How much does Medicare pay for CPT 64421?

Medicare allowed an average of $159.51 per service and paid $126.37 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $888.68, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 64421?

Injection of anesthetic agent and/or steroid into multiple rib nerves for regional nerve block. It was billed 6,641 times to 2,165 Medicare beneficiaries by 60 providers in 2024.

Does 64421 pay differently in an office than a hospital?

Yes. The allowed amount averaged $36.05 in an office setting and $249.51 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 64421 most?

Ambulatory Surgical Center, with 2,277 services from 9 clinicians. Next are Pain Management, Interventional Pain Management, Anesthesiology.

CPT 64421

Injection of anesthetic agent and/or steroid into multiple rib nerves for regional nerve block

$159.51Medicare-allowed amount per service, averaged across 6,641 services

Providers submitted

$888.68

Asking price, not received

Medicare allowed

$159.51

The fee schedule figure

Medicare paid

$126.37

Balance is patient coinsurance

Providers submitted an average of $888.68 for this code and Medicare allowed $159.51 — 5.6× 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 $126.37 (79%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $36.05
Hospital / facility: $249.51

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 2,800 services were billed in an office setting and 3,841 in a facility.

Services: 6,641
Beneficiaries: 2,165
Providers billing it: 60
Total allowed: $1,059,306

What Medicare pays for CPT 64421

Across 6,641 services billed by 60 providers to 2,165 beneficiaries, Medicare allowed an average of $159.51 per service. That is 3.1 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 64421

Specialty	Services	Beneficiaries	Avg allowed	Providers
Ambulatory Surgical Center	2,277	479	$398.40	9
Pain Management	1,565	607	$34.04	11
Interventional Pain Management	845	288	$32.60	12
Anesthesiology	512	160	$36.55	10
Physical Medicine and Rehabilitation	403	191	$37.73	5
Neurology	317	142	$41.34	1
Rheumatology	254	131	$35.86	5
Family Practice	158	34	$35.68	1
Certified Registered Nurse Anesthetist (CRNA)	107	32	$35.80	1
Internal Medicine	70	34	$38.74	1
Nurse Practitioner	49	28	$24.31	2
Critical Care (Intensivists)	43	22	$22.70	1
Physician Assistant	41	17	$21.20	1

64421 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	3,190	$253.71	$174.69	10
Florida	740	$32.98	$25.51	13
Pennsylvania	438	$34.06	$26.52	3
Texas	329	$68.15	$52.97	7
Michigan	317	$41.34	$37.77	1
Puerto Rico	225	$35.17	$24.71	1
Kentucky	171	$299.62	$266.45	2
Alaska	166	$43.58	$26.04	1
Ohio	145	$190.68	$158.80	3
Nebraska	133	$34.74	$29.50	2
New York	128	$37.08	$17.50	1
Alabama	121	$29.54	$25.47	1
Illinois	99	$36.16	$26.67	2
Tennessee	88	$229.53	$209.54	2
Arizona	81	$230.93	$201.31	2
New Jersey	72	$42.66	$32.84	1
Virginia	65	$23.48	$16.58	2
Minnesota	35	$30.22	$28.73	1
Wisconsin	31	$341.36	$258.18	1
Kansas	27	$24.09	$20.34	1
Massachusetts	18	$449.94	$350.06	1
Delaware	11	$24.19	$19.25	1
District of Columbia	11	$38.80	$28.00	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.