Billing code 64486: TAP blockMedicare rate & RVUs in Washington
A unilateral transversus abdominis plane block by injection provides abdominal wall analgesia, commonly for pain control after abdominal surgery.
Medicare pays $129.80–$145.95 for 64486 in the office in Washington, from Rest Of Washington to Seattle (King Cnty). Which amount applies depends on the service address.
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 64486 covers
This service places local anesthetic into the plane between abdominal wall muscle layers to reduce pain from the abdominal wall on one side. Anesthesiologists, pain physicians, and other qualified clinicians commonly perform the block for perioperative analgesia, including after abdominal operations. The service covers injection rather than delivery through a catheter for continuous infusion; imaging guidance, when used, is included in the block service.
Report 64486 for the unilateral injection service, documenting the side, block site, medication, and clinical purpose. A catheter-based continuous infusion is reported with 64487, while bilateral injection has its own code, 64488. The 0-day global period includes same-day preoperative and postoperative care. 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. CMS lists bilateral modifier 50 payment at 150%; assistant-at-surgery payment is restricted, and 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 64486 pays more and less in Washington
| Payment locality | Office | Facility |
|---|---|---|
| Rest Of Washington | $129.80 | $48.56 |
| Seattle (King Cnty) | $145.95 | $51.28 |
How the 64486 rate is calculated
Each of 64486’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 · 64486
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 1.17Practice expense 2.50Malpractice 0.09
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 64486
The CMS indicators that decide how 64486 is paid alongside other services.
CMS payment indicators · 64486
TAP 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
64486 without 50 · national office
$125.59
TAP block
64486-50 · Bilateral: 150%
$188.39
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).
64486 compared with similar codes
Compare codes
64486 vs 64487 vs 64488 vs 64489: national Medicare rates
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How to choose
- 64487TAP block
- Both describe unilateral TAP blocks, but 64486 is for injection and 64487 is for continuous infusion through a catheter.
- 64488TAP block
- Use 64486 for a unilateral injection block; 64488 identifies bilateral injection.
- 64489TAP block
- Use 64489 for bilateral continuous infusion through a catheter; 64486 is a unilateral injection service.
64486 billing questions
When should 64486 be chosen instead of 64487?
Use 64486 for a unilateral TAP block delivered by injection. Use 64487 when the service uses a catheter for continuous infusion.
How is a bilateral injection block reported?
Code 64488 specifically describes bilateral TAP block by injection. CMS lists modifier 50 payment at 150% for a bilateral procedure; follow the applicable reporting convention for the service and claim.
Is ultrasound guidance separately reported?
Imaging guidance, when performed for this block, is included in the service rather than separately reported as guidance for the TAP block.
What documentation supports 64486?
Document the unilateral side, injection site, medication, and reason for the block. The record should also support that the service was an injection rather than catheter-based continuous infusion.
Are same-day preoperative and postoperative visits separately included?
The 0-day global period includes same-day preoperative and postoperative care for this procedure.
Can an assistant or co-surgeon be billed for this block?
CMS restricts assistant-at-surgery payment for 64486. 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 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
Show the CMS file lines behind this rate
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