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CPT code 64590: Neurostimulator generator, pulse generator or receiver2026 Medicare rate & RVUs in Delaware

Reports placement or replacement of an implanted pulse generator or receiver for peripheral, sacral, or gastric neurostimulation, including connection to an electrode array.

CMS RVU26DEffective Oct 1, 2026One payment locality26.7K Medicare services in 2024

In Delaware, Medicare pays $423.71 for 64590 in the office and $264.32 when it’s performed in a hospital or facility.

$423.71Office (non-facility)
$264.32Hospital or facility
−1.0%vs the national office rate ($428.20)

Check a contract rate as a % of Medicare · 64590 nationwide

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

We’ll open 64590 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Delaware
  2. What 64590 covers
  3. Compared with other areas
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Related codes
  8. Rate history
  9. Where it applies
  10. Billing questions
  11. Sources

What 64590 covers

This service places or replaces the implanted power unit that drives a peripheral, sacral, or gastric neurostimulator. The surgeon or other qualified proceduralist typically creates or reopens a pocket, positions the generator or receiver, and connects it to the implanted electrode array. Examples include generator replacement for a patient receiving sacral neuromodulation for urinary or bowel symptoms, or for gastric stimulation for gastroparesis. The work is commonly performed in an operating room or procedure facility; the generator procedure is distinct from placing or revising the nerve electrode.

Report this code when the implanted generator or receiver is inserted or replaced, not for lead work alone. The operative report should identify the device, the reason for insertion or replacement, the pocket and connection work, and any electrode-array procedure performed. Medicare includes related postoperative visits for 10 days. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and others at 50%. Modifier 50 is inappropriate for this service. Medicare does not pay an assistant at surgery; co-surgeon payment requires supporting documentation, and team-surgery billing is 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.

How Delaware compares for 64590

Across 109 of 109 payment localities, the office rate for 64590 runs from $382.84 in Arkansas to $540.26 in San Benito County, CA. Delaware pays $423.71. The RVUs are the same everywhere; the geographic indexes change the dollars.

64590 in Delaware vs other payment areas
  1. Delaware · this page$423.71
  2. Los Angeles, CA · California$470.33+$46.62
  3. Washington, DC area · District of Columbia$482.25+$58.54
  4. Miami, FL · Florida$475.23+$51.52
  5. Chicago, IL · Illinois$462.13+$38.42
  6. Manhattan, NY · New York$491.64+$67.93
  7. Alaska · Alaska$515.71+$92.00

Other areas in Delaware first, then benchmark localities. Bars start at $0.

Every other payment area

64590 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$387.89$246.73
ArkansasArkansas$382.84$244.26
ArizonaArizona$417.32$260.99
Bakersfield, CACalifornia$444.65$267.84
Chico, CACalifornia$442.54$265.72
El Centro, CACalifornia$442.66$265.85
Fresno, CACalifornia$442.54$265.72
Hanford, CACalifornia$442.54$265.72

64590 rates by state

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

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

Explore a state

Local rates. Clear comparisons.

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

$382.84

$515.71

Color shows the midpoint of each state’s locality range.

View every state and territory as a table
64590 office rate range by state
State / territoryOffice rate rangeLocalities
AK$515.711
AL$387.891
AR$382.841
AZ$417.321
CA$442.54–$540.2629
CO$440.071
CT$454.951
DC$482.251
DE$423.711
FL$430.00–$475.233
GA$407.20–$437.402
GU$450.521
HI$450.521
IA$393.281
ID$396.321
IL$421.24–$462.134
IN$398.311
KS$393.281
KY$399.731
LA$399.83–$417.482
MA$438.51–$478.462
MD$430.71–$482.253
ME$399.96–$417.062
MI$410.66–$436.602
MN$417.931
MO$394.75–$416.833
MS$388.781
MT$428.151
NC$403.461
ND$413.721
NE$394.721
NH$434.901
NJ$459.08–$478.372
NM$413.361
NV$424.371
NY$409.07–$504.675
OH$407.701
OK$397.321
OR$420.01–$451.012
PA$407.36–$445.642
PR$430.451
RI$436.571
SC$406.471
SD$412.011
TN$395.271
TX$405.07–$439.558
UT$411.441
VA$416.99–$482.252
VI$430.451
VT$413.781
WA$437.13–$486.022
WI$401.341
WV$407.551
WY$421.861

See 64590 in every payment locality

How the 64590 rate is calculated

Each of 64590’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 · 64590

RVUs × geographic indexes × conversion factor

Office or facility?

Work4.97

4.97 RVUs× 1.000 GPCI

Practice expense7.12

7.12 RVUs× 1.000 GPCI

Malpractice0.73

0.73 RVUs× 1.000 GPCI

Adjusted RVUs

12.8200

Conversion factor

$33.4009

Medicare rate

$428.20

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

The exact Delaware inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

7,160

Code
64590
Physician work
4.97
Practice expense
7.12
Malpractice
0.73

GPCI2026.csv

40

Locality
Delaware
Physician work
1.005
Practice expense
0.988
Malpractice
0.899
Office calculation for 64590 in Delaware
ComponentRVULocality factorAdjusted
Physician work4.97× 1.0054.9948
Practice expense7.12× 0.9887.0346
Malpractice0.73× 0.8990.6563
Total RVUs12.6857
Conversion factor× 33.4009

Office rate, Delaware$423.71

Office: (4.97 × 1.005 + 7.12 × 0.988 + 0.73 × 0.899) × $33.4009 = $423.71

Facility: (4.97 × 1.005 + 2.29 × 0.988 + 0.73 × 0.899) × $33.4009 = $264.32

Open 64590 in the RVU calculator

Payment rules and modifiers for 64590

64590 has a 10-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 64590

Neurostimulator generator, pulse generator or receiver

RuleCMS valueWhat it means
Global period010Minor procedure: the day of the procedure plus 10 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)1Permitted with supporting documentation.
Team surgery (66)0Not permitted.
Professional/technical0Physician service: no professional/technical split.
Split (54/55/56)0.10/0.80/0.10Share of the payment for pre-op, the procedure itself, and post-op care.

Global surgery period · 64590

Neurostimulator generator, pulse generator or receiver

10-day global period ends

Oct 11, 2026

Covers Oct 1, 2026 through Oct 11, 2026 (11 days).

Visit on Oct 31, 2026

After the global period ends: visits and procedures are billed normally.

SurgeryVisit
Sep 28, 2026Oct 14, 2026

What modifiers do to the payment

Modifier 51 · payment effect

With and without the modifier

64590 without 51 · national office

$428.20

Neurostimulator generator, pulse generator or receiver

64590-51 · Second procedure: 50%

$214.10

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

Codes related to 64590

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

Codes related to 64590
CodeHow it relatesOffice range, Delaware
Same family
64595Generator revision, sacral or gastric systemCovers revision or removal of the peripheral, sacral, or gastric generator or receiver.$344.33
Often billed with
64561Sacral nerve lead, percutaneous approachMay accompany permanent percutaneous sacral electrode-array placement when both are implanted in one session.$734.70
64581Sacral nerve lead, open approachMay accompany open sacral electrode-array placement during a one-session permanent implantation.No office rate

How 64590 has changed in Delaware

64590 · Office / nonfacility

$423.71

Effective 2026-10-01

The base rate is $23.04 higher than on 2025-10-01, moving from $400.67 to $423.71 (5.8%).

It is unchanged from the immediately preceding available release, effective 2026-07-01.

Base rate by release · bars start at $0 · select a bar to compare

One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.

What changed, release by release

  1. January 1, 2026

    RVU26A

    $400.67changed to$423.71

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 5.10 changed to 4.97
    • Practice expense RVU 6.62 changed to 7.12
    • Malpractice RVU 0.71 changed to 0.73
    • Work GPCI 1.009 changed to 1.005
    • Practice expense GPCI 0.992 changed to 0.988
    • Malpractice GPCI 0.949 changed to 0.899

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $440.03changed to$400.67

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 7.44 changed to 6.62
    • Malpractice RVU 0.73 changed to 0.71

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $432.85changed to$440.03

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $267.74changed to$432.85

    • Conversion factor 33.8872 changed to 32.7442
    • Work RVU 2.45 changed to 5.10
    • Practice expense RVU 5.07 changed to 7.44
    • Malpractice RVU 0.35 changed to 0.73
    • Work GPCI 1.007 changed to 1.009
    • Practice expense GPCI 1.007 changed to 0.992
    • Malpractice GPCI 0.938 changed to 0.949

  5. January 1, 2023

    RVU23A

    $276.84changed to$267.74

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 5.11 changed to 5.07
    • Malpractice RVU 0.34 changed to 0.35
    • Work GPCI 1.005 changed to 1.007
    • Practice expense GPCI 1.022 changed to 1.007
    • Malpractice GPCI 0.927 changed to 0.938

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $283.78changed to$276.84

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 5.24 changed to 5.11

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $278.00changed to$283.78

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 4.79 changed to 5.24
    • Work GPCI 1.006 changed to 1.005
    • Practice expense GPCI 1.021 changed to 1.022
    • Malpractice GPCI 1.023 changed to 0.927

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $279.19changed to$278.00

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 4.83 changed to 4.79
    • Malpractice RVU 0.32 changed to 0.34
    • Work GPCI 1.007 changed to 1.006
    • Practice expense GPCI 1.019 changed to 1.021
    • Malpractice GPCI 1.119 changed to 1.023

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $279.59changed to$279.19

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 4.86 changed to 4.83
    • Malpractice RVU 0.31 changed to 0.32

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $277.63changed to$279.59

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 4.80 changed to 4.86
    • Work GPCI 1.010 changed to 1.007
    • Practice expense GPCI 1.025 changed to 1.019
    • Malpractice GPCI 1.101 changed to 1.119

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $276.87changed to$277.63

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 4.77 changed to 4.80
    • Work GPCI 1.012 changed to 1.010
    • Practice expense GPCI 1.031 changed to 1.025
    • Malpractice GPCI 1.083 changed to 1.101

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $278.26changed to$276.87

    • Conversion factor 35.9335 changed to 35.8043
    • Malpractice RVU 0.32 changed to 0.31

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $276.88changed to$278.26

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $272.39changed to$276.88

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 4.70 changed to 4.77
    • Malpractice RVU 0.28 changed to 0.32
    • Practice expense GPCI 1.038 changed to 1.031
    • Malpractice GPCI 0.878 changed to 1.083

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $272.85changed to$272.39

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 5.12 changed to 4.70
    • Malpractice RVU 0.29 changed to 0.28
    • Practice expense GPCI 1.044 changed to 1.038
    • Malpractice GPCI 0.672 changed to 0.878

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $272.85

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$423.71$264.32RVU26D
2026-07-01$423.71$264.32RVU26C
2026-04-01$423.71$264.32RVU26B
2026-01-01$423.71$264.32RVU26A
2025-10-01$400.67$286.44RVU25D
2025-07-01$400.67$286.44RVU25C
2025-04-01$400.67$286.44RVU25B
2025-01-01$400.67$286.44RVU25A
2024-10-01$440.03$293.42RVU24D
2024-07-01$440.03$293.42RVU24C
2024-04-01$440.03$293.42RVU24B
2024-03-09$440.03$293.42RVU24AR
2024-01-01$432.85$288.63RVU24A
2023-10-01$267.74$162.64RVU23D
2023-07-01$267.74$162.64RVU23C
2023-04-01$267.74$162.64RVU23B
2023-01-01$267.74$162.64RVU23A
2022-10-01$276.84$164.73RVU22D
2022-07-01$276.84$164.73RVU22C
2022-04-01$276.84$164.73RVU22B
2022-01-01$276.84$164.73RVU22A
2021-10-01$283.78$165.38RVU21D
2021-07-01$283.78$165.38RVU21C
2021-04-01$283.78$165.38RVU21B
2021-01-01$283.78$165.38RVU21A
2020-10-01$278.00$169.30RVU20D
2020-07-01$278.00$169.30RVU20C
2020-04-01$278.00$169.30RVU20B
2020-01-01$278.00$169.30RVU20A
2019-10-01$279.19$170.49RVU19D
2019-07-01$279.19$170.49RVU19C
2019-04-01$279.19$170.49RVU19B
2019-01-01$279.19$170.49RVU19A
2018-10-01$279.59$170.64RVU18D
2018-07-01$279.59$170.64RVU18C
2018-04-01$279.59$170.64RVU18B
2018-01-01$279.59$170.64RVU18AR1
2017-10-01$277.63$169.85RVU17D
2017-07-01$277.63$169.85RVU17C
2017-04-01$277.63$169.85RVU17B
2017-01-01$277.63$169.85RVU17A
2016-10-01$276.87$169.09RVU16D
2016-07-01$276.87$169.09RVU16C
2016-04-01$276.87$169.09RVU16B
2016-01-01$276.87$169.09RVU16A
2015-10-01$278.26$170.45RVU15D
2015-07-01$278.26$170.45RVU15C
2015-04-01$276.88$169.61RVU15B
2015-01-01$276.88$169.61RVU15A
2014-10-01$272.39$165.67RVU14D
2014-07-01$272.39$165.67RVU14C
2014-04-01$272.39$165.67RVU14B
2014-01-01$272.39$165.67RVU14A
2013-10-01$272.85$161.32RVU13D
2013-07-01$272.85$161.32RVU13C
2013-04-01$272.85$161.32RVU13B
2013-01-01$272.85$161.32RVU13AR

Price 64590 for an earlier date of service

Where the Delaware rate applies

Delaware is a Medicare payment area, not a city. Our Census mapping connects it to 79 cities and communities in Delaware. Some span more than one payment area; confirm with the service ZIP.

  • Arden
  • Ardencroft
  • Ardentown
  • Bear
  • Bellefonte
  • Bethany Beach
  • Bethel
  • Blades

Browse all communities in Delaware

64590 billing questions

How is this different from 64595?

64590 is for inserting or replacing the generator or receiver. Use 64595 when the generator or receiver is revised or removed without insertion or replacement.

Does this code include placement of the electrode array?

No. This code represents generator or receiver work; electrode-array placement, revision, or removal is a separate service when performed and supported by the operative documentation.

Can it be reported with a sacral electrode-array code?

It may be reported with 64561 or 64581 when the electrode array and implanted generator are placed during the same permanent implantation encounter. The record should describe both services.

What documentation supports generator replacement?

Document the existing device and its indication, why replacement was performed, the generator or receiver work, and its connection to the electrode array.

Should modifier 50 be used for bilateral treatment?

No. Modifier 50 is inappropriate for this generator or receiver service.

Are postoperative visits included?

Related postoperative visits during the 10-day global period are included in the service.

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 64590PPRRVU2026_Oct_nonQPP.csv, line 7,160 (RVU26D)
Geographic factors for DelawareGPCI2026.csv, line 40 (RVU26D)

Open CMS sourceHow we calculate rates

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