$98.30
64420 represents the first intercostal nerve blocked. Use 64421 only for additional intercostal nerves and report it with 64420.
On this page
CMS RVU26D · Effective 2026-10-01
64421 Intercostal nerve block Medicare reimbursement rates in Iowa
Reports anesthetic blockade of each intercostal nerve beyond the first, such as for chest wall pain managed with a regional block. Compare 64421 office and facility rates across CMS payment localities in Iowa.
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 64421 in Iowa?
Iowa 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
$32.62
1 of 1 localities have a supported rate.
Payment area: Iowa
One mapped payment locality.
Facility setting
$20.39
1 of 1 localities have a supported rate.
Payment area: Iowa
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 64421: Additional intercostal nerve block
Reports anesthetic blockade of each intercostal nerve beyond the first, such as for chest wall pain managed with a regional block.
This add-on represents anesthetic blockade of additional intercostal nerves after the first nerve is blocked. Physicians, anesthesiologists, and pain specialists may use multiple intercostal blocks for chest wall analgesia, including pain related to rib injuries or thoracic procedures. The service targets individual nerves supplying the chest wall rather than a broader thoracic regional approach.
Report 64421 with 64420 for the first intercostal nerve; use 64421 for each additional nerve treated. The procedure note should identify the nerves and side treated, the anesthetic administered, and the clinical reason for blocking multiple nerves. CMS classifies 64421 as an add-on code: it is billed only with a primary procedure and paid within that procedure’s global period. For a bilateral procedure reported with modifier 50, CMS pays 150%.
CMS billing rules for 64421
- 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 RVU0.49 · 47%
- Practice expense (office) RVU0.51 · 49%
- Malpractice RVU0.05 · 5%
20.3K
Medicare services in 2024 · #1140 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.
64421 compared with similar codes
Office rates for Iowa, from the same CMS release.
$139.00
64461 describes a thoracic paravertebral block. Choose it when that regional approach is performed rather than individual intercostal nerve blocks.
$73.17
64462 represents an additional thoracic paravertebral injection site when paired with 64461; it is not the add-on for additional intercostal nerves.
Compare 64421 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
Iowa →
Office / nonfacility
$32.62
Facility
$20.39
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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 64421 in Iowa.
PPRRVU2026_Oct_nonQPP.csv
7,104
- Code
- 64421
- Physician work
- 0.49
- Practice expense
- 0.51
- Malpractice
- 0.05
GPCI2026.csv
53
- Locality
- Iowa
- Physician work
- 1.000
- Practice expense
- 0.915
- Malpractice
- 0.397
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 0.49 | × 1.000 | 0.4900 |
| Practice expense | 0.51 | × 0.915 | 0.4667 |
| Malpractice | 0.05 | × 0.397 | 0.0199 |
| Total RVUs | 0.9765 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Iowa$32.62
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 0.49 | 1 |
| Practice expense | 0.51 | 0.915 |
| Malpractice | 0.05 | 0.397 |
(0.49 × 1 + 0.51 × 0.915 + 0.05 × 0.397) × $33.4009 = $32.62
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 0.49 | 1 |
| Practice expense | 0.11 | 0.915 |
| Malpractice | 0.05 | 0.397 |
(0.49 × 1 + 0.11 × 0.915 + 0.05 × 0.397) × $33.4009 = $20.39
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.
64421 billing questions
When is 64421 reported instead of 64420?
64420 represents the initial intercostal nerve block. Report 64421 for each additional intercostal nerve blocked in the same service.
Which primary code must accompany 64421?
Report 64421 with 64420 for the initial intercostal nerve block. CMS treats 64421 as an add-on code and pays it within the primary procedure’s global period.
What should the procedure note identify?
Document the clinical reason for the blocks, the intercostal nerves and side treated, and the anesthetic administered. The record should support that additional nerves beyond the first were blocked.
How is a bilateral procedure handled?
CMS pays a bilateral procedure reported with modifier 50 at 150%. The documentation should support treatment on both sides.
Is 64421 reported for every nerve injected?
Use 64420 for the first intercostal nerve and 64421 for each additional nerve. The documented nerve count should support the reported additional services.
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.
7,10164417,,Njx aa&/strd ax nerve img,A,,1.28,4.16,,0.43,,0.13,5.57,1.84,0,000,0.00,0.00,0.00,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,10264418,,Njx aa&/strd sprscap nrv,A,,1.07,1.51,,0.26,,0.11,2.69,1.44,0,000,0.00,0.00,0.00,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,10364420,,Njx aa&/strd ntrcost nrv 1,A,,1.05,2.03,,0.43,,0.09,3.17,1.57,0,000,0.00,0.00,0.00,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,10464421,,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
5006102,IL,15,SUBURBAN CHICAGO,1.007,1.027,1.772
5106102,IL,99,REST OF ILLINOIS,1.000,0.913,1.563
5208102,IN,00,INDIANA,1.000,0.927,0.486
5305102,IA,00,IOWA,1.000,0.915,0.397
5405202,KS,00,KANSAS,1.000,0.904,0.504
5515102,KY,00,KENTUCKY,1.000,0.889,0.915
5607202,LA,01,NEW ORLEANS,1.000,0.941,1.136