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CMS RVU26D · Effective 2026-10-01

64435 Nerve block Medicare reimbursement rates in Wisconsin

Reports injection around a paracervical uterine nerve to provide regional anesthesia or pain relief during cervical or uterine care. Compare 64435 office and facility rates across CMS payment localities in Wisconsin.

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 64435 in Wisconsin?

Wisconsin 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

$70.20

1 of 1 localities have a supported rate.

Payment area: Wisconsin

One mapped payment locality.

Facility setting

$35.32

1 of 1 localities have a supported rate.

Payment area: Wisconsin

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 64435 in your payment locality →

Nerve blocks

About 64435: Paracervical nerve injection

Reports injection around a paracervical uterine nerve to provide regional anesthesia or pain relief during cervical or uterine care.

This service places anesthetic, with or without steroid, around a paracervical (uterine) nerve to create a regional block. Gynecologists, anesthesiologists, and pain physicians may perform it in an office, procedure room, or hospital. A typical setting is pain control for a cervical or uterine procedure; the code is selected for the paracervical nerve target, not simply because an injection is near the pelvis.

Document the nerve targeted, side, clinical reason, and procedure performed. The code has a 0-day global period, so same-day preoperative and postoperative care is included. For bilateral reporting, modifier 50 is paid at 150%. When multiple procedures occur in one session, the highest-valued procedure is paid in full and other procedures are paid at 50%. An assistant at surgery is not paid; co-surgeons and team surgery are not permitted.

CMS billing rules for 64435

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 RVU0.73 · 32%
  • Practice expense (office) RVU1.39 · 62%
  • Malpractice RVU0.13 · 6%

60

Medicare services in 2024 · #5244 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.

64435 compared with similar codes

Office rates for Wisconsin, from the same CMS release.

64430

Nerve block

Pudendal nerve

$90.82

64435 targets the paracervical (uterine) nerve; 64430 is for a pudendal nerve injection. Choose based on the documented nerve targeted.

64425

Nerve block

Ilioinguinal and iliohypogastric

$115.25

64425 describes injection of the ilioinguinal or iliohypogastric nerves. It is not selected for a paracervical nerve block.

64450

Nerve block

Other peripheral nerve or branch

$76.94

64450 is for an eligible peripheral nerve or branch without a more specific code. Use 64435 when the documented target is the paracervical nerve.

Compare 64435 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 64435 in Wisconsin.

PPRRVU2026_Oct_nonQPP.csv

7,107

Code
64435
Physician work
0.73
Practice expense
1.39
Malpractice
0.13

GPCI2026.csv

111

Locality
Wisconsin
Physician work
1.000
Practice expense
0.958
Malpractice
0.308
Office / nonfacility calculation for 64435 in Wisconsin
ComponentRVULocality factorAdjusted
Physician work0.73× 1.0000.7300
Practice expense1.39× 0.9581.3316
Malpractice0.13× 0.3080.0400
Total RVUs2.1017
Conversion factor× 33.4009

Office / nonfacility rate, Wisconsin$70.20

Values as parsed from CMS release RVU26D, effective 2026-10-01. The amount is rounded to the nearest cent only at the end.
Explore RVUs, geographic factors and the full formula

Office / nonfacility

Office / nonfacility calculation inputs
ComponentRVULocal GPCI
Work0.731
Practice expense1.390.958
Malpractice0.130.308

(0.73 × 1 + 1.39 × 0.958 + 0.13 × 0.308) × $33.4009 = $70.20

Facility

Facility calculation inputs
ComponentRVULocal GPCI
Work0.731
Practice expense0.30.958
Malpractice0.130.308

(0.73 × 1 + 0.3 × 0.958 + 0.13 × 0.308) × $33.4009 = $35.32

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.

64435 billing questions

How is this different from a pudendal nerve block?

This code is for injection at the paracervical (uterine) nerve. Use the pudendal nerve code, 64430, when the documented target is the pudendal nerve.

When should modifier 50 be reported?

When the paracervical nerve injection is performed bilaterally, report modifier 50. CMS pays the bilateral procedure at 150%.

What does the 0-day global period include?

Same-day preoperative and postoperative care is included in the procedure. The global period is 0 days.

What documentation supports reporting this code?

Document the paracervical nerve target, laterality, reason for the block, and the injection performed. The record should distinguish this target from another pelvic nerve.

How does CMS handle this with another procedure in the same session?

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

RVUs for 64435PPRRVU2026_Oct_nonQPP.csv, line 7,107 (RVU26D)
Geographic factors for WisconsinGPCI2026.csv, line 111 (RVU26D)
Open CMS sourceHow this rate is calculatedBuild a fee sheet