$221.91
Use 64490 for the primary cervical or thoracic facet level. Use 64491 only for an additional second level and report it with the primary-level service.
On this page
CMS RVU26D · Effective 2026-10-01
64491 Facet injection Medicare reimbursement rates in Guam
Reports an additional cervical or thoracic facet-joint injection level performed with a primary-level procedure during the same treatment session. Compare 64491 office and facility rates across CMS payment localities in Guam.
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 64491 in Guam?
Guam has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
$108.61
1 of 1 localities have a supported rate.
Payment area: Hawaii, Guam
One mapped payment locality.
Facility setting
$50.50
1 of 1 localities have a supported rate.
Payment area: Hawaii, Guam
One mapped payment locality.
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.
Pain management
About 64491: Cervical or thoracic facet injection, second level
Reports an additional cervical or thoracic facet-joint injection level performed with a primary-level procedure during the same treatment session.
This add-on code covers injection at a second cervical or thoracic paravertebral facet-joint level, or the nerves supplying that joint, commonly for diagnostic evaluation or treatment of suspected facet-mediated neck or upper-back pain. Pain-management physicians and other qualified practitioners perform the procedure, often using imaging to guide needle placement. The code is specific to the cervical or thoracic region; lumbar facet levels are reported from a separate code family.
Report 64491 with the primary-level code 64490 when a second level is treated; it is not reported by itself. Documentation should identify the spinal region, each treated level and side, and the procedure performed. Imaging guidance is included in the facet-injection service. CMS treats 64491 as an add-on paid within the primary procedure’s global period. For a bilateral procedure reported with modifier 50, CMS pays 150% of the applicable amount.
CMS billing rules for 64491
- Global period
- Add-on code: billed only together with a primary procedure and paid within that procedure's global period.
- Bilateral procedures
- Bilateral procedure with modifier 50 is paid at 150%.
Where the value comes from
- Work RVU1.13 · 37%
- Practice expense (office) RVU1.81 · 59%
- Malpractice RVU0.11 · 4%
134K
Medicare services in 2024 · #477 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.
64491 compared with similar codes
Office rates for Guam, from the same CMS release.
$109.36
64492 represents an additional cervical or thoracic level beyond the second; 64491 represents the second level.
$103.02
64494 is the additional second-level code for lumbar or sacral facet injections. Choose 64491 when the treated levels are cervical or thoracic.
Compare 64491 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.
1 of 1 payment localities
Hawaii, Guam →
Office / nonfacility
$108.61
Facility
$50.50
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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 64491 in Hawaii, Guam.
PPRRVU2026_Oct_nonQPP.csv
7,135
- Code
- 64491
- Physician work
- 1.13
- Practice expense
- 1.81
- Malpractice
- 0.11
GPCI2026.csv
46
- Locality
- Hawaii, Guam
- Physician work
- 1.000
- Practice expense
- 1.137
- Malpractice
- 0.579
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 1.13 | × 1.000 | 1.1300 |
| Practice expense | 1.81 | × 1.137 | 2.0580 |
| Malpractice | 0.11 | × 0.579 | 0.0637 |
| Total RVUs | 3.2517 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Hawaii, Guam$108.61
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 1.13 | 1 |
| Practice expense | 1.81 | 1.137 |
| Malpractice | 0.11 | 0.579 |
(1.13 × 1 + 1.81 × 1.137 + 0.11 × 0.579) × $33.4009 = $108.61
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 1.13 | 1 |
| Practice expense | 0.28 | 1.137 |
| Malpractice | 0.11 | 0.579 |
(1.13 × 1 + 0.28 × 1.137 + 0.11 × 0.579) × $33.4009 = $50.50
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.
64491 billing questions
When is 64491 reported with 64490?
Report 64491 for a second cervical or thoracic facet-joint level in the same session as the primary-level service reported with 64490. It cannot be reported alone.
How does 64491 differ from 64490?
64490 represents the primary level; 64491 represents the additional second level. The documentation should show that a distinct second level was treated.
Can 64491 be reported with 64492?
When a third cervical or thoracic level is treated, 64492 is the additional-level code for that level, alongside the primary-level service. The record should support each treated level.
How is bilateral treatment handled?
For a bilateral procedure, CMS pays 150% when modifier 50 is used. Document the treated side or sides and levels.
Is imaging guidance separately reported?
Imaging guidance is included in the facet-injection service. Do not separately report guidance for the injection represented by 64491.
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.
7,13264488,,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
7,13864494,,Inj paravert f jnt l/s 2 lev,A,,0.98,1.81,,0.25,,0.08,2.87,1.31,0,ZZZ,0.00,0.00,0.00,0,1,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4309102,FL,99,REST OF FLORIDA,1.000,0.956,1.503
4410212,GA,01,ATLANTA,1.003,1.016,1.201
4510212,GA,99,REST OF GEORGIA,1.000,0.892,1.192
4601212,HI,01,"HAWAII, GUAM",1.000,1.137,0.579
4702202,ID,00,IDAHO,1.000,0.920,0.473
4806102,IL,16,CHICAGO,1.007,1.005,2.295
4906102,IL,12,EAST ST. LOUIS,1.000,0.920,2.014