Billing code 64418: Nerve injectionMedicare rate & RVUs in Massachusetts
Report this service for an anesthetic and/or steroid injection targeting the suprascapular nerve to evaluate or relieve shoulder pain.
Medicare pays $92.35–$100.69 for 64418 in the office in Massachusetts, from Rest Of Massachusetts to Metropolitan Boston. Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 9 sections
What 64418 covers
The clinician places an injection at the suprascapular nerve, which supplies sensation to parts of the shoulder. Pain medicine physicians, anesthesiologists, physiatrists, and other clinicians may use the block diagnostically or therapeutically for shoulder pain, including pain associated with rotator cuff disease or glenohumeral arthritis. The injected medication may be anesthetic, steroid, or both; the service is defined by the nerve targeted, not simply by an injection into the shoulder joint.
Report 64418 when documentation identifies the suprascapular nerve as the injection target and supports the clinical indication, side, approach, and medication administered. The code has a 0-day global period, so same-day preoperative and postoperative care is included. For bilateral treatment, modifier 50 is paid at 150%. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Medicare does not pay an assistant at surgery for this service; co-surgeons and team surgery are not permitted.
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.
Where 64418 pays more and less in Massachusetts
| Payment locality | Office | Facility |
|---|---|---|
| Metropolitan Boston | $100.69 | $50.84 |
| Rest Of Massachusetts | $92.35 | $48.38 |
How the 64418 rate is calculated
Each of 64418’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 64418
RVUs × geographic indexes × conversion factor
Work1.07
1.07 RVUs× 1.000 GPCI
Practice expense1.51
1.51 RVUs× 1.000 GPCI
Malpractice0.11
0.11 RVUs× 1.000 GPCI
Adjusted RVUs
2.6900
Conversion factor
$33.4009
Medicare rate
$89.85
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 64418
The CMS indicators that decide how 64418 is paid alongside other services.
CMS payment indicators · 64418
Nerve injection
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 000 | Same-day global: pre- and post-op care on the day of the procedure is included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 1 | Bilateral with modifier 50 pays 150% of the fee schedule amount. |
| Assistant at surgery (80/81/82/AS) | 1 | Not paid (statutory restriction). |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
What modifiers do to the payment
Modifier 50 · payment effect
With and without the modifier
64418 without 50 · national office
$89.85
Nerve injection
64418-50 · Bilateral: 150%
$134.78
Both sides on one line with modifier 50 are paid at 150% of the fee schedule amount (subject to multiple-procedure rules with other procedures).
64418 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 64417Axillary nerve block
- 64418 identifies the suprascapular nerve as the target; 64417 targets the axillary nerve. Choose according to the nerve injected, not merely the shoulder diagnosis.
- 64415Brachial plexus block
- 64415 is for a brachial plexus injection, while 64418 specifically targets the suprascapular nerve.
- 64450Nerve block
- Use 64418 for the specifically named suprascapular nerve. Use 64450 when the injected peripheral nerve or branch lacks a more specific code.
64418 billing questions
How is 64418 different from a shoulder joint injection?
64418 targets the suprascapular nerve. An injection placed into the shoulder joint itself is a different service and should not be selected based only on the shared shoulder-pain indication.
When should 64450 be considered instead?
Use 64418 when the suprascapular nerve is the target. Code 64450 is for an injection targeting a peripheral nerve or branch without a more specific code for that nerve.
What documentation supports reporting 64418?
Document the shoulder-pain indication, the suprascapular nerve as the target, laterality, injection approach, and medication administered.
Can ultrasound guidance be reported separately?
When ultrasound needle guidance is performed and documented, 76942 may be separately reportable. The record should support the guidance service as well as the nerve injection.
How does Medicare pay when both sides are treated?
For bilateral treatment, Medicare pays 150% when the service is reported with modifier 50.
What happens when another procedure is performed in the same session?
The highest-valued procedure is paid in full, and other procedures in that session are subject to 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 indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file lines behind this rate
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