CPT code 64864: Facial nerve repair, extracranial nerve2026 Medicare rate & RVUs

Medicare pays $755.19 for 64864 nationally in a facility.

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

What 64864 covers

This service involves surgically reconnecting an injured extracranial cranial nerve, most often the facial nerve, by bringing the nerve ends together and repairing them. It may be performed by an otolaryngologist, plastic surgeon, or neurosurgeon in an operating room after facial trauma or an operative injury, including damage encountered during parotid-region surgery. The repair is distinct from reconstruction that bridges a nerve gap with a graft or redirects another nerve to restore facial function.

Report the code when the operative record supports repair of an extracranial cranial nerve and identifies the nerve and repair performed. The day-before preoperative visit and 90 days of related postoperative care are included in the major-surgery global period. For multiple procedures in one session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Modifier 50 is not appropriate. An assistant at surgery may be paid; co-surgeon payment requires supporting documentation, and team surgery 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.

Where 64864 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

64864 rates by state

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

How the 64864 rate is calculated

Each of 64864’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 64864

64864 has a 90-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

64864 compared with similar codes

How to choose

64865Facial nerve repairIntracranial segment

Choose 64864 for extracranial cranial nerve repair. Code 64865 applies to intracranial repair requiring craniotomy.

64866Facial nerve transferSpinal accessory or hypoglossal

64864 repairs the injured nerve itself; 64866 is used for a facial-to-hypoglossal nerve connection.

64885Nerve graftHead or neck, under 4 cm

64864 describes repair by reconnecting the injured nerve. Code 64885 is for head-and-neck nerve reconstruction using a graft under 4 cm.

64886Nerve graftHead or neck, over 4 cm

Use 64886 for head-and-neck nerve graft reconstruction when the graft is over 4 cm, rather than direct repair under 64864.

Codes related to 64864

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

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