CPT code 64865: Facial nerve repair, intracranial segment2026 Medicare rate & RVUs in California
Reports surgical suture repair of a facial nerve injury within the cranial cavity, such as an intracranial transection addressed during skull-base surgery.
CMS doesn’t publish an office rate for 64865 in California.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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What 64865 covers
This code is for surgical repair of an injured facial nerve segment located inside the cranial cavity. A neurosurgeon or skull-base surgeon may perform the repair during an operation in which an intracranial facial nerve injury is identified, including an injury associated with tumor surgery or trauma. The key distinction from extracranial facial nerve repair is the location of the nerve being repaired, not simply the fact that the procedure involves the face.
Select the code when the operative report supports repair of the intracranial facial nerve, and document the injury site and repair performed. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Modifier 50 is inappropriate. Assistant-at-surgery payment may be made; 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 64865 pays more and less in California
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
29 of 29 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Bakersfield, CA | Unavailable | $961.15 |
| Chico, CA | Unavailable | $954.50 |
| El Centro, CA | Unavailable | $954.88 |
| Fresno, CA | Unavailable | $954.50 |
| Hanford, CA | Unavailable | $954.50 |
| Los Angeles, CA | Unavailable | $1,007.10 |
| Madera, CA | Unavailable | $954.50 |
| Marin County, CA | Unavailable | $1,098.43 |
| Merced, CA | Unavailable | $954.50 |
| Modesto, CA | Unavailable | $954.50 |
| Napa, CA | Unavailable | $1,053.49 |
| Oxnard, CA | Unavailable | $996.79 |
| Redding, CA | Unavailable | $954.50 |
| Rest of California | Unavailable | $954.50 |
| Riverside, CA | Unavailable | $979.37 |
| Sacramento, CA | Unavailable | $987.71 |
| Salinas, CA | Unavailable | $983.70 |
| San Benito County, CA | Unavailable | $1,123.31 |
| San Diego, CA | Unavailable | $996.47 |
| San Francisco, CA | Unavailable | $1,095.82 |
| San Luis Obispo, CA | Unavailable | $969.42 |
| Santa Clara County, CA | Unavailable | $1,112.63 |
| Santa Cruz, CA | Unavailable | $997.89 |
| Santa Maria, CA | Unavailable | $984.55 |
| Santa Rosa, CA | Unavailable | $1,007.12 |
| Stockton, CA | Unavailable | $954.50 |
| Vallejo, CA | Unavailable | $1,049.73 |
| Visalia, CA | Unavailable | $954.50 |
| Yuba City, CA | Unavailable | $954.50 |
How the 64865 rate is calculated
Each of 64865’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 · 64865
RVUs × geographic indexes × conversion factor
Work15.69
15.69 RVUs× 1.000 GPCI
Practice expense10.39
10.39 RVUs× 1.000 GPCI
Malpractice2.30
2.30 RVUs× 1.000 GPCI
Adjusted RVUs
28.3800
Conversion factor
$33.4009
Medicare rate
$947.92
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 64865
64865 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 64865
Facial nerve repair, intracranial segment
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 090 | Major surgery: the day before, the day of, and 90 days after are included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 2 | Paid. |
| Co-surgeons (62) | 1 | Permitted with supporting documentation. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.11/0.76/0.13 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 64865
Facial nerve repair, intracranial segment
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.
Pre-op dayGlobal period
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
64865 without 51 · national facility
$947.92
Facial nerve repair, intracranial segment
64865-51 · Second procedure: 50%
$473.96
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%).
64865 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 64864Facial nerve repairExtracranial nerve
- Both codes repair the facial nerve, but 64865 is for the intracranial segment and 64864 is for the extracranial segment.
- 64866Facial nerve transferSpinal accessory or hypoglossal
- 64866 describes anastomosis of the facial nerve to the spinal accessory nerve, not suture repair of an injured intracranial facial nerve.
- 64868Nerve anastomosisFacial and another nerve
- 64868 describes anastomosis of the facial nerve to the hypoglossal nerve, a nerve-transfer approach rather than intracranial facial nerve repair.
- 64885Nerve graftHead or neck, under 4 cm
- 64885 is a head or neck nerve graft procedure. Choose it for the graft service rather than direct intracranial facial nerve suture repair.
64865 billing questions
How is this code distinguished from 64864?
Use 64865 for repair of the facial nerve within the cranial cavity. Code 64864 is for extracranial facial nerve repair.
Does modifier 50 apply when both sides are involved?
No. CMS identifies bilateral adjustment as inappropriate for this code.
What documentation supports reporting 64865?
The operative report should establish that the injured facial nerve segment was intracranial and describe the repair performed.
How does the 90-day global period affect postoperative care?
The day-before preoperative visit and 90 days of related postoperative care are included in the global period.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment may be made. Co-surgeon payment requires supporting documentation; team surgery is not permitted.
What happens when another procedure is performed in the same session?
Under the standard multiple procedure reduction, the highest-valued procedure is paid in full and other procedures 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
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