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CPT code 64778: Digital neuroma excision, each additional nerve2026 Medicare rate & RVUs

Reports excision of a neuroma from an additional digital nerve in the hand or foot during the same session as the primary nerve procedure.

CMS RVU26DEffective Oct 1, 2026109 payment localities16 Medicare services in 2024

Medicare pays $154.98 for 64778 nationally in a facility.

Medicare rate · 64778

Digital neuroma excision, each additional nerve

Office or facility?

Work RVUs
3.03
Total RVUs
4.64
Global days
ZZZ

National rate · 2026

$154.98

Facility setting, before claim adjustments.

See every locality for 64778 →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 64778 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 64778 covers

This add-on represents excision of a neuroma from an additional digital nerve in a finger or toe. A hand, orthopedic, plastic, or podiatric surgeon may perform the work in an operating room when a patient has painful neuromas involving more than one digital nerve, such as after nerve injury or prior surgery. The surgeon identifies and removes the additional affected nerve lesion as part of the operative treatment.

Report 64778 only with the primary digital nerve neuroma excision code, 64776, for an additional nerve treated during the same operative session. The operative note should identify the hand or foot, the distinct digital nerves treated, and the neuroma excised at each site. CMS classifies 64778 as an add-on code: it is billed only with a primary procedure and paid within that procedure’s global period.

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 64778 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

64778 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$141.65
AlaskaUnavailable$198.09
ArizonaUnavailable$150.90
ArkansasUnavailable$140.04
Atlanta, GAUnavailable$160.10
Austin, TXUnavailable$154.62
Bakersfield, CAUnavailable$151.66
Baltimore area, MDUnavailable$164.03
Beaumont, TXUnavailable$150.55
Brazoria, TXUnavailable$150.80

64778 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
64778 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 64778 rate is calculated

Each of 64778’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 · 64778

RVUs × geographic indexes × conversion factor

Office or facility?

Work3.03

3.03 RVUs× 1.000 GPCI

Practice expense0.97

0.97 RVUs× 1.000 GPCI

Malpractice0.64

0.64 RVUs× 1.000 GPCI

Adjusted RVUs

4.6400

Conversion factor

$33.4009

Medicare rate

$154.98

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

Payment rules and modifiers for 64778

The CMS indicators that decide how 64778 is paid alongside other services.

CMS payment indicators · 64778

Digital neuroma excision, each additional nerve

RuleCMS valueWhat it means
Global periodZZZAdd-on code: falls within the primary procedure’s global period.
Multiple procedures0No multiple-procedure reduction.
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.

64778 compared with similar codes

Compare codes · National

4 codes, side by side

Office or facility?

  • 64778

    Digital neuroma excision, each additional nerve3.03 wRVU

    Not priced

  • 64776

    Neuroma excision, digital nerve, hand or foot5.46 wRVU

    Not priced

  • 64774

    Neuroma excision, cutaneous nerve, surgically treated5.66 wRVU

    Not priced

  • 64783

    Neuroma excision, additional major peripheral nerve3.62 wRVU

    Not priced

How to choose

64776Neuroma excisionDigital nerve, hand or foot
64776 reports the primary digital nerve neuroma excision. Use 64778 only for an additional digital nerve treated in the same operative session.
64774Neuroma excisionCutaneous nerve, surgically treated
64774 applies to a neuroma of a cutaneous nerve. Choose 64778 when the additional neuroma excised is on a digital nerve in the hand or foot.
64783Neuroma excisionAdditional major peripheral nerve
64783 is an add-on for additional limb nerve neuroma excision outside the digital-nerve use of 64778.

Codes related to 64778

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

Codes related to 64778
CodeHow it relatesNational office range
Add-on codes
64776Neuroma excision, digital nerve, hand or footPrimary digital nerve neuroma excision reported with this additional-nerve add-on.No office rate
Used instead
64774Neuroma excision, cutaneous nerve, surgically treatedFor excision of a neuroma from a cutaneous nerve rather than an additional digital nerve.No office rate
64782Neuroma excision, major arm or leg nerveFor neuroma excision involving a major peripheral nerve rather than a digital nerve.No office rate
Same family
64783Neuroma excision, additional major peripheral nerveAdd-on neuroma excision code for additional limb nerve treatment, not additional digital nerves.No office rate

64778 billing questions

When should 64778 be reported instead of 64776?

Use 64776 for the primary digital nerve neuroma excision. Report 64778 for each additional digital nerve neuroma excised in the same session.

Can 64778 be billed by itself?

No. It is an add-on code and must be reported with the primary digital nerve procedure, 64776.

What should the operative note document?

Document the treated hand or foot, identify each distinct digital nerve, and describe the neuroma excised from the additional nerve.

How many units should be reported?

Report the add-on for each additional digital nerve neuroma excised beyond the primary nerve treated under 64776. The record should support each separately treated nerve.

How does the global period affect 64778?

CMS pays this add-on within the global period of its primary procedure. It is not reported as a standalone 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 64778PPRRVU2026_Oct_nonQPP.csv, line 7,231 (RVU26D)

Open CMS sourceHow we calculate rates

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