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CPT code 64581: Sacral nerve lead, open approach2026 Medicare rate & RVUs

Reports open placement of a neurostimulator electrode array at a sacral nerve, including a sacral nerve stimulation test lead, for neuromodulation treatment.

CMS RVU26DEffective Oct 1, 2026109 payment localities4.3K Medicare services in 2024

Medicare pays $587.86 for 64581 nationally in a facility.

Medicare rate · 64581

Sacral nerve lead, open approach

Office or facility?

Work RVUs
11.9
Total RVUs
17.60
Global days
090

National rate · 2026

$587.86

Facility setting, before claim adjustments.

See every locality for 64581 →Billed by an NP, PA or therapist? →

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

Your location

Medicare pays by the payment locality where the service is performed.

On this page 10 sections
  1. Medicare rate
  2. What 64581 covers
  3. By payment locality
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Similar codes
  8. Related codes
  9. Billing questions
  10. Sources

What 64581 covers

This code covers an open surgical approach to place a neurostimulator electrode array at a sacral nerve, including placement of a sacral nerve stimulation test lead. Urologists, urogynecologists, and colorectal surgeons may perform the procedure for conditions such as urinary urgency incontinence, nonobstructive urinary retention, or fecal incontinence. It is typically performed in an operating room or other surgical setting.

Report the code when the documented approach is open and the electrode array is placed at a sacral nerve; a percutaneous approach is coded differently. The operative note should identify the approach, target nerve, and electrode placement. If a pulse generator is also implanted, that generator service is reported separately. The service has a 90-day global period, including the day-before preoperative visit and related postoperative care. When multiple procedures are performed in the same session, the highest-valued is paid in full and others at 50%. Modifier 50 is inappropriate. Medicare does not pay an assistant at surgery for this service; co-surgeons and team surgery are not permitted.

This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.

Where 64581 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

64581 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$546.20
AlaskaUnavailable$769.27
ArizonaUnavailable$575.42
ArkansasUnavailable$541.13
Atlanta, GAUnavailable$602.78
Austin, TXUnavailable$589.75
Bakersfield, CAUnavailable$585.54
Baltimore area, MDUnavailable$617.59
Beaumont, TXUnavailable$571.82
Brazoria, TXUnavailable$577.13

64581 rates by state

Office rate range in each state. Select a state to see its payment localities.

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Local rates. Clear comparisons.

Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.

View every state and territory as a table
64581 office rate range by state
State / territoryOffice rate rangeLocalities
AKNo published base rate1
ALNo published base rate1
ARNo published base rate1
AZNo published base rate1
CANo published base rate29
CONo published base rate1
CTNo published base rate1
DCNo published base rate1
DENo published base rate1
FLNo published base rate3
GANo published base rate2
GUNo published base rate1
HINo published base rate1
IANo published base rate1
IDNo published base rate1
ILNo published base rate4
INNo published base rate1
KSNo published base rate1
KYNo published base rate1
LANo published base rate2
MANo published base rate2
MDNo published base rate3
MENo published base rate2
MINo published base rate2
MNNo published base rate1
MONo published base rate3
MSNo published base rate1
MTNo published base rate1
NCNo published base rate1
NDNo published base rate1
NENo published base rate1
NHNo published base rate1
NJNo published base rate2
NMNo published base rate1
NVNo published base rate1
NYNo published base rate5
OHNo published base rate1
OKNo published base rate1
ORNo published base rate2
PANo published base rate2
PRNo published base rate1
RINo published base rate1
SCNo published base rate1
SDNo published base rate1
TNNo published base rate1
TXNo published base rate8
UTNo published base rate1
VANo published base rate2
VINo published base rate1
VTNo published base rate1
WANo published base rate2
WINo published base rate1
WVNo published base rate1
WYNo published base rate1

How the 64581 rate is calculated

Each of 64581’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.

How the rate is built · 64581

RVUs × geographic indexes × conversion factor

Office or facility?

Work11.90

11.90 RVUs× 1.000 GPCI

Practice expense3.97

3.97 RVUs× 1.000 GPCI

Malpractice1.73

1.73 RVUs× 1.000 GPCI

Adjusted RVUs

17.6000

Conversion factor

$33.4009

Medicare rate

$587.86

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

Payment rules and modifiers for 64581

64581 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 64581

Sacral nerve lead, open approach

RuleCMS valueWhat it means
Global period090Major surgery: the day before, the day of, and 90 days after are included.
Multiple procedures2Standard reduction: highest-valued procedure at 100%, others at 50%.
Bilateral (modifier 50)0The 150% bilateral adjustment doesn’t apply.
Assistant at surgery (80/81/82/AS)1Not paid (statutory restriction).
Co-surgeons (62)0Not permitted.
Team surgery (66)0Not permitted.
Professional/technical0Physician service: no professional/technical split.
Split (54/55/56)0.11/0.76/0.13Share of the payment for pre-op, the procedure itself, and post-op care.

Global surgery period · 64581

Sacral nerve lead, open approach

90-day global period ends

Dec 30, 2026

Covers Sep 30, 2026 through Dec 30, 2026 (92 days, including the day before surgery).

Visit on Oct 31, 2026

Day 30 of the 90-day post-op period: related follow-up care is included in the surgical payment.

  • 24Unrelated E/M visit by the same physician
  • 79Unrelated procedure (starts its own global period)
  • 58Staged, more extensive, or therapy procedure that was planned
  • 78Unplanned return to the operating room for a related complication
SurgeryVisit
Sep 23, 2026Jan 10, 2027

Pre-op dayGlobal period

What modifiers do to the payment

Modifier 51 · payment effect

With and without the modifier

64581 without 51 · national facility

$587.86

Sacral nerve lead, open approach

64581-51 · Second procedure: 50%

$293.93

When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).

When to use modifier 51

64581 compared with similar codes

Compare codes · National

4 codes, side by side

Office or facility?

  • 64581

    Sacral nerve lead, open approach11.9 wRVU

    Not priced

  • 64561

    Sacral nerve lead, percutaneous approach5.3 wRVU

    $742.84

  • 64590

    Neurostimulator generator, pulse generator or receiver4.97 wRVU

    $428.20

  • 64575

    Nerve stimulation, open peripheral nerve placement4.31 wRVU

    Not priced

How to choose

64561Sacral nerve leadPercutaneous approach
Both address sacral nerve electrode placement, but 64581 is for an open approach and 64561 is for percutaneous placement.
64590Neurostimulator generatorPulse generator or receiver
64581 covers placement of the electrode array; 64590 covers insertion or replacement of the pulse generator or receiver.
64575Nerve stimulationOpen peripheral nerve placement
64575 describes open electrode-array implantation at a peripheral nerve other than the sacral nerve; 64581 identifies the sacral nerve target.

Codes related to 64581

Related codes aren’t interchangeable: bill the code that matches the service performed.

Codes related to 64581
CodeHow it relatesNational office range
Used instead
64561Sacral nerve lead, percutaneous approachPercutaneous placement at the sacral nerve is reported instead when that approach is used.$654.44–$989.70
Often billed with
64590Neurostimulator generator, pulse generator or receiverReported for pulse-generator implantation when the generator is placed with the sacral electrode array.$382.84–$540.26
Same family
64575Nerve stimulation, open peripheral nerve placementOpen electrode-array implantation in the peripheral nerve family, for a different nerve target.No office rate

64581 billing questions

How is this different from 64561?

64581 describes open placement of the sacral nerve electrode array. Use 64561 when the array is placed percutaneously.

Can the pulse generator be reported separately?

Yes. If a pulse generator is implanted in the same session, report that distinct service with 64590; 64581 covers the electrode array placement.

Should modifier 50 be appended for bilateral work?

No. The CMS bilateral adjustment does not apply, and modifier 50 is inappropriate for this code.

What does the 90-day global period include?

It includes the day-before preoperative visit and 90 days of related postoperative care.

Can an assistant surgeon or co-surgeon be reported?

Medicare does not pay an assistant at surgery for this service. Co-surgeons and team surgery are not permitted.

Where these rates come from

FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.

CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027

Show the CMS file lines behind this rate
RVUs for 64581PPRRVU2026_Oct_nonQPP.csv, line 7,155 (RVU26D)

Open CMS sourceHow we calculate rates

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