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

In Puerto Rico, Medicare pays $430.45 for 64590 in the office and $267.35 when it’s performed in a hospital or facility.

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.

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 Puerto Rico 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. Puerto Rico pays $430.45. The RVUs are the same everywhere; the geographic indexes change the dollars.

Every other payment area

64590 rates by state

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

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.

Payment rules and modifiers for 64590

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

What modifiers do to the payment

When to use modifier 51

Codes related to 64590

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

How 64590 has changed in Puerto Rico

Price 64590 for an earlier date of service

Where the Puerto Rico rate applies

Puerto Rico is a Medicare payment area, not a city. Our Census mapping connects it to 292 cities and communities in Puerto Rico. Some span more than one payment area; confirm with the service ZIP.

• Aceitunas
• Adjuntas
• Aguada
• Aguadilla
• Aguas Buenas
• Aguas Claras
• Aguilita
• Aibonito

Browse all communities in Puerto Rico

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

Open CMS sourceHow we calculate rates