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CMS RVU26D · Effective 2026-10-01

64408 Vagus nerve block Medicare reimbursement rates in Tennessee

Injection of anesthetic around the vagus nerve for a diagnostic or therapeutic block, including selected vagal sensory blocks for neurogenic cough. Compare 64408 office and facility rates across CMS payment localities in Tennessee.

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 64408 in Tennessee?

Tennessee has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.

Office / nonfacility

$73.42

1 of 1 localities have a supported rate.

Payment area: Tennessee

One mapped payment locality.

Facility setting

$36.07

1 of 1 localities have a supported rate.

Payment area: Tennessee

One mapped payment locality.

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.

Find 64408 in your payment locality →

Peripheral nerve block

About 64408: Vagus nerve anesthetic injection

Injection of anesthetic around the vagus nerve for a diagnostic or therapeutic block, including selected vagal sensory blocks for neurogenic cough.

This service places anesthetic at the vagus nerve to interrupt or assess nerve-mediated symptoms. A recognized clinical use is a vagal sensory block, including a superior laryngeal nerve block, for selected patients with neurogenic cough. Pain physicians, anesthesiologists, and otolaryngologists may perform the injection in an office or procedural setting; the record should identify the nerve target, side, indication, and technique.

Select 64408 when the documented target is the vagus nerve, rather than another named nerve or an unspecified peripheral nerve. The code has 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 at 50%. For bilateral treatment, modifier 50 is paid at 150%. Assistant-at-surgery payment requires documented medical necessity; co-surgeons and team surgery are not permitted.

CMS billing rules for 64408

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
Assistant at surgery is paid only with documentation of medical necessity.
Co-surgeons
Co-surgeons not permitted.
Team surgery
Team surgery not permitted.

Where the value comes from

  • Work RVU0.73 · 31%
  • Practice expense (office) RVU1.55 · 65%
  • Malpractice RVU0.11 · 5%

2.3K

Medicare services in 2024 · #2351 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.

64408 compared with similar codes

Office rates for Tennessee, from the same CMS release.

64400

Nerve block

Trigeminal nerve or branch

$110.43

64400 identifies a trigeminal nerve injection, used for a cranial nerve target in the trigeminal distribution. Choose 64408 when the documented target is the vagus nerve.

64405

Occipital nerve block

Greater occipital nerve

$71.84

64405 is specific to the greater occipital nerve. It is not interchangeable with a block directed at the vagus nerve.

64450

Nerve block

Other peripheral nerve or branch

$74.82

64450 is for an other peripheral nerve or branch without a more specific code. Use 64408 when the vagus nerve is the documented target.

Compare 64408 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.

1 of 1 payment localities

Office and facility base rates · shared scale starting at $0

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How this local rate is calculated

Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 64408 in Tennessee.

PPRRVU2026_Oct_nonQPP.csv

7,098

Code
64408
Physician work
0.73
Practice expense
1.55
Malpractice
0.11

GPCI2026.csv

95

Locality
Tennessee
Physician work
1.000
Practice expense
0.909
Malpractice
0.537
Office / nonfacility calculation for 64408 in Tennessee
ComponentRVULocality factorAdjusted
Physician work0.73× 1.0000.7300
Practice expense1.55× 0.9091.4090
Malpractice0.11× 0.5370.0591
Total RVUs2.1980
Conversion factor× 33.4009

Office / nonfacility rate, Tennessee$73.42

Explore RVUs, geographic factors and the full formula

Office / nonfacility

Office / nonfacility calculation inputs
ComponentRVULocal GPCI
Work0.731
Practice expense1.550.909
Malpractice0.110.537

(0.73 × 1 + 1.55 × 0.909 + 0.11 × 0.537) × $33.4009 = $73.42

Facility

Facility calculation inputs
ComponentRVULocal GPCI
Work0.731
Practice expense0.320.909
Malpractice0.110.537

(0.73 × 1 + 0.32 × 0.909 + 0.11 × 0.537) × $33.4009 = $36.07

The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.

64408 billing questions

When should 64408 be selected instead of 64450?

Use 64408 when the documented injection target is the vagus nerve. Code 64450 describes an injection of an other peripheral nerve or branch when a more specific code does not identify the target.

Can 64408 be reported for a neurogenic cough block?

It may describe a vagal sensory block, including a superior laryngeal nerve block, when the documentation identifies the vagal target and supports the service performed.

How is bilateral treatment reported?

When the vagus nerve is treated bilaterally, report modifier 50; CMS pays the bilateral procedure at 150%.

What same-day care is included?

The 0-day global period includes same-day preoperative and postoperative care. Services on a different date are not covered by that same-day global period.

How does CMS handle another procedure performed in the same session?

Under the standard multiple procedure reduction, the highest-valued procedure is paid in full and other procedures are paid at 50%.

Can an assistant or co-surgeon be reported?

Assistant-at-surgery payment is available only with documentation of medical necessity. 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.

RVUs for 64408PPRRVU2026_Oct_nonQPP.csv, line 7,098 (RVU26D)
Geographic factors for TennesseeGPCI2026.csv, line 95 (RVU26D)
Open CMS sourceHow this rate is calculatedBuild a fee sheet