CPT code 64891: Nerve graft, hand or foot, over 4 cm2026 Medicare rate & RVUs

Medicare pays $1,040.77 for 64891 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 64891 covers

A surgeon uses this service to bridge a peripheral nerve gap in the hand or foot when the nerve ends cannot be brought together for direct repair. The graft restores continuity across the defect, such as after traumatic nerve loss or excision of a damaged nerve segment. Hand, plastic, orthopedic, and peripheral nerve surgeons commonly perform the procedure in an operating room using microsurgical technique. The code specifies one graft strand and a graft length exceeding 4 cm at a hand or foot site.

Choose the code from the operative report’s documented anatomic site, number of strands, and graft length; distinguish it from shorter grafts and grafts for other body regions. Documentation should identify the injured or resected nerve, the gap bridged, the graft configuration, and its length. The service has 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. Assistant-at-surgery payment may be allowed; 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.

Where 64891 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

64891 rates by state

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

How the 64891 rate is calculated

Each of 64891’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 64891

64891 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

64891 compared with similar codes

How to choose

64890Nerve graftSingle strand, under 4 cm

Both are single-strand hand or foot grafts; the documented graft length separates the codes. Use 64890 for a length up to 4 cm and 64891 when it exceeds 4 cm.

64893Nerve graftSingle strand, arm or leg, over 4 cm

Both describe a single-strand graft longer than 4 cm. Choose 64891 for a hand or foot nerve and 64893 for an arm or leg nerve.

64896Nerve graftMultiple strands, over 4 cm

Both cover a hand or foot graft longer than 4 cm, but 64896 is for a multiple-strand graft rather than one strand.

Codes related to 64891

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