 | Facility $38.11 |
| Napa | Office $89.32 | Facility $41.33 |
| Oxnard-Thousand Oaks-Ventura | Office $82.65 | Facility $39.61 |
| Redding | Office $78.01 | Facility $38.11 |
| Rest Of California | Office $78.01 | Facility $38.11 |
| Riverside-San Bernardino-Ontario | Office $79.41 | Facility $39.51 |
| Sacramento-Roseville-Folsom | Office $81.58 | Facility $39.24 |
| Salinas | Office $81.28 | Facility $39.08 |
| San Diego-Chula Vista-Carlsbad | Office $82.99 | Facility $39.45 |
| San Francisco-Oakland-Berkeley (Marin Cnty) | Office $94.15 | Facility $42.82 |
| San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty) | Office $94.01 | Facility $42.67 |
| San Jose-Sunnyvale-Santa Clara (San Benito Cnty) | Office $96.34 | Facility $43.84 |
| San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty) | Office $95.74 | Facility $43.24 |
| San Luis Obispo-Paso Robles | Office $80.01 | Facility $38.54 |
| Santa Cruz-Watsonville | Office $83.63 | Facility $39.40 |
| Santa Maria-Santa Barbara | Office $81.53 | Facility $39.08 |
| Santa Rosa-Petaluma | Office $84.45 | Facility $39.75 |
| Stockton | Office $78.01 | Facility $38.11 |
| Vallejo | Office $89.10 | Facility $41.12 |
| Visalia | Office $78.01 | Facility $38.11 |
| Yuba City | Office $78.01 | Facility $38.11 |
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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.
7,10464421,,Njx aa&/strd ntrcost nrv ea,A,,0.49,0.51,,0.11,,0.05,1.05,0.65,0,ZZZ,0.00,0.00,0.00,0,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,10564425,,Njx aa&/strd ii ih nerves,A,,0.98,2.55,,0.42,,0.09,3.62,1.49,0,000,0.00,0.00,0.00,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,10664430,,Njx aa&/strd pudendal nerve,A,,0.98,1.78,,0.37,,0.11,2.87,1.46,0,000,0.00,0.00,0.00,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,10764435,,Njx aa&/strd paracrv nrv,A,,0.73,1.39,,0.30,,0.13,2.25,1.16,0,000,0.00,0.00,0.00,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,10864445,,Njx aa&/strd sciatic nrv img,A,,1.36,3.68,,0.47,,0.15,5.19,1.98,0,000,0.00,0.00,0.00,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,10964446,,Njx aa&/strd sc nrv nfs img,A,,1.71,0.26,NA,0.26,,0.15,2.12,2.12,0,000,0.00,0.00,0.00,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,11064447,,Njx aa&/strd femoral nrv img,A,,1.31,2.59,,0.39,,0.12,4.02,1.82,0,000,0.00,0.00,0.00,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00