CPT 64490
Global 000 ActiveInj paravert f jnt c/t 1 lev
CPT 64490 Billing & Documentation Guide
CPT code 64490 (Inj paravert f jnt c/t 1 lev) is classified under Surgery (Endocrine/Nervous/Eye/Ear) with a global period indicator of 000. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 1.77, a non-facility practice expense RVU of 4.2, and a malpractice RVU of 0.17, a total non-facility RVU of 6.14 and facility RVU of 2.82. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $211.59, though rates vary from $182.55 to $270.96 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 64490, ensure documentation supports medical necessity and the specific components required for the code's level of service. For E/M codes, document MDM (medical decision-making) elements: problems addressed, data reviewed, and risk. For procedural codes, document the indication, technique, and any complications. Always verify NCCI edits before bundling 64490 with related codes; this code has 10 PTP bundling relationships on file (see table below).
Payment Status & Global Period
Active code (paid under MPFS)
Endoscopic or minor procedure with related preoperative and postoperative work performed on the same day
MUE Limit (Medically Unlikely Edits)
Submitting more than 1 units of 64490 for the same patient on the same date triggers automatic line denial unless an appropriate modifier and supporting documentation justify the higher quantity.
RVU Breakdown, CPT 64490
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 1.77 | 1.77 |
| Practice Expense RVU | 4.2 | 0.88 |
| Malpractice RVU | 0.17 | 0.17 |
| Total RVU | 6.14 | 2.82 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 64490
State-level averages across all MAC localities. Non-facility rates typically apply to office-based services; facility rates apply to hospital outpatient / inpatient.
| State | Non-Facility | Facility | Range (Non-Fac) | Localities |
|---|---|---|---|---|
| California | $230.31 | $99.1 | $216.92 - $270.96 | 29 |
| Florida | $210.93 | $99.66 | $201.77 - $219.52 | 3 |
| Georgia | $199.83 | $94.05 | $191.02 - $208.64 | 2 |
| Illinois | $205.73 | $98.58 | $196.07 - $213.67 | 4 |
| Michigan | $198.84 | $94.72 | $193.61 - $204.07 | 2 |
| North Carolina | $193.63 | $90.17 | $193.63 - $193.63 | 1 |
| New York | $226.14 | $102.43 | $196.38 - $240.24 | 5 |
| Ohio | $192.92 | $91.68 | $192.92 - $192.92 | 1 |
| Pennsylvania | $203.13 | $94.52 | $193.27 - $212.99 | 2 |
| Texas | $202.83 | $93.66 | $192.05 - $212.69 | 8 |
Source: CMS PFSRVU 2026 · Updated 2026-04-01. Full locality-level detail available for all 53 states, contact us for custom reports.
NCCI Bundling Edits, CPT 64490
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 64490 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 0178T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0179T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0180T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 01991 | Column 1 (primary), can be billed with modifier | No | Anesthesia service included in surgical procedure |
| 01992 | Column 1 (primary), can be billed with modifier | No | Anesthesia service included in surgical procedure |
| 0213T | Column 1 (primary), can be billed with modifier | No | Mutually exclusive procedures |
| 0214T | Column 1 (primary), can be billed with modifier | No | Mutually exclusive procedures |
| 0215T | Column 1 (primary), can be billed with modifier | No | Mutually exclusive procedures |
| 0216T | Column 1 (primary), can be billed with modifier | No | Mutually exclusive procedures |
| 0217T | Column 1 (primary), can be billed with modifier | No | Mutually exclusive procedures |
Frequently Asked Questions, CPT 64490
What does CPT code 64490 mean? +
CPT code 64490 represents: Inj paravert f jnt c/t 1 lev. It's in the Surgery (Endocrine/Nervous/Eye/Ear) category with a global period of 000.
What is the Medicare reimbursement for CPT 64490? +
The 2026 Medicare national average non-facility payment for CPT 64490 is $211.59. Rates range from $182.55 to $270.96 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 64490? +
Surgery codes commonly use modifier 22 (increased procedural services), 50 (bilateral), 51 (multiple procedures), 52 (reduced services), 58/78/79 (staged, unplanned return, unrelated within global), 62 (co-surgeons), 80/82 (assistant surgeon), and 59 or the X{EPSU} subset for distinct procedural service.
What bundling edits apply to CPT 64490? +
This code has 10 NCCI PTP bundling relationships. See the NCCI Bundling section below for full list.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on May 31, 2026.
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