Billing code 64517: Plexus blockMedicare rate & RVUs in Missouri
An anesthetic injection targeting the hypogastric plexus is reported for diagnostic or therapeutic management of visceral pelvic pain.
Medicare pays $185.42–$196.79 for 64517 in the office in Missouri, from Rest Of Missouri to Metropolitan St. Louis. 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 64517 covers
This procedure places an anesthetic agent at the hypogastric plexus to interrupt pain signaling from pelvic viscera. Pain medicine physicians, anesthesiologists, and other clinicians who perform image-guided pain procedures commonly use it for persistent pelvic pain, including pain associated with pelvic malignancy. The treatment target is the hypogastric plexus, not the celiac plexus or a lumbar sympathetic chain target.
Report the code when the documented service is an anesthetic injection directed to the hypogastric plexus. The record should identify the pain indication, intended plexus, injection performed, and relevant response or outcome. CMS assigns a 0-day global period, so same-day preoperative and postoperative care is included. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and the others are subject to the standard 50% reduction. Modifier 50 is inappropriate. 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 64517 pays more and less in Missouri
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
3 payment localities
$185.42 to $196.79
| Payment locality | Office | Facility |
|---|---|---|
| Metropolitan Kansas City | $195.01 | $111.58 |
| Metropolitan St. Louis | $196.79 | $112.21 |
| Rest Of Missouri | $185.42 | $108.84 |
How the 64517 rate is calculated
Each of 64517’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 · 64517
RVUs × geographic indexes × conversion factor
Work2.15
2.15 RVUs× 1.000 GPCI
Practice expense3.72
3.72 RVUs× 1.000 GPCI
Malpractice0.20
0.20 RVUs× 1.000 GPCI
Adjusted RVUs
6.0700
Conversion factor
$33.4009
Medicare rate
$202.74
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 64517
The CMS indicators that decide how 64517 is paid alongside other services.
CMS payment indicators · 64517
Plexus block
| 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) | 0 | The 150% bilateral adjustment doesn’t apply. |
| 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 51 · payment effect
With and without the modifier
64517 without 51 · national office
$202.74
Plexus block
64517-51 · Second procedure: 50%
$101.37
When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).
64517 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 64530Celiac plexus block
- Choose 64517 for an injection directed to the hypogastric plexus in pelvic pain management. Choose 64530 when the target is the celiac plexus.
- 64520Sympathetic block
- 64520 describes injection at a lumbar or thoracic sympathetic target. It is not the code for an injection directed to the hypogastric plexus.
- 64510Nerve block
- 64510 is for injection at the stellate ganglion, a different target from the hypogastric plexus.
64517 billing questions
How is this code distinguished from a celiac plexus injection?
Use this code when the injection targets the hypogastric plexus for pelvic visceral pain. A celiac plexus injection targets a different plexus and is reported with 64530.
Should modifier 50 be appended for bilateral treatment?
No. CMS identifies bilateral adjustment as inappropriate for this code, so do not report modifier 50.
Is same-day postoperative care separately included?
No. The 0-day global period includes same-day preoperative and postoperative care.
How does the multiple-procedure reduction affect payment?
When other procedures are performed in the same session, the highest-valued procedure is paid in full and the other procedures are paid at 50% under the standard multiple-procedure reduction.
Can an assistant or co-surgeon be reported?
Medicare does not pay an assistant at surgery for this service. Co-surgeons and team surgery are not permitted.
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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