How much does Medicare pay for CPT 64491?

Medicare allowed an average of $100.48 per service and paid $79.57 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $671.81, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 64491?

Injection of upper or middle spine facet joint using imaging guidance, second level. It was billed 96,619 times to 62,258 Medicare beneficiaries by 2,611 providers in 2024.

Does 64491 pay differently in an office than a hospital?

Yes. The allowed amount averaged $120.55 in an office setting and $74.32 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 64491 most?

Pain Management, with 29,859 services from 811 clinicians. Next are Interventional Pain Management, Anesthesiology, Physical Medicine and Rehabilitation.

CPT 64491

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

$100.48Medicare-allowed amount per service, averaged across 96,619 services

Providers submitted

$671.81

Asking price, not received

Medicare allowed

$100.48

The fee schedule figure

Medicare paid

$79.57

Balance is patient coinsurance

Providers submitted an average of $671.81 for this code and Medicare allowed $100.48 — 6.7× 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 $79.57 (79%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $120.55
Hospital / facility: $74.32

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. 54,679 services were billed in an office setting and 41,940 in a facility.

Services: 96,619
Beneficiaries: 62,258
Providers billing it: 2,611
Total allowed: $9,708,277

What Medicare pays for CPT 64491

Across 96,619 services billed by 2,611 providers to 62,258 beneficiaries, Medicare allowed an average of $100.48 per service. That is 1.6 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 64491

Specialty	Services	Beneficiaries	Avg allowed	Providers
Pain Management	29,859	19,360	$100.32	811
Interventional Pain Management	21,853	13,733	$103.54	508
Anesthesiology	21,463	13,696	$100.61	576
Physical Medicine and Rehabilitation	18,600	12,349	$95.42	585
Orthopedic Surgery	1,090	717	$110.82	25
Neurology	1,073	645	$124.00	23
Neurosurgery	682	461	$92.58	19
Family Practice	293	189	$100.14	9
Certified Registered Nurse Anesthetist (CRNA)	265	176	$107.92	9
Diagnostic Radiology	250	176	$115.67	8
Emergency Medicine	208	143	$80.82	8
Internal Medicine	204	122	$117.67	7
Sports Medicine	188	117	$83.47	5
Interventional Radiology	176	110	$93.94	5
Osteopathic Manipulative Medicine	125	84	$75.75	3

64491 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	15,683	$112.75	$88.96	330
Texas	8,867	$99.17	$80.71	256
California	7,835	$98.35	$74.03	201
Arizona	5,129	$104.61	$84.95	130
New York	3,952	$114.06	$82.05	123
Virginia	3,499	$111.19	$87.06	75
Georgia	3,322	$85.65	$70.33	108
South Carolina	3,130	$103.13	$86.46	67
North Carolina	2,718	$105.80	$88.43	74
Oklahoma	2,580	$105.85	$91.84	48
Pennsylvania	2,426	$102.42	$81.90	71
Maryland	2,340	$86.43	$66.85	65
Tennessee	2,290	$93.93	$81.21	65
Illinois	2,271	$95.62	$74.39	64
Ohio	2,071	$85.91	$70.56	63
Colorado	2,062	$98.65	$78.09	60
Massachusetts	1,944	$102.41	$76.43	61
Louisiana	1,738	$86.04	$72.15	44
Alabama	1,625	$97.68	$85.64	42
New Jersey	1,609	$107.15	$79.76	52
Indiana	1,454	$86.10	$74.19	50
Kentucky	1,385	$101.68	$87.47	39
Mississippi	1,358	$82.72	$71.10	28
Arkansas	1,348	$89.11	$76.90	40
Missouri	1,266	$85.32	$70.23	40
Washington	1,172	$94.96	$74.22	33
Michigan	1,139	$109.67	$88.33	40
Minnesota	1,048	$74.40	$61.18	37
Utah	989	$112.63	$92.24	32
Oregon	945	$86.97	$70.70	28
Wisconsin	917	$81.37	$68.50	34
Nevada	915	$100.20	$81.40	28
Kansas	655	$80.17	$67.55	21
Connecticut	601	$119.26	$89.45	18
New Mexico	579	$94.42	$80.01	17
Nebraska	539	$106.30	$91.83	17
West Virginia	434	$79.60	$62.68	14
Delaware	407	$97.57	$77.26	16
Iowa	394	$86.16	$74.83	12
Idaho	388	$79.61	$67.39	13
New Hampshire	379	$90.04	$70.60	12
South Dakota	223	$80.25	$65.79	7
Montana	194	$84.37	$67.03	6
Alaska	150	$128.45	$82.80	5
Rhode Island	142	$90.97	$75.37	4
North Dakota	136	$70.32	$57.92	4
Maine	133	$84.34	$66.44	6
Vermont	112	$105.57	$84.86	4
Wyoming	59	$94.81	$73.62	3
Puerto Rico	51	$109.94	$101.29	3
District of Columbia	16	$108.56	$76.05	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
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.