CPT code 64866: Facial nerve transfer, spinal accessory or hypoglossal2026 Medicare rate & RVUs in Oregon
Reports microsurgical connection of the facial nerve to the spinal accessory or hypoglossal nerve to restore motor input in selected cases of facial paralysis.
CMS doesn’t publish an office rate for 64866 in Oregon.
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 64866 covers
This operation redirects motor input to the face by connecting the facial nerve to the spinal accessory or hypoglossal nerve. It is used in selected cases of facial paralysis when the native facial nerve pathway cannot provide useful function. A surgeon with microsurgical nerve expertise, often in otolaryngology, facial plastic and reconstructive surgery, plastic surgery, or neurosurgery, performs the nerve coaptation, generally in an operating room.
Select this code when the operative report identifies the facial nerve and one of these specific donor nerves as the anastomosis partners. Documentation should establish the paralysis indication, relevant nerve anatomy and findings, and the procedure performed. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures are performed 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 for this service. An assistant at surgery may be paid; co-surgeons require 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 64866 pays more and less in Oregon
| Payment locality | Office | Facility |
|---|---|---|
| Portland, OR | Unavailable | $1,162.70 |
| Rest of Oregon | Unavailable | $1,094.88 |
How the 64866 rate is calculated
Each of 64866’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 · 64866
RVUs × geographic indexes × conversion factor
Work16.41
16.41 RVUs× 1.000 GPCI
Practice expense14.29
14.29 RVUs× 1.000 GPCI
Malpractice3.04
3.04 RVUs× 1.000 GPCI
Adjusted RVUs
33.7400
Conversion factor
$33.4009
Medicare rate
$1,126.95
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 64866
64866 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 64866
Facial nerve transfer, spinal accessory or hypoglossal
| 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 · 64866
Facial nerve transfer, spinal accessory or hypoglossal
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
64866 without 51 · national facility
$1,126.95
Facial nerve transfer, spinal accessory or hypoglossal
64866-51 · Second procedure: 50%
$563.48
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%).
64866 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 64868Nerve anastomosisFacial and another nerve
- Use 64866 when the facial nerve is connected to the spinal accessory or hypoglossal nerve; 64868 covers connection to another nerve.
- 64864Facial nerve repairExtracranial nerve
- 64864 is direct repair of the facial nerve outside the skull. 64866 redirects facial nerve input to the spinal accessory or hypoglossal nerve.
- 64865Facial nerve repairIntracranial segment
- 64865 is direct repair of the facial nerve within the skull. 64866 describes a nerve transfer to one of the specified donor nerves.
64866 billing questions
How does 64866 differ from 64868?
64866 is for connecting the facial nerve to the spinal accessory or hypoglossal nerve. 64868 is the related code for anastomosis to another nerve.
When would direct facial nerve repair be reported instead?
Codes 64864 and 64865 describe direct facial nerve repair in extracranial and intracranial settings, respectively. Use 64866 when the procedure transfers facial nerve input to the specified donor nerve rather than directly repairing facial nerve continuity.
Can modifier 50 be used for a bilateral procedure?
No. CMS identifies bilateral adjustment as inappropriate for this code; modifier 50 should not be used.
What documentation supports 64866?
The operative report should identify the facial nerve and the spinal accessory or hypoglossal nerve, explain the clinical indication and relevant findings, and describe the nerve connection performed.
What postoperative care is included in the global period?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
May an assistant or co-surgeon be reported?
CMS allows payment for an assistant at surgery. Co-surgeon payment requires supporting documentation; team surgery is not permitted.
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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