How much does Medicare pay for CPT 64490?

Medicare allowed an average of $259.70 per service and paid $203.06 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $1961.22, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 64490?

Injection of upper or middle spine facet joint using imaging guidance, single level. It was billed 175,362 times to 97,312 Medicare beneficiaries by 3,756 providers in 2024.

Does 64490 pay differently in an office than a hospital?

Yes. The allowed amount averaged $236.60 in an office setting and $272.00 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 64490 most?

Ambulatory Surgical Center, with 65,573 services from 844 clinicians. Next are Pain Management, Anesthesiology, Interventional Pain Management.

CPT 64490

Injection of upper or middle spine facet joint using imaging guidance, single level

$259.70Medicare-allowed amount per service, averaged across 175,362 services

Providers submitted

$1961.22

Asking price, not received

Medicare allowed

$259.70

The fee schedule figure

Medicare paid

$203.06

Balance is patient coinsurance

Providers submitted an average of $1961.22 for this code and Medicare allowed $259.70 — 7.6× 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 $203.06 (78%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $236.60
Hospital / facility: $272.00

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 60,911 services were billed in an office setting and 114,451 in a facility.

Services: 175,362
Beneficiaries: 97,312
Providers billing it: 3,756
Total allowed: $45,541,511

What Medicare pays for CPT 64490

Across 175,362 services billed by 3,756 providers to 97,312 beneficiaries, Medicare allowed an average of $259.70 per service. That is 1.8 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 64490

Specialty	Services	Beneficiaries	Avg allowed	Providers
Ambulatory Surgical Center	65,573	26,610	$376.56	844
Pain Management	32,834	21,257	$189.75	876
Anesthesiology	23,908	15,277	$190.96	635
Interventional Pain Management	23,731	14,919	$196.74	546
Physical Medicine and Rehabilitation	23,378	15,392	$178.90	695
Orthopedic Surgery	1,320	889	$213.09	32
Neurology	1,196	717	$239.94	26
Neurosurgery	884	576	$184.83	22
Diagnostic Radiology	424	305	$209.36	16
Family Practice	356	241	$186.06	11
Certified Registered Nurse Anesthetist (CRNA)	303	197	$204.16	10
Sports Medicine	292	185	$145.79	7
Internal Medicine	263	163	$208.46	10
Emergency Medicine	250	167	$150.61	8
Interventional Radiology	207	136	$187.57	5

64490 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
Florida	24,445	$254.99	$206.93	422
California	18,508	$320.04	$216.42	354
Texas	16,264	$256.80	$210.67	358
Arizona	8,666	$262.61	$210.10	165
Georgia	8,380	$271.61	$223.98	188
Maryland	6,368	$286.62	$230.71	123
New York	5,989	$272.38	$197.57	158
South Carolina	4,760	$236.61	$196.70	79
Tennessee	4,571	$242.69	$211.81	89
Colorado	4,402	$259.04	$204.63	89
Pennsylvania	4,099	$244.92	$195.30	111
Virginia	4,077	$219.63	$168.23	85
Louisiana	3,918	$245.34	$212.35	65
Illinois	3,857	$244.90	$191.82	95
New Jersey	3,762	$312.75	$233.22	96
Ohio	3,524	$222.96	$185.07	94
North Carolina	3,208	$205.26	$167.90	86
Mississippi	3,154	$234.63	$213.14	46
Minnesota	3,055	$273.71	$214.88	67
Indiana	3,016	$254.07	$210.84	84
Oklahoma	2,978	$213.36	$179.66	54
Oregon	2,650	$295.03	$221.94	49
Washington	2,631	$267.77	$199.53	59
Arkansas	2,615	$242.66	$207.96	56
Massachusetts	2,554	$230.95	$172.00	71
Alabama	2,432	$215.50	$191.60	57
Nevada	2,224	$288.21	$220.92	49
Kentucky	2,063	$237.53	$203.20	46
Michigan	1,839	$248.24	$202.18	54
Missouri	1,810	$201.52	$165.40	50
Wisconsin	1,788	$228.63	$188.77	54
Kansas	1,732	$238.97	$199.33	33
Utah	1,290	$230.14	$184.84	38
Connecticut	1,005	$284.68	$209.85	27
New Mexico	976	$243.44	$203.34	19
Delaware	852	$285.51	$223.30	22
Idaho	813	$217.83	$187.18	21
Nebraska	810	$238.61	$200.98	22
Iowa	785	$253.32	$215.99	18
Montana	632	$244.77	$200.61	15
New Hampshire	579	$242.17	$187.37	17
West Virginia	490	$165.26	$133.57	15
South Dakota	286	$142.64	$115.07	8
Alaska	285	$296.21	$192.03	9
Wyoming	274	$264.66	$215.34	6
Rhode Island	271	$266.27	$210.49	6
North Dakota	205	$220.73	$184.74	6
Maine	204	$150.65	$115.63	9
Vermont	138	$191.88	$152.43	5
District of Columbia	64	$236.89	$173.81	3
Puerto Rico	51	$222.05	$187.09	3
Hawaii	13	$241.59	$181.91	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
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
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.