Injection of a local anesthetic, steroid, or both around the greater occipital nerve, usually for occipital neuralgia or cervicogenic headache.
- Medicare
- $78.83
- Work RVU
- 0.92
- Global, days
- 0
- Region
- Spine
Documentation requirements
What must appear in the operative or office note to support the claim.
Source · Editorial brief grounded in 3 cited references ↓
- Side or sides injected
- Drug, dose, and volume
- Diagnosis such as occipital neuralgia or cervicogenic headache with exam findings
- Imaging used, with saved image and report if ultrasound is billed
- Response to prior blocks for repeat injections
- Post-injection assessment
Applicable modifiers
Modifiers commonly billed with this code.
Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual
What this code covers
Source · Editorial summary grounded in 3 cited references ↓
64405 is a greater occipital nerve block with anesthetic, steroid, or both. In an orthopedic spine practice it comes up with patients who have neck pain and occipital headache from cervical spondylosis, or occipital neuralgia after a cervical fusion or whiplash injury.
The code is reported per nerve. A bilateral block is billed with modifier 50 or with RT and LT depending on the payer's preference. Do not bill two units on a single line unless the payer instructs it. Imaging guidance is not part of the code. If ultrasound is used and an image is saved with a written report, many payers allow 76942 separately, but some bundle it, so check the payer policy.
Global period is 0 days. A same-day E/M can be billed with modifier 25 only when it addresses something beyond the decision to do the block, like a new complaint or a med change. Lesser occipital nerve blocks are not 64405; they report 64450. Frequency limits vary, and repeat blocks need documented relief from the last one.
RVU & reimbursement
Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.
Source · CMS Physician Fee Schedule, RVU26A · January 2026
Work RVU vs. total RVU
The work RVU (0.92) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (2.36) adds practice overhead and malpractice, and is what drives the Medicare payment below.
| Work RVU | 0.92 |
| Practice expense RVU | 1.23 |
| Malpractice RVU | 0.21 |
| Total RVU | 2.36 |
| Medicare national rate | $78.83 |
| Global period | 0 days |
Payment by site of service
Medicare pays different rates by setting. HOPD typically pays substantially more than ASC for the same procedure.
Source · CMS OPPS Addendum B·ASC HCPCS payment rates·2026
| Setting | Medicare rate (national) |
|---|---|
Office (PFS non-facility) Procedure performed in physician's office | $78.83 |
HOPD (APC 5441) Hospital outpatient department | $313.60 |
ASC (PI P3) Ambulatory surgical center (freestanding) | $41.29 |
Common denial reasons
The recurring reasons claims for CPT 64405 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Bilateral block billed without modifier 50 or RT and LT
- Lesser occipital nerve billed as 64405
- Ultrasound billed without a saved image or report
- Same-day E/M with modifier 25 but no separate problem
- Repeat injections without documented relief
- Diagnosis does not support occipital nerve block
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 3 cited references ↓
01How do you bill a bilateral occipital nerve block?
02Can ultrasound be billed with 64405?
03What code is used for a lesser occipital nerve block?
Sources & references
Editorial content was developed using the following public sources.
Mira Scribe
Mira Scribe's notes record headache location, tenderness over the occipital nerve, and response to prior blocks, so repeat injections have the history payers ask for.
See how Mira captures CPT 64405 documentation