Billing code 64490: Facet injectionMedicare rate & RVUs in Massachusetts
Image-guided injection of a cervical or thoracic facet joint or its supplying nerve at one level for suspected facet-mediated pain.
Medicare pays $212.31–$234.10 for 64490 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 64490 covers
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.
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 64490 pays more and less in Massachusetts
| Payment locality | Office | Facility |
|---|---|---|
| Metropolitan Boston | $234.10 | $101.69 |
| Rest Of Massachusetts | $212.31 | $95.54 |
How the 64490 rate is calculated
Each of 64490’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 · 64490
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 1.77Practice expense 4.20Malpractice 0.17
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 64490
The CMS indicators that decide how 64490 is paid alongside other services.
CMS payment indicators · 64490
Facet 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) | 2 | Paid. |
| 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
64490 without 50 · national office
$205.08
Facet injection
64490-50 · Bilateral: 150%
$307.62
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).
64490 compared with similar codes
Compare codes
64490 vs 64491 vs 64492 vs 64493 vs 64479: national Medicare rates
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How to choose
- 64491Facet injection
- 64490 is for one cervical or thoracic level; 64491 is used for an additional level in that region.
- 64492Facet injection
- 64492 represents a further additional cervical or thoracic level, not the first level treated.
- 64493Facet joint injection
- 64493 is the single-level code for lumbar or sacral facet injection; 64490 is for cervical or thoracic treatment.
- 64479Epidural injection
- 64479 describes a cervical or thoracic transforaminal epidural injection targeting the nerve-root region, rather than a facet joint or its supplying nerve.
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 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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