Billing code 64420: Intercostal blockMedicare rate & RVUs in Nevada
Reports injection of anesthetic, with or without steroid, near one intercostal nerve to relieve localized chest-wall pain or neuralgia.
Medicare pays $105.45 for 64420 in the office in Nevada (Nevada**). 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 64420 covers
An intercostal nerve block places local anesthetic, with or without steroid, near one nerve running beneath a rib to interrupt chest-wall pain. Anesthesiologists, pain physicians, and surgeons may perform it for localized pain after rib injury or thoracic surgery, or for intercostal neuralgia, in an office, procedure suite, or hospital.
Report 64420 for one targeted intercostal nerve; when additional intercostal nerves are blocked in the same session, report 64421 for each additional nerve. The record should identify the side and nerve or level treated, clinical indication, medication, technique, and response. CMS assigns a 0-day global period, so same-day preoperative and postoperative care is included. For bilateral treatment, modifier 50 is paid at 150%. When procedures are performed in the same session, the highest-valued procedure is paid in full and the others receive the standard multiple-procedure reduction. Assistant-at-surgery payment is statutorily restricted; 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.
64420 in Nevada**
| Payment locality | Office | Facility |
|---|---|---|
| Nevada** | $105.45 | $51.95 |
How the 64420 rate is calculated
Each of 64420’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 · 64420
RVUs × geographic indexes × conversion factor
Work1.05
1.05 RVUs× 1.000 GPCI
Practice expense2.03
2.03 RVUs× 1.000 GPCI
Malpractice0.09
0.09 RVUs× 1.000 GPCI
Adjusted RVUs
3.1700
Conversion factor
$33.4009
Medicare rate
$105.88
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 64420
The CMS indicators that decide how 64420 is paid alongside other services.
CMS payment indicators · 64420
Intercostal 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) | 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
64420 without 50 · national office
$105.88
Intercostal block
64420-50 · Bilateral: 150%
$158.82
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).
64420 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 64421Intercostal nerve block
- 64420 represents the first single intercostal nerve treated; 64421 reports each additional intercostal nerve in the same session.
- 64461Paravertebral block
- 64461 is a thoracic paravertebral block at one injection site. Use 64420 when the injection targets a specific intercostal nerve.
- 64466Thoracic block
- 64466 describes a thoracic fascial plane block, not an injection directed at one intercostal nerve.
64420 billing questions
When should I use 64420 instead of 64421?
Use 64420 for the first, single intercostal nerve treated. Report 64421 for each additional intercostal nerve blocked in the same session.
How is bilateral treatment reported?
For bilateral treatment, report modifier 50. CMS pays the bilateral procedure at 150%.
What documentation supports 64420?
Document the indication, side and intercostal nerve or level treated, medication and technique, and the patient's response.
Is same-day postoperative care included?
Yes. The 0-day global period includes same-day preoperative and postoperative care.
How does the multiple-procedure reduction affect 64420?
When it is performed with other procedures in the same session, the highest-valued procedure is paid in full and the others receive the standard 50% 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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