CPT 64491
Global ZZZ ActiveInj paravert f jnt c/t 2 lev
CPT 64491 Billing & Documentation Guide
CPT code 64491 (Inj paravert f jnt c/t 2 lev) is classified under Surgery (Endocrine/Nervous/Eye/Ear) with a global period indicator of ZZZ. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 1.13, a non-facility practice expense RVU of 1.81, and a malpractice RVU of 0.11, a total non-facility RVU of 3.05 and facility RVU of 1.52. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $104.75, though rates vary from $91.57 to $131.04 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 64491, 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 64491 with related codes; this code has 10 PTP bundling relationships on file (see table below).
Payment Status & Global Period
Active code (paid under MPFS)
Add-on code (global concept does not apply)
MUE Limit (Medically Unlikely Edits)
Submitting more than 1 units of 64491 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 64491
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 1.13 | 1.13 |
| Practice Expense RVU | 1.81 | 0.28 |
| Malpractice RVU | 0.11 | 0.11 |
| Total RVU | 3.05 | 1.52 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 64491
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 | $112.62 | $52.15 | $106.61 - $131.04 | 29 |
| Florida | $105.55 | $54.28 | $101.06 - $109.97 | 3 |
| Georgia | $99.87 | $51.12 | $96.05 - $103.69 | 2 |
| Illinois | $103.31 | $53.93 | $98.68 - $107.2 | 4 |
| Michigan | $99.69 | $51.7 | $97.09 - $102.28 | 2 |
| North Carolina | $96.5 | $48.82 | $96.5 - $96.5 | 1 |
| New York | $111.97 | $54.96 | $97.76 - $118.86 | 5 |
| Ohio | $96.64 | $49.99 | $96.64 - $96.64 | 1 |
| Pennsylvania | $101.23 | $51.17 | $96.71 - $105.74 | 2 |
| Texas | $100.88 | $50.57 | $96.17 - $105.04 | 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 64491
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 64491 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 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 |
| 0218T | Column 1 (primary), can be billed with modifier | No | Mutually exclusive procedures |
| 0282T | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 0283T | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 0284T | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 0285T | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
Frequently Asked Questions, CPT 64491
What does CPT code 64491 mean? +
CPT code 64491 represents: Inj paravert f jnt c/t 2 lev. It's in the Surgery (Endocrine/Nervous/Eye/Ear) category with a global period of ZZZ.
What is the Medicare reimbursement for CPT 64491? +
The 2026 Medicare national average non-facility payment for CPT 64491 is $104.75. Rates range from $91.57 to $131.04 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 64491? +
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 64491? +
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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