$34.08
64420 represents the first single intercostal nerve treated; 64421 reports each additional intercostal nerve in the same session.
On this page
CMS RVU26D · Effective 2026-10-01
64420 Intercostal block Medicare reimbursement rates in Vermont
Reports injection of anesthetic, with or without steroid, near one intercostal nerve to relieve localized chest-wall pain or neuralgia. Compare 64420 office and facility rates across CMS payment localities in Vermont.
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 64420 in Vermont?
Vermont 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
$103.72
1 of 1 localities have a supported rate.
Payment area: Vermont
One mapped payment locality.
Facility setting
$50.81
1 of 1 localities have a supported rate.
Payment area: Vermont
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.
Pain management
About 64420: Single intercostal nerve block
Reports injection of anesthetic, with or without steroid, near one intercostal nerve to relieve localized chest-wall pain or neuralgia.
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.
CMS billing rules for 64420
- 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 RVU1.05 · 33%
- Practice expense (office) RVU2.03 · 64%
- Malpractice RVU0.09 · 3%
22.3K
Medicare services in 2024 · #1104 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.
64420 compared with similar codes
Office rates for Vermont, from the same CMS release.
$146.12
64461 is a thoracic paravertebral block at one injection site. Use 64420 when the injection targets a specific intercostal nerve.
$138.76
64466 describes a thoracic fascial plane block, not an injection directed at one intercostal nerve.
Compare 64420 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
Vermont →
Office / nonfacility
$103.72
Facility
$50.81
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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 64420 in Vermont.
PPRRVU2026_Oct_nonQPP.csv
7,103
- Code
- 64420
- Physician work
- 1.05
- Practice expense
- 2.03
- Malpractice
- 0.09
GPCI2026.csv
105
- Locality
- Vermont
- Physician work
- 1.000
- Practice expense
- 0.990
- Malpractice
- 0.506
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 1.05 | × 1.000 | 1.0500 |
| Practice expense | 2.03 | × 0.990 | 2.0097 |
| Malpractice | 0.09 | × 0.506 | 0.0455 |
| Total RVUs | 3.1052 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Vermont$103.72
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 1.05 | 1 |
| Practice expense | 2.03 | 0.99 |
| Malpractice | 0.09 | 0.506 |
(1.05 × 1 + 2.03 × 0.99 + 0.09 × 0.506) × $33.4009 = $103.72
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 1.05 | 1 |
| Practice expense | 0.43 | 0.99 |
| Malpractice | 0.09 | 0.506 |
(1.05 × 1 + 0.43 × 0.99 + 0.09 × 0.506) × $33.4009 = $50.81
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.
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 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.
7,10064416,,Njx aa&/strd brch pl nfs img,A,,1.76,0.26,NA,0.26,,0.15,2.17,2.17,0,000,0.00,0.00,0.00,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,10164417,,Njx aa&/strd ax nerve img,A,,1.28,4.16,,0.43,,0.13,5.57,1.84,0,000,0.00,0.00,0.00,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,10264418,,Njx aa&/strd sprscap nrv,A,,1.07,1.51,,0.26,,0.11,2.69,1.44,0,000,0.00,0.00,0.00,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,10364420,,Njx aa&/strd ntrcost nrv 1,A,,1.05,2.03,,0.43,,0.09,3.17,1.57,0,000,0.00,0.00,0.00,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,10464421,,Njx aa&/strd ntrcost nrv ea,A,,0.49,0.51,,0.11,,0.05,1.05,0.65,0,ZZZ,0.00,0.00,0.00,0,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,10564425,,Njx aa&/strd ii ih nerves,A,,0.98,2.55,,0.42,,0.09,3.62,1.49,0,000,0.00,0.00,0.00,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,10664430,,Njx aa&/strd pudendal nerve,A,,0.98,1.78,,0.37,,0.11,2.87,1.46,0,000,0.00,0.00,0.00,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
10204412,TX,18,HOUSTON,1.008,0.993,1.376
10304412,TX,99,REST OF TEXAS,1.000,0.949,0.903
10403502,UT,09,UTAH,1.000,0.940,0.898
10514512,VT,50,VERMONT,1.000,0.990,0.506
10611302,VA,00,VIRGINIA,1.000,0.983,0.706
10709202,VI,50,VIRGIN ISLANDS,1.000,1.011,0.985
10802402,WA,02,SEATTLE (KING CNTY),1.050,1.227,0.817