$106.61–$131.04
64490 is for one cervical or thoracic level; 64491 is used for an additional level in that region.
On this page
CMS RVU26D · Effective 2026-10-01
64490 Facet injection Medicare reimbursement rates in California
Image-guided injection of a cervical or thoracic facet joint or its supplying nerve at one level for suspected facet-mediated pain. Compare 64490 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 64490 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
$216.92–$270.96
29 of 29 localities have a supported rate.
Lowest: Chico
Highest: San Jose-Sunnyvale-Santa Clara (San Benito Cnty)
A spread of $54.04 per service.
Facility setting
$95.38–$111.05
29 of 29 localities have a supported rate.
Lowest: Chico
Highest: San Jose-Sunnyvale-Santa Clara (San Benito Cnty)
A spread of $15.67 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 64490 pays more and less in California
29 payment localities
$216.92 to $270.96
Pain management
About 64490: Cervical or thoracic facet injection, one level
Image-guided injection of a cervical or thoracic facet joint or its supplying nerve at one level for suspected facet-mediated pain.
Code 64490 represents an image-guided injection directed to a cervical or thoracic facet joint, or a nerve supplying that joint, at one spinal level. Pain physicians, anesthesiologists, physiatrists, and interventional radiologists commonly perform it for suspected facet-mediated neck or upper-back pain, including diagnostic blocks used to assess the facet joint as a pain source. The target is a facet joint or its supplying nerve, rather than a spinal nerve root approached through the foramen.
Report one unit for one treated level; use the cervical/thoracic additional-level codes when more levels are treated, and distinguish this region from the lumbar series. Document the spinal region, level, side, target, clinical indication, and image-guided technique. Fluoroscopy or CT guidance is included in the service. CMS assigns a 0-day global period, so same-day preoperative and postoperative care is included. With modifier 50, bilateral payment is 150%. In a same-session multiple-procedure situation, the highest-valued procedure is paid in full and others at 50%. Assistant-at-surgery payment may be made; co-surgeons and team surgery are not permitted.
CMS billing rules for 64490
- 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
- Assistant at surgery may be paid.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU1.77 · 29%
- Practice expense (office) RVU4.20 · 68%
- Malpractice RVU0.17 · 3%
220.8K
Medicare services in 2024 · #365 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.
64490 compared with similar codes
Office rates for California, from the same CMS release.
$107.35–$132.13
64492 represents a further additional cervical or thoracic level, not the first level treated.
$202.14–$253.89
64493 is the single-level code for lumbar or sacral facet injection; 64490 is for cervical or thoracic treatment.
$303.00–$380.54
64479 describes a cervical or thoracic transforaminal epidural injection targeting the nerve-root region, rather than a facet joint or its supplying nerve.
Compare 64490 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 $217.45 | Facility $95.92 |
| Chico | Office $216.92 | Facility $95.38 |
| El Centro | Office $216.95 | Facility $95.41 |
| Fresno | Office $216.92 | Facility $95.38 |
| Hanford-Corcoran | Office $216.92 | Facility $95.38 |
| Los Angeles-Long Beach-Anaheim (Los Angeles/Orange Cnty) | Office $231.27 | Facility $100.09 |
| Madera | Office $216.92 | Facility $95.38 |
| Merced | Office $216.92 | Facility $95.38 |
| Modesto | Office $216.92 | Facility $95.38 |
| Napa | Office $250.62 | Facility $104.47 |
| Oxnard-Thousand Oaks-Ventura | Office $230.13 | Facility $99.05 |
| Redding | Office $216.92 | Facility $95.38 |
| Rest Of California | Office $216.92 | Facility $95.38 |
| Riverside-San Bernardino-Ontario | Office $218.78 | Facility $97.24 |
| Sacramento-Roseville-Folsom | Office $227.44 | Facility $98.48 |
| Salinas | Office $226.58 | Facility $98.06 |
| San Diego-Chula Vista-Carlsbad | Office $231.75 | Facility $99.12 |
| San Francisco-Oakland-Berkeley (Marin Cnty) | Office $265.14 | Facility $108.79 |
| San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty) | Office $264.95 | Facility $108.59 |
| San Jose-Sunnyvale-Santa Clara (San Benito Cnty) | Office $270.96 | Facility $111.05 |
| San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty) | Office $270.17 | Facility $110.26 |
| San Luis Obispo-Paso Robles | Office $222.95 | Facility $96.65 |
| Santa Cruz-Watsonville | Office $233.85 | Facility $99.12 |
| Santa Maria-Santa Barbara | Office $227.39 | Facility $98.09 |
| Santa Rosa-Petaluma | Office $236.21 | Facility $100.03 |
| Stockton | Office $216.92 | Facility $95.38 |
| Vallejo | Office $250.34 | Facility $104.19 |
| Visalia | Office $216.92 | Facility $95.38 |
| Yuba City | Office $216.92 | Facility $95.38 |
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64490 billing questions
When should 64490 be chosen over 64491 or 64492?
Use 64490 for one cervical or thoracic level. The additional-level codes apply when more levels in that region are treated during the session.
Can fluoroscopy or CT guidance be billed separately?
No. Image guidance is included in this facet injection service.
How is a bilateral injection reported?
Report modifier 50 for bilateral treatment; CMS pays the bilateral procedure at 150%.
What documentation supports reporting 64490?
Record the cervical or thoracic region, treated level and side, facet joint or supplying nerve targeted, clinical reason, and image-guided technique.
Is same-day evaluation and postoperative care separately included?
The 0-day global period includes same-day preoperative and postoperative care.
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.
7,13164487,,Tap block uni by infusion,A,,1.36,5.88,,0.21,,0.11,7.35,1.68,0,000,0.00,0.00,0.00,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,13264488,,Tap block bi injection,A,,1.37,2.93,,0.21,,0.12,4.42,1.70,0,000,0.00,0.00,0.00,2,2,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,13364489,,Tap block bi by infusion,A,,1.71,10.21,,0.26,,0.15,12.07,2.12,0,000,0.00,0.00,0.00,2,2,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,13464490,,Inj paravert f jnt c/t 1 lev,A,,1.77,4.20,,0.88,,0.17,6.14,2.82,0,000,0.00,0.00,0.00,2,1,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,13564491,,Inj paravert f jnt c/t 2 lev,A,,1.13,1.81,,0.28,,0.11,3.05,1.52,0,ZZZ,0.00,0.00,0.00,0,1,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,13664492,,Inj paravert f jnt c/t 3 lev,A,,1.13,1.84,,0.31,,0.09,3.06,1.53,0,ZZZ,0.00,0.00,0.00,0,1,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,13764493,,Inj paravert f jnt l/s 1 lev,A,,1.48,4.08,,0.82,,0.14,5.70,2.44,0,000,0.00,0.00,0.00,2,1,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00