How much does Medicare pay for CPT 64405?

Medicare allowed an average of $71.75 per service and paid $54.70 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $500.68, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 64405?

Injection of anesthetic agent and/or steroid into upper neck and back of head nerve. It was billed 35,917 times to 15,751 Medicare beneficiaries by 729 providers in 2024.

Does 64405 pay differently in an office than a hospital?

Yes. The allowed amount averaged $73.52 in an office setting and $63.65 in a facility. The office rate is generally higher because the practice supplies the room, staff and equipment out of that single payment; in a hospital those are billed separately by the facility.

Which specialty bills 64405 most?

Neurology, with 16,562 services from 313 clinicians. Next are Nurse Practitioner, Pain Management, Physician Assistant.

CPT 64405

Injection of anesthetic agent and/or steroid into upper neck and back of head nerve

$71.75Medicare-allowed amount per service, averaged across 35,917 services

Providers submitted

$500.68

Asking price, not received

Medicare allowed

$71.75

The fee schedule figure

Medicare paid

$54.70

Balance is patient coinsurance

Providers submitted an average of $500.68 for this code and Medicare allowed $71.75 — 7.0× less. That gap is normal and means nothing on its own: Medicare pays its fee schedule regardless of what is billed, so the submitted figure describes a hospital chargemaster, not a price anyone paid. Of the allowed amount Medicare paid $54.70 (76%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $73.52
Hospital / facility: $63.65

The office rate is higher because the practice supplies the room, staff and equipment out of that payment. In a hospital the facility bills those separately, so the clinician's share is smaller — the total cost to Medicare is usually higher, not lower. 29,478 services were billed in an office setting and 6,439 in a facility.

Services: 35,917
Beneficiaries: 15,751
Providers billing it: 729
Total allowed: $2,577,045

What Medicare pays for CPT 64405

Across 35,917 services billed by 729 providers to 15,751 beneficiaries, Medicare allowed an average of $71.75 per service. That is 2.3 services per beneficiary, so this is a code patients typically receive more than once. The allowed amount is the figure that matters: it is what Medicare and the patient together owe, set by the fee schedule and adjusted for local practice costs. What a provider chose to submit has no bearing on it.

Who bills 64405

Specialty	Services	Beneficiaries	Avg allowed	Providers
Neurology	16,562	7,367	$76.59	313
Nurse Practitioner	5,684	2,126	$63.71	103
Pain Management	2,671	1,388	$77.03	68
Physician Assistant	2,339	955	$60.29	50
Anesthesiology	1,749	994	$70.47	54
Physical Medicine and Rehabilitation	1,720	850	$76.17	45
Interventional Pain Management	1,375	697	$80.99	37
Oral Surgery (Dentist only)	966	239	$57.37	7
Family Practice	717	217	$55.23	6
Ambulatory Surgical Center	516	257	$26.76	16
General Practice	398	30	$79.59	1
Internal Medicine	247	83	$78.92	4
Ophthalmology	167	84	$113.17	1
Rheumatology	151	109	$66.24	3
Maxillofacial Surgery	128	76	$60.71	2

64405 reimbursement by state

Two different numbers. Allowed is what Medicare actually allowed in that state, which includes the local practice-cost adjustment. Standardized strips that geographic adjustment out of the payment, so it is the column to use when comparing states — a difference there reflects how the code was billed, not what it costs to run a practice locally.

State	Services	Allowed	Standardized pmt	Providers
California	6,393	$73.09	$52.82	96
New York	3,675	$64.77	$46.44	67
Massachusetts	2,916	$69.01	$50.69	29
Arizona	2,099	$56.24	$44.54	32
Michigan	1,929	$91.40	$69.09	29
Florida	1,804	$89.05	$64.58	52
Texas	1,523	$89.53	$68.41	39
Pennsylvania	1,491	$69.19	$52.37	31
Minnesota	1,358	$67.26	$54.20	34
Virginia	1,211	$72.05	$56.16	25
Ohio	955	$62.59	$49.02	16
North Carolina	771	$60.71	$49.57	14
Alabama	627	$68.26	$57.77	9
Illinois	607	$78.18	$57.97	17
New Jersey	565	$70.21	$50.25	14
Colorado	543	$60.34	$46.48	7
Oklahoma	533	$62.56	$50.62	13
Tennessee	505	$68.82	$56.45	16
Arkansas	477	$72.15	$60.29	16
Kentucky	456	$80.32	$65.33	11
Maryland	453	$55.03	$39.63	14
South Carolina	419	$89.04	$71.05	11
Washington	382	$68.10	$52.56	13
Indiana	379	$84.24	$70.64	12
Kansas	343	$59.57	$49.14	9
New Hampshire	290	$67.16	$50.40	9
Montana	270	$80.65	$62.35	7
Georgia	257	$80.49	$62.40	7
North Dakota	221	$69.03	$55.48	5
Missouri	203	$67.44	$50.36	6
Utah	203	$83.36	$65.09	6
Wisconsin	198	$77.24	$63.12	6
Mississippi	177	$51.44	$45.76	7
New Mexico	159	$63.70	$48.13	4
Maine	159	$64.79	$49.36	2
Louisiana	146	$59.99	$50.36	2
Connecticut	136	$69.11	$47.84	5
Oregon	124	$58.32	$42.94	4
Nevada	120	$41.89	$31.36	4
Alaska	104	$115.86	$71.86	2
District of Columbia	102	$69.64	$44.67	3
South Dakota	99	$75.06	$62.50	5
Wyoming	95	$91.05	$73.11	2
Iowa	89	$57.93	$48.79	4
Idaho	88	$58.35	$47.12	3
Hawaii	66	$82.74	$62.27	2
West Virginia	53	$87.49	$68.44	2
Vermont	47	$71.51	$46.64	2
Puerto Rico	39	$61.42	$46.59	1
Nebraska	21	$75.56	$57.71	1
Rhode Island	20	$54.64	$42.90	1
Delaware	17	$76.15	$53.19	1

Related codes

64483Injection of anesthetic and/or steroid drug into sacral spine nerve ro$263.09
64493Injection of lower or sacral spine facet joint$243.14
64494Injection of lower or sacral spine facet joint$96.60
64450Injection of anesthetic agent and/or steroid into other nerve or branc$44.99
64447Injection of anesthetic agent and/or steroid into thigh nerve (femoral$58.78
64484Injection of anesthetic and/or steroid drug into sacral spine nerve ro$84.15
64490Injection of upper or middle spine facet joint$259.70
64415Injection of anesthetic agent and/or steroid into arm nerve bundle (br$67.89
64491Injection of upper or middle spine facet joint$100.48
64445Injection of anesthetic agent and/or steroid into lower back and leg n$173.06
64479Injection of anesthetic and/or steroid drug into upper or middle spine$275.58
64455Injection of anesthetic and/or steroid drug into foot nerve$48.08

Billing this code is not the same as earning it

An allowed amount is revenue to a practice, not income to a clinician. It funds staff, premises, equipment and supplies before anyone is paid. What clinicians actually earn is published separately by the Department of Labor, and what industry pays them is published separately again by CMS — this site carries both.

What doctors are paid →·Look up a clinician →·All procedure codes →

Where this comes from. CMS Medicare Physician & Other Practitioners, by Provider and Service, 2024. It covers fee-for-service Original Medicare Part B only — not Medicare Advantage, not Medicaid, and not commercial insurance, which typically pays more for the same code.

How it is averaged. CMS publishes one average per provider per code. Every figure here is re-weighted by the number of services, so a clinician who billed the code 4,000 times counts 4,000 times more than one who billed it twice. CMS also suppresses any provider-code pair with fewer than 11 beneficiaries, so low-volume practice is missing from these totals by design.