CPT 64520
Global 000 ActiveN block lumbar/thoracic
CPT 64520 Billing & Documentation Guide
CPT code 64520 (N block lumbar/thoracic) 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 1.32, a non-facility practice expense RVU of 5.81, and a malpractice RVU of 0.12, a total non-facility RVU of 7.25 and facility RVU of 2.3. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $250.95, though rates vary from $212.85 to $330.92 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 64520, 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 64520 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 64520 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 64520
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 1.32 | 1.32 |
| Practice Expense RVU | 5.81 | 0.86 |
| Malpractice RVU | 0.12 | 0.12 |
| Total RVU | 7.25 | 2.3 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 64520
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 | $277.47 | $81.83 | $259.68 - $330.92 | 29 |
| Florida | $246.6 | $80.71 | $235.63 - $256.24 | 3 |
| Georgia | $234.08 | $76.35 | $221.97 - $246.2 | 2 |
| Illinois | $239.42 | $79.66 | $227.53 - $250.8 | 4 |
| Michigan | $231.95 | $76.71 | $225.79 - $238.11 | 2 |
| North Carolina | $227.71 | $73.45 | $227.71 - $227.71 | 1 |
| New York | $268.12 | $83.68 | $231.26 - $285.09 | 5 |
| Ohio | $225.31 | $74.36 | $225.31 - $225.31 | 1 |
| Pennsylvania | $238.85 | $76.91 | $226.02 - $251.68 | 2 |
| Texas | $239.11 | $76.33 | $224.41 - $253.04 | 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 64520
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 64520 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 |
| 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 |
| 0333T | Column 1 (primary), can be billed with modifier | No | Standards of medical/surgical practice |
Frequently Asked Questions, CPT 64520
What does CPT code 64520 mean? +
CPT code 64520 represents: N block lumbar/thoracic. It's in the Surgery (Endocrine/Nervous/Eye/Ear) category with a global period of 000.
What is the Medicare reimbursement for CPT 64520? +
The 2026 Medicare national average non-facility payment for CPT 64520 is $250.95. Rates range from $212.85 to $330.92 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 64520? +
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 64520? +
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 June 1, 2026.
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