$144.71–$159.94
This code targets the sphenopalatine ganglion; 64510 targets the stellate ganglion. Select according to the structure actually blocked.
On this page
CMS RVU26D · Effective 2026-10-01
64505 Nerve block Medicare reimbursement rates in Pennsylvania
Reports delivery of anesthetic to the sphenopalatine ganglion, often for headache or facial pain when that ganglion is the treatment target. Compare 64505 office and facility rates across CMS payment localities in Pennsylvania.
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 64505 in Pennsylvania?
Pennsylvania has 2 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 2 payment areas shown below, using the same CMS release.
Office / nonfacility
$141.96–$157.37
2 of 2 localities have a supported rate.
Facility setting
$93.52–$102.44
2 of 2 localities have a supported rate.
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 64505: Sphenopalatine ganglion anesthetic block
Reports delivery of anesthetic to the sphenopalatine ganglion, often for headache or facial pain when that ganglion is the treatment target.
This service places anesthetic at the sphenopalatine ganglion to temporarily interrupt pain signaling. It is commonly used for selected headache syndromes, including cluster headache, and some facial pain conditions. Pain physicians, anesthesiologists, neurologists, or other qualified clinicians may perform the block in an office or procedure setting. A transnasal approach is common; the documented technique should show that the ganglion, rather than another nerve or nasal structure, was targeted.
Report the code when the service is directed to the sphenopalatine ganglion. Documentation should identify the indication, side, approach, and anesthetic delivery. 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 other procedures are subject to the standard 50% reduction. Bilateral reporting with modifier 50 is paid at 150%. Assistant-at-surgery payment is restricted; co-surgeons and team surgery are not permitted.
CMS billing rules for 64505
- Global period
- Minor procedure with a 0-day global period: same-day preoperative and postoperative care is included.
- Multiple procedures
- Standard multiple procedure reduction: the highest-valued procedure is paid in full and others at 50% when performed in the same session.
- Bilateral procedures
- Bilateral procedure with modifier 50 is paid at 150%.
- Assistant at surgery
- Statutory restriction: assistant at surgery is not paid.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU1.33 · 30%
- Practice expense (office) RVU2.79 · 62%
- Malpractice RVU0.38 · 8%
4.9K
Medicare services in 2024 · #1883 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.
64505 compared with similar codes
Office rates for Pennsylvania, from the same CMS release.
$114.11–$127.42
Use 64400 for anesthetic injection targeting a trigeminal nerve division or branch. This code is for the sphenopalatine ganglion.
$75.07–$82.42
Use 64405 when the greater occipital nerve is blocked. This code applies when the sphenopalatine ganglion is the target.
Compare 64505 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.
2 of 2 payment localities
Metropolitan Philadelphia →
Office / nonfacility
$157.37
Facility
$102.44
Rest Of Pennsylvania →
Office / nonfacility
$141.96
Facility
$93.52
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64505 billing questions
How is this different from a trigeminal nerve block?
Use this code when the sphenopalatine ganglion is the anesthetic target. A trigeminal nerve block is selected when the clinician targets a trigeminal nerve or branch instead.
What documentation supports reporting the block?
Record the clinical indication, the sphenopalatine ganglion as the target, the side treated, the approach, and anesthetic delivery. The note should distinguish the ganglion block from anesthesia applied to nasal tissue alone.
How should bilateral treatment be reported?
CMS identifies this as a bilateral procedure; report modifier 50 for bilateral service. CMS pays bilateral reporting at 150%.
Are same-day preoperative and postoperative services included?
Yes. The code has a 0-day global period, which includes same-day preoperative and postoperative care.
Can an assistant or co-surgeon be reported?
CMS does not pay an assistant at surgery for this code. Co-surgeons and team surgery are not permitted.
What happens when another procedure is performed in the same session?
The highest-valued procedure is paid in full; other procedures are subject to the standard multiple-procedure reduction, with payment at 50%.
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.
7,13764493,,Inj paravert f jnt l/s 1 lev,A,,1.48,4.08,,0.82,,0.14,5.70,2.44,0,000,0.00,0.00,0.00,2,1,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,13864494,,Inj paravert f jnt l/s 2 lev,A,,0.98,1.81,,0.25,,0.08,2.87,1.31,0,ZZZ,0.00,0.00,0.00,0,1,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,13964495,,Inj paravert f jnt l/s 3 lev,A,,0.98,1.90,,0.29,,0.08,2.96,1.35,0,ZZZ,0.00,0.00,0.00,0,1,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,14064505,,N block spenopalatine gangl,A,,1.33,2.79,,1.21,,0.38,4.50,2.92,0,000,0.00,0.00,0.00,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,14164510,,N block stellate ganglion,A,,1.19,3.31,,0.79,,0.11,4.61,2.09,0,000,0.00,0.00,0.00,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,14264517,,N block inj hypogas plxs,A,,2.15,3.72,,1.06,,0.20,6.07,3.41,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,14364520,,N block lumbar/thoracic,A,,1.32,5.81,,0.86,,0.12,7.25,2.30,0,000,0.00,0.00,0.00,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00