Injection of anesthetic, steroid, or both around a peripheral nerve or branch that does not have its own specific nerve block code.
- Medicare
- $80.83
- Work RVU
- 0.73
- Global, days
- 0
- Region
- Multi-region
Documentation requirements
What must appear in the operative or office note to support the claim.
Source · Editorial brief grounded in 3 cited references ↓
- Specific nerve or branch injected and side
- Drug, dose, and volume
- Indication such as neuralgia, entrapment, or post-op analgesia
- Imaging used with saved image and report if billed
- Number of separate nerves injected
- Response to prior injections for repeats
Applicable modifiers
Modifiers commonly billed with this code.
Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual
What this code covers
Source · Editorial summary grounded in 3 cited references ↓
Think of 64450 as the catch-all for peripheral nerve blocks that do not have a named code. In orthopedics that includes saphenous blocks at the ankle, superficial peroneal and sural nerve blocks around the ankle, lateral femoral cutaneous nerve injections for meralgia paresthetica, and lesser occipital nerve blocks. Genicular nerve blocks no longer belong here; they moved to 64454.
Imaging guidance is not part of 64450. Ultrasound is often allowed separately with 76942 when a saved image and a written report are in the chart, though some payers bundle it.
Units and laterality trip people up. Payers vary on whether multiple nerves in one session get multiple units or separate lines with 59 or XS. Bilateral blocks may need modifier 50 or RT and LT. A digital block or local nerve block the surgeon does at the start of their own procedure is part of the surgery and not billed with 64450. Global period is 0 days. Same-day E/M needs modifier 25 and a separate problem.
RVU & reimbursement
Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.
Source · CMS Physician Fee Schedule, RVU26A · January 2026
Work RVU vs. total RVU
The work RVU (0.73) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (2.42) adds practice overhead and malpractice, and is what drives the Medicare payment below.
| Work RVU | 0.73 |
| Practice expense RVU | 1.62 |
| Malpractice RVU | 0.07 |
| Total RVU | 2.42 |
| Medicare national rate | $80.83 |
| Global period | 0 days |
Payment by site of service
Medicare pays different rates by setting. HOPD typically pays substantially more than ASC for the same procedure.
Source · CMS OPPS Addendum B·ASC HCPCS payment rates·2026
| Setting | Medicare rate (national) |
|---|---|
Office (PFS non-facility) Procedure performed in physician's office | $80.83 |
HOPD (APC 5442) Hospital outpatient department | $721.17 |
ASC (PI P3) Ambulatory surgical center (freestanding) | $54.38 |
Common denial reasons
The recurring reasons claims for CPT 64450 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Genicular nerve block billed with 64450 instead of 64454
- Surgeon's own anesthetic block billed with their surgery
- Multiple nerves billed without 59 or XS
- Ultrasound billed without image and report
- Nerve not named in the note
- Same-day E/M without a separate problem
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 3 cited references ↓
01Is a genicular nerve block billed with 64450?
02Can ultrasound be billed with 64450?
03Can a surgeon bill 64450 for a digital block before surgery?
04How do you bill 64450 for two different nerves?
Sources & references
Editorial content was developed using the following public sources.
Mira Scribe
Mira Scribe's notes name the exact nerve, side, and indication, which is what decides whether a block lands on 64450 or a more specific code.
See how Mira captures CPT 64450 documentation