How much does Medicare pay for CPT 64420?

Medicare allowed an average of $116.89 per service and paid $90.12 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $860.18, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 64420?

Injection of anesthetic agent and/or steroid into rib nerve. It was billed 7,989 times to 4,290 Medicare beneficiaries by 174 providers in 2024.

Does 64420 pay differently in an office than a hospital?

Yes. The allowed amount averaged $99.02 in an office setting and $125.98 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 64420 most?

Ambulatory Surgical Center, with 2,118 services from 9 clinicians. Next are Anesthesiology, Pain Management, Physical Medicine and Rehabilitation.

CPT 64420

Injection of anesthetic agent and/or steroid into rib nerve

$116.89Medicare-allowed amount per service, averaged across 7,989 services

Providers submitted

$860.18

Asking price, not received

Medicare allowed

$116.89

The fee schedule figure

Medicare paid

$90.12

Balance is patient coinsurance

Providers submitted an average of $860.18 for this code and Medicare allowed $116.89 — 7.4× 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 $90.12 (77%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $99.02
Hospital / facility: $125.98

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 2,693 services were billed in an office setting and 5,296 in a facility.

Services: 7,989
Beneficiaries: 4,290
Providers billing it: 174
Total allowed: $933,834

What Medicare pays for CPT 64420

Across 7,989 services billed by 174 providers to 4,290 beneficiaries, Medicare allowed an average of $116.89 per service. That is 1.9 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 64420

Specialty	Services	Beneficiaries	Avg allowed	Providers
Ambulatory Surgical Center	2,118	483	$199.22	9
Anesthesiology	1,965	1,861	$80.23	106
Pain Management	1,486	659	$86.74	14
Physical Medicine and Rehabilitation	560	279	$108.25	9
Interventional Pain Management	539	303	$87.50	13
Neurology	481	206	$81.90	2
Family Practice	291	98	$108.73	2
Certified Registered Nurse Anesthetist (CRNA)	187	120	$67.22	7
Rheumatology	172	133	$97.31	5
Internal Medicine	90	63	$114.86	2
Nurse Practitioner	40	29	$68.43	2
Critical Care (Intensivists)	39	39	$80.46	2
Physician Assistant	21	17	$49.39	1

64420 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	3,273	$152.15	$102.50	20
Florida	669	$91.90	$70.41	17
Michigan	445	$80.20	$63.25	1
Pennsylvania	342	$93.52	$65.27	10
Texas	275	$94.83	$73.52	11
Minnesota	263	$81.38	$46.56	16
Kentucky	235	$130.40	$112.66	2
Ohio	226	$90.08	$67.22	9
Illinois	222	$104.88	$69.21	8
Maryland	203	$67.59	$36.08	6
New York	182	$88.69	$59.32	7
Massachusetts	147	$100.95	$63.24	9
Puerto Rico	143	$108.09	$69.55	1
South Carolina	123	$62.55	$33.41	5
District of Columbia	121	$90.62	$38.89	6
New Hampshire	121	$123.75	$94.06	3
Alabama	121	$85.35	$74.83	1
Nebraska	120	$80.46	$68.11	2
Virginia	98	$66.02	$37.95	4
Alaska	96	$125.27	$69.75	4
Georgia	67	$60.74	$32.78	5
Arizona	61	$134.36	$107.87	3
Tennessee	54	$121.91	$113.60	2
Mississippi	49	$71.77	$32.17	2
New Jersey	46	$128.90	$94.20	1
South Dakota	40	$91.63	$54.08	3
Delaware	36	$60.75	$33.46	3
Kansas	33	$72.76	$61.52	1
Wisconsin	31	$158.94	$103.33	2
Connecticut	25	$86.28	$38.74	2
Utah	20	$91.69	$76.29	1
Louisiana	20	$72.80	$39.06	1
Arkansas	17	$87.09	$72.63	1
Indiana	15	$61.12	$28.59	1
New Mexico	15	$34.11	$25.48	1
North Carolina	13	$79.27	$34.73	1
Rhode Island	11	$86.38	$61.41	1
Colorado	11	$81.72	$48.90	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
64405Injection of anesthetic agent and/or steroid into upper neck and back$71.75
64479Injection of anesthetic and/or steroid drug into upper or middle spine$275.58

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.