Single-shot injection of anesthetic, steroid, or both around the femoral nerve, with imaging guidance included when it is used.
- Medicare
- $134.27
- Work RVU
- 1.31
- Global, days
- 0
- Region
- Knee
Documentation requirements
What must appear in the operative or office note to support the claim.
Source · Editorial brief grounded in 3 cited references ↓
- Nerve targeted and side
- Imaging used and saved image if required by the payer
- Surgeon request for post-op pain management
- Type of anesthesia used for the surgical case
- Drug, concentration, and volume
- Block timing relative to the surgical anesthetic
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 ↓
64447 is a single-injection femoral nerve block. Imaging guidance, usually ultrasound, is part of the code, so 76942 is not billed with it. The continuous catheter version is 64448.
In orthopedics this is a post-op pain block for total knee arthroplasty, ACL reconstruction, and femur or patella fractures. Anesthesia usually places it. The surgeon does not bill it, but the surgeon's request in the record decides whether anesthesia gets paid.
Under Medicare's anesthesia policy, a post-op pain block is separately payable when the surgical anesthetic is general or something other than the block itself, and the surgeon asked anesthesia to manage post-op pain. Append modifier 59 or XU. If the femoral block is the main anesthetic for the case, it is part of the anesthesia service. Adductor canal blocks are where coders disagree. Some guidance treats the saphenous nerve as a femoral branch and uses 64447, and some payers want 64450. Code from the nerve named in the note and follow the payer's written policy. One unit per side.
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 (1.31) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (4.02) adds practice overhead and malpractice, and is what drives the Medicare payment below.
| Work RVU | 1.31 |
| Practice expense RVU | 2.59 |
| Malpractice RVU | 0.12 |
| Total RVU | 4.02 |
| Medicare national rate | $134.27 |
| 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 | $134.27 |
HOPD (APC 5442) Hospital outpatient department | $721.17 |
ASC (PI P3) Ambulatory surgical center (freestanding) | $86.94 |
Common denial reasons
The recurring reasons claims for CPT 64447 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Block was the primary surgical anesthetic
- No surgeon request for post-op analgesia documented
- 76942 billed separately and bundled
- Missing modifier 59 or XU with the anesthesia claim
- Nerve blocked not named in the procedure note
- Laterality modifier missing
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 3 cited references ↓
01Is ultrasound billed with 64447?
02Can anesthesia bill a femoral nerve block with a total knee?
03What code is used for an adductor canal block?
04What is the continuous femoral catheter code?
Sources & references
Editorial content was developed using the following public sources.
Mira Scribe
Mira Scribe's pre-op notes record the surgeon's plan for post-op pain control, which is the documentation anesthesia needs to bill the femoral block separately.
See how Mira captures CPT 64447 documentation