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CPT code 64721: Carpal tunnel release, median nerve at carpal tunnel2026 Medicare rate & RVUs in Puerto Rico

Reports open surgical release of the median nerve at the carpal tunnel, typically by dividing the transverse carpal ligament to relieve compression.

CMS RVU26DEffective Oct 1, 2026One payment locality153.3K Medicare services in 2024

In Puerto Rico, Medicare pays $485.31 for 64721 in the office and $425.20 when it’s performed in a hospital or facility.

$485.31Office (non-facility)
$425.20Hospital or facility
+0.6%vs the national office rate ($482.64)

Check a contract rate as a % of Medicare · 64721 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 64721 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Puerto Rico
  2. What 64721 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 64721 covers

A hand or orthopedic surgeon typically performs this open operation for median nerve compression at the wrist, often when carpal tunnel symptoms warrant surgical decompression. The surgeon opens the wrist or palm and releases the transverse carpal ligament to reduce pressure on the median nerve. The procedure is commonly performed in an operating room or ambulatory surgery setting.

Report 64721 for the documented open median nerve release at the carpal tunnel; the operative note should identify the side and describe the release performed. The code has a 90-day global period, including the day-before preoperative visit and related postoperative care during that period. For multiple procedures in one session, the highest-valued procedure is paid in full and others at 50%. Modifier 50 identifies bilateral surgery, paid at 150%. Medicare does not pay an assistant at surgery, and 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.

How Puerto Rico compares for 64721

Across 109 of 109 payment localities, the office rate for 64721 runs from $426.06 in Arkansas to $612.23 in San Benito County, CA. Puerto Rico pays $485.31. The RVUs are the same everywhere; the geographic indexes change the dollars.

64721 in Puerto Rico vs other payment areas
  1. Puerto Rico · this page$485.31
  2. Los Angeles, CA · California$530.80+$45.49
  3. Washington, DC area · District of Columbia$546.32+$61.01
  4. Miami, FL · Florida$544.99+$59.68
  5. Chicago, IL · Illinois$528.04+$42.73
  6. Manhattan, NY · New York$558.98+$73.67
  7. Alaska · Alaska$567.49+$82.18

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

Every other payment area

64721 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$432.34$380.32
ArkansasArkansas$426.06$374.99
ArizonaArizona$468.97$411.36
Bakersfield, CACalifornia$500.40$435.24
Chico, CACalifornia$497.66$432.50
El Centro, CACalifornia$497.83$432.67
Fresno, CACalifornia$497.66$432.50
Hanford, CACalifornia$497.66$432.50

64721 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.

$426.06

$567.49

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

View every state and territory as a table
64721 office rate range by state
State / territoryOffice rate rangeLocalities
AK$567.491
AL$432.341
AR$426.061
AZ$468.971
CA$497.66–$612.2329
CO$495.751
CT$514.971
DC$546.321
DE$476.661
FL$486.62–$544.993
GA$457.93–$494.382
GU$508.121
HI$508.121
IA$438.261
ID$442.211
IL$476.24–$528.044
IN$444.651
KS$438.631
KY$447.911
LA$448.18–$470.172
MA$493.76–$541.442
MD$485.00–$546.323
ME$447.14–$467.852
MI$461.89–$495.262
MN$467.701
MO$442.10–$468.913
MS$434.041
MT$482.581
NC$451.441
ND$463.001
NE$439.931
NH$490.301
NJ$518.79–$541.112
NM$465.421
NV$477.411
NY$458.44–$575.705
OH$457.891
OK$444.501
OR$471.67–$508.692
PA$457.24–$503.732
PR$485.311
RI$491.641
SC$455.831
SD$460.691
TN$441.161
TX$454.41–$495.888
UT$462.021
VA$468.03–$546.322
VI$485.311
VT$463.431
WA$492.09–$549.972
WI$447.681
WV$459.221
WY$474.051

See 64721 in every payment locality

How the 64721 rate is calculated

Each of 64721’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 · 64721

RVUs × geographic indexes × conversion factor

Office or facility?

Work4.85

4.85 RVUs× 1.000 GPCI

Practice expense8.61

8.61 RVUs× 1.000 GPCI

Malpractice0.99

0.99 RVUs× 1.000 GPCI

Adjusted RVUs

14.4500

Conversion factor

$33.4009

Medicare rate

$482.64

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

The exact Puerto Rico inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

7,210

Code
64721
Physician work
4.85
Practice expense
8.61
Malpractice
0.99

GPCI2026.csv

91

Locality
Puerto Rico
Physician work
1.000
Practice expense
1.011
Malpractice
0.985
Office calculation for 64721 in Puerto Rico
ComponentRVULocality factorAdjusted
Physician work4.85× 1.0004.8500
Practice expense8.61× 1.0118.7047
Malpractice0.99× 0.9850.9751
Total RVUs14.5299
Conversion factor× 33.4009

Office rate, Puerto Rico$485.31

Office: (4.85 × 1 + 8.61 × 1.011 + 0.99 × 0.985) × $33.4009 = $485.31

Facility: (4.85 × 1 + 6.83 × 1.011 + 0.99 × 0.985) × $33.4009 = $425.20

Open 64721 in the RVU calculator

Payment rules and modifiers for 64721

64721 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 64721

Carpal tunnel release, median nerve at carpal tunnel

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)1Bilateral with modifier 50 pays 150% of the fee schedule amount.
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 · 64721

Carpal tunnel release, median nerve at carpal tunnel

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 50 · payment effect

With and without the modifier

64721 without 50 · national office

$482.64

Carpal tunnel release, median nerve at carpal tunnel

64721-50 · Bilateral: 150%

$723.96

Both sides on one line with modifier 50 are paid at 150% of the fee schedule amount (subject to multiple-procedure rules with other procedures).

When to use modifier 50

Codes related to 64721

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

Codes related to 64721
CodeHow it relatesOffice range, Puerto Rico
Add-on codes
64727Internal neurolysis, microscope-assisted nerve dissectionAdd-on for qualifying internal neurolysis requiring an operating microscope.No office rate
Used instead
29848Carpal tunnel release, endoscopic approachEndoscopic approach to carpal tunnel release rather than the open approach.No office rate
64728Carpal tunnel decompression, median nerveA separate median nerve decompression code for the carpal tunnel; distinguish by the documented procedure.$1,356.62

How 64721 has changed in Puerto Rico

64721 · Office / nonfacility

$485.31

Effective 2026-10-01

The base rate is $40.34 higher than on 2025-10-01, moving from $444.97 to $485.31 (9.1%).

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

    $444.97changed to$485.31

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 4.97 changed to 4.85
    • Practice expense RVU 7.76 changed to 8.61
    • Practice expense GPCI 1.007 changed to 1.011
    • Malpractice GPCI 0.982 changed to 0.985

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $453.88changed to$444.97

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 7.62 changed to 7.76
    • Malpractice RVU 1.01 changed to 0.99

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $446.47changed to$453.88

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $456.95changed to$446.47

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 7.50 changed to 7.62
    • Malpractice RVU 0.97 changed to 1.01
    • Practice expense GPCI 1.008 changed to 1.007
    • Malpractice GPCI 0.984 changed to 0.982

  5. October 1, 2023

    RVU23D

    $455.44changed to$456.95

    • Practice expense GPCI 1.000 changed to 1.008
    • Malpractice GPCI 1.000 changed to 0.984

  6. January 1, 2023

    RVU23A

    $459.02changed to$455.44

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 7.26 changed to 7.50
    • Malpractice RVU 0.99 changed to 0.97
    • Practice expense GPCI 1.008 changed to 1.000
    • Malpractice GPCI 0.986 changed to 1.000

    Held through RVU23B, RVU23C.

  7. January 1, 2022

    RVU22A

    $456.87changed to$459.02

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 7.12 changed to 7.26
    • Malpractice RVU 0.96 changed to 0.99

    Held through RVU22B, RVU22C, RVU22D.

  8. January 1, 2021

    RVU21A

    $454.06changed to$456.87

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 6.61 changed to 7.12
    • Malpractice GPCI 0.988 changed to 0.986

    Held through RVU21B, RVU21C, RVU21D.

  9. January 1, 2020

    RVU20A

    $449.96changed to$454.06

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 6.48 changed to 6.61
    • Malpractice RVU 1.00 changed to 0.96
    • Practice expense GPCI 1.007 changed to 1.008
    • Malpractice GPCI 0.990 changed to 0.988

    Held through RVU20B, RVU20C, RVU20D.

  10. January 1, 2019

    RVU19A

    $445.49changed to$449.96

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 6.38 changed to 6.48
    • Malpractice RVU 0.99 changed to 1.00

    Held through RVU19B, RVU19C, RVU19D.

  11. January 1, 2018

    RVU18AR1

    $395.87changed to$445.49

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 6.33 changed to 6.38
    • Malpractice RVU 1.00 changed to 0.99
    • Practice expense GPCI 0.856 changed to 1.007
    • Malpractice GPCI 0.642 changed to 0.990

    Held through RVU18B, RVU18C, RVU18D.

  12. January 1, 2017

    RVU17A

    $348.18changed to$395.87

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 6.32 changed to 6.33
    • Malpractice RVU 1.02 changed to 1.00
    • Practice expense GPCI 0.705 changed to 0.856
    • Malpractice GPCI 0.293 changed to 0.642

    Held through RVU17B, RVU17C, RVU17D.

  13. January 1, 2016

    RVU16A

    $349.79changed to$348.18

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 6.33 changed to 6.32
    • Malpractice RVU 1.03 changed to 1.02

    Held through RVU16B, RVU16C, RVU16D.

  14. July 1, 2015

    RVU15C

    $348.05changed to$349.79

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  15. January 1, 2015

    RVU15A

    $342.35changed to$348.05

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 6.26 changed to 6.33
    • Malpractice RVU 0.94 changed to 1.03
    • Practice expense GPCI 0.692 changed to 0.705
    • Malpractice GPCI 0.271 changed to 0.293

    Held through RVU15B.

  16. January 1, 2014

    RVU14A

    $335.87changed to$342.35

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 6.87 changed to 6.26
    • Malpractice RVU 0.98 changed to 0.94
    • Practice expense GPCI 0.678 changed to 0.692
    • Malpractice GPCI 0.249 changed to 0.271

    Held through RVU14B, RVU14C, RVU14D.

  17. January 1, 2013

    RVU13AR

    Earliest loaded release: $335.87

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$485.31$425.20RVU26D
2026-07-01$485.31$425.20RVU26C
2026-04-01$485.31$425.20RVU26B
2026-01-01$485.31$425.20RVU26A
2025-10-01$444.97$437.48RVU25D
2025-07-01$444.97$437.48RVU25C
2025-04-01$444.97$437.48RVU25B
2025-01-01$444.97$437.48RVU25A
2024-10-01$453.88$446.17RVU24D
2024-07-01$453.88$446.17RVU24C
2024-04-01$453.88$446.17RVU24B
2024-03-09$453.88$446.17RVU24AR
2024-01-01$446.47$438.89RVU24A
2023-10-01$456.95$448.75RVU23D
2023-07-01$455.44$447.31RVU23C
2023-04-01$455.44$447.31RVU23B
2023-01-01$455.44$447.31RVU23A
2022-10-01$459.02$450.30RVU22D
2022-07-01$459.02$450.30RVU22C
2022-04-01$459.02$450.30RVU22B
2022-01-01$459.02$450.30RVU22A
2021-10-01$456.87$449.14RVU21D
2021-07-01$456.87$449.14RVU21C
2021-04-01$456.87$449.14RVU21B
2021-01-01$456.87$449.14RVU21A
2020-10-01$454.06$447.87RVU20D
2020-07-01$454.06$447.87RVU20C
2020-04-01$454.06$447.87RVU20B
2020-01-01$454.06$447.87RVU20A
2019-10-01$449.96$445.24RVU19D
2019-07-01$449.96$445.24RVU19C
2019-04-01$449.96$445.24RVU19B
2019-01-01$449.96$445.24RVU19A
2018-10-01$445.49$442.95RVU18D
2018-07-01$445.49$442.95RVU18C
2018-04-01$445.49$442.95RVU18B
2018-01-01$445.49$442.95RVU18AR1
2017-10-01$395.87$393.72RVU17D
2017-07-01$395.87$393.72RVU17C
2017-04-01$395.87$393.72RVU17B
2017-01-01$395.87$393.72RVU17A
2016-10-01$348.18$346.16RVU16D
2016-07-01$348.18$346.16RVU16C
2016-04-01$348.18$346.16RVU16B
2016-01-01$348.18$346.16RVU16A
2015-10-01$349.79$347.51RVU15D
2015-07-01$349.79$347.51RVU15C
2015-04-01$348.05$345.78RVU15B
2015-01-01$348.05$345.78RVU15A
2014-10-01$342.35$340.36RVU14D
2014-07-01$342.35$340.36RVU14C
2014-04-01$342.35$340.36RVU14B
2014-01-01$342.35$340.36RVU14A
2013-10-01$335.87$334.03RVU13D
2013-07-01$335.87$334.03RVU13C
2013-04-01$335.87$334.03RVU13B
2013-01-01$335.87$334.03RVU13AR

Price 64721 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

64721 billing questions

How does 64721 differ from endoscopic carpal tunnel release?

Use 64721 for the open median nerve release at the carpal tunnel. The endoscopic approach is reported with 29848.

Can internal neurolysis be reported with 64721?

CPT 64727 is an add-on for qualifying internal neurolysis requiring an operating microscope. The operative documentation should support that additional work.

How is bilateral carpal tunnel release reported?

Report modifier 50 for bilateral surgery; CMS pays the bilateral procedure at 150%.

Are routine postoperative visits separately payable?

Related postoperative care during the 90-day global period is included, along with the day-before preoperative visit.

Can an assistant or co-surgeon be billed for 64721?

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

What happens when 64721 is performed with another procedure?

Under the standard multiple procedure reduction, the highest-valued procedure is paid in full and other procedures in the same session are paid at 50%.

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 64721PPRRVU2026_Oct_nonQPP.csv, line 7,210 (RVU26D)
Geographic factors for Puerto RicoGPCI2026.csv, line 91 (RVU26D)

Open CMS sourceHow we calculate rates

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