$144.71–$159.94
Choose 64510 for an injection targeting the stellate ganglion. Code 64520 is for a lumbar or thoracic sympathetic-chain target.
On this page
CMS RVU26D · Effective 2026-10-01
64520 Sympathetic block Medicare reimbursement rates in Pennsylvania
Reports an anesthetic injection to a lumbar or thoracic sympathetic chain, commonly used to evaluate or treat sympathetically maintained pain. Compare 64520 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 64520 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
$226.02–$251.68
2 of 2 localities have a supported rate.
Facility setting
$74.25–$79.57
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 64520: Lumbar or thoracic sympathetic block
Reports an anesthetic injection to a lumbar or thoracic sympathetic chain, commonly used to evaluate or treat sympathetically maintained pain.
This service places an anesthetic injection near a lumbar or thoracic sympathetic chain to interrupt sympathetic nerve activity. Pain medicine physicians and anesthesiologists commonly perform it for diagnostic or therapeutic management of sympathetically maintained pain, including pain associated with complex regional pain syndrome. The block may be performed in an office or facility setting, with the target selected according to the clinical problem and anatomy.
Report the code for the lumbar or thoracic sympathetic target, not for a block of a different plexus or ganglion. Documentation should identify the indication, treated side and target, injection performed, and relevant response when assessed. The code has a 0-day global period, so same-day preoperative and postoperative care is included. When multiple procedures are performed in one session, Medicare pays the highest-valued procedure in full and applies a 50% reduction to the others. 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 64520
- 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 RVU1.32 · 18%
- Practice expense (office) RVU5.81 · 80%
- Malpractice RVU0.12 · 2%
11.3K
Medicare services in 2024 · #1410 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.
64520 compared with similar codes
Office rates for Pennsylvania, from the same CMS release.
$192.19–$210.42
Code 64517 identifies a hypogastric plexus injection; 64520 is selected when the documented target is the lumbar or thoracic sympathetic chain.
$220.83–$245.06
Code 64530 is for a celiac plexus injection. Use 64520 for the lumbar or thoracic sympathetic-chain target instead.
Compare 64520 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
$251.68
Facility
$79.57
Rest Of Pennsylvania →
Office / nonfacility
$226.02
Facility
$74.25
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64520 billing questions
How is this code different from a stellate ganglion block?
This code is for a lumbar or thoracic sympathetic-chain target. Use the stellate ganglion code, 64510, when the injection targets the stellate ganglion.
Can the code be reported bilaterally?
Yes. CMS specifies modifier 50 for bilateral reporting, with payment at 150%.
What does the 0-day global period include?
Same-day preoperative and postoperative care is included in the procedure payment.
How are other same-session procedures paid?
Under the standard multiple-procedure reduction, the highest-valued procedure is paid in full and the other procedures are paid at 50%.
Can an assistant, co-surgeon, or surgical team be reported?
Medicare does not pay an assistant at surgery for this code. 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 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.
7,14064505,,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
7,14464530,,N block inj celiac pelus,A,,1.54,5.37,,0.87,,0.15,7.06,2.56,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,14564553,,Implant neuroelectrodes,A,,5.98,136.45,,5.00,,2.52,144.95,13.50,0,010,0.10,0.80,0.10,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,14664555,,Implant neuroelectrodes,A,,5.62,60.37,,2.60,,0.58,66.57,8.80,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00