Billing code 64446: Sciatic nerve blockMedicare rate & RVUs in Washington
Reports a sciatic nerve block delivered through a catheter for continuous infusion, commonly for ongoing lower-extremity analgesia after surgery.
CMS doesn’t publish an office rate for 64446 in Washington.
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 64446 covers
This service covers delivery of anesthetic through a catheter placed at the sciatic nerve for continuous regional analgesia. Anesthesiologists and pain physicians commonly provide it around lower-extremity surgery, such as procedures involving the foot, ankle, or lower leg. Imaging guidance, when used, is included in the service. The catheter allows medication delivery to continue beyond a single injection.
Choose this code for a continuous sciatic catheter service rather than a single-injection sciatic block. Documentation should identify the nerve and side, catheter placement, the continuous infusion plan, and any imaging used. CMS assigns a 0-day global period, so same-day preoperative and postoperative care is included. When multiple procedures occur in one session, the highest-valued procedure is paid in full and others at 50%. Bilateral reporting with modifier 50 is paid at 150%. Assistant-at-surgery payment is 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.
Where 64446 pays more and less in Washington
| Payment locality | Office | Facility |
|---|---|---|
| Rest Of Washington | Unavailable | $70.82 |
| Seattle (King Cnty) | Unavailable | $74.72 |
How the 64446 rate is calculated
Each of 64446’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 · 64446
RVUs × geographic indexes × conversion factor
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Work 1.71Practice expense 0.26Malpractice 0.15
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 64446
The CMS indicators that decide how 64446 is paid alongside other services.
CMS payment indicators · 64446
Sciatic nerve 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
64446 without 50 · national facility
$70.81
Sciatic nerve block
64446-50 · Bilateral: 150%
$106.22
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).
64446 compared with similar codes
Compare codes
64446 vs 64445 vs 64448 vs 64449: national Medicare rates
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How to choose
- 64445Sciatic nerve block
- Choose 64446 for continuous delivery through a sciatic catheter; 64445 describes a single-injection sciatic block.
- 64448Femoral nerve block
- Both describe continuous catheter blocks, but 64448 targets the femoral nerve rather than the sciatic nerve.
- 64449Lumbar plexus block
- 64449 targets the lumbar plexus for continuous delivery; 64446 is specific to the sciatic nerve.
64446 billing questions
How does 64446 differ from 64445?
64446 is for continuous anesthetic delivery through a sciatic nerve catheter. Use 64445 for a single-injection sciatic nerve block.
Can imaging guidance be reported separately?
Imaging guidance, when performed for this block, is included in 64446.
What should the procedure note identify?
Document the sciatic nerve and side, catheter placement, the continuous infusion plan, and imaging used.
How is bilateral reporting handled?
For bilateral performance, CMS specifies modifier 50, with payment at 150%.
How does CMS handle other procedures in the same session?
The highest-valued procedure is paid in full, and other procedures in the same session are paid 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 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
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