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Billing code 61458: Nerve decompressionMedicare rate & RVUs

Reports suboccipital exposure and exploration of a cranial nerve with decompression, commonly for microvascular compression causing trigeminal neuralgia or hemifacial spasm.

CMS RVU26DEffective Oct 1, 2026109 payment localities1.2K Medicare services in 2024

Medicare pays $1,963.64 for 61458 nationally in a facility.

Medicare rate · 61458

Nerve decompression

Swap in your local Medicare rate.

Work RVUs
28.12
Total RVUs
58.79
Global days
090

National rate · 2026

$1,963.64

Facility setting, before claim adjustments.

See every locality for 61458 → · 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.

On this page 10 sections
  1. Medicare rate
  2. What 61458 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 61458 covers

This service involves a suboccipital craniectomy to expose and explore a cranial nerve and relieve compression, commonly during microvascular decompression for trigeminal neuralgia or hemifacial spasm. A neurosurgeon identifies the symptomatic nerve and compressive structure, often an offending vessel, and performs the decompression. The procedure is generally performed in an operating room under general anesthesia; nerve decompression, rather than tumor removal or nerve division, defines the service.

Select the code from the operative work, not the diagnosis alone. Documentation should identify the suboccipital exposure, nerve explored, cause of compression, decompression performed, and any distinct additional procedures. The 90-day global includes the day-before preoperative visit and related postoperative care through day 90. For multiple procedures in one session, the highest-valued procedure is paid in full and others at 50%. Modifier 50 is inappropriate for this descriptor and anatomy. An assistant at surgery may be paid; co-surgeon payment requires supporting documentation, and team-surgery payment 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 61458 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

61458 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$1,713.49
Alaska*Unavailable$2,296.74
ArizonaUnavailable$1,887.23
ArkansasUnavailable$1,683.27
AtlantaUnavailable$2,055.95
AustinUnavailable$1,956.97
BakersfieldUnavailable$1,887.40
Baltimore/Surr. CntysUnavailable$2,118.25
BeaumontUnavailable$1,878.95
BrazoriaUnavailable$1,878.56

61458 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
61458 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 61458 rate is calculated

Each of 61458’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 · 61458

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 28.12Practice expense 18.84Malpractice 11.83

58.7900 adjusted RVUs×$33.4009 conversion factor=$1,963.64

All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.

Payment rules and modifiers for 61458

61458 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 61458

Nerve decompression

RuleCMS valueWhat it means
Global period090Major surgery: the day before, the day of, and 90 days after are included.
Multiple procedures2Standard reduction: highest-valued procedure at 100%, others at 50%.
Bilateral (modifier 50)0The 150% bilateral adjustment doesn’t apply.
Assistant at surgery (80/81/82/AS)2Paid.
Co-surgeons (62)1Permitted with supporting documentation.
Team surgery (66)0Not permitted.
Professional/technical0Physician service: no professional/technical split.
Split (54/55/56)0.11/0.76/0.13Share of the payment for pre-op, the procedure itself, and post-op care.

Global surgery period · 61458

Nerve decompression

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.

  • 24 Unrelated E/M visit by the same physician
  • 79 Unrelated procedure (starts its own global period)
  • 58 Staged, more extensive, or therapy procedure that was planned
  • 78 Unplanned return to the operating room for a related complication
SurgeryVisit
Sep 23, 2026Jan 10, 2027

Pre-op dayGlobal period

What modifiers do to the payment

Modifier 51 · payment effect

With and without the modifier

61458 without 51 · national facility

$1,963.64

Nerve decompression

61458-51 · Second procedure: 50%

$981.82

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%).

When to use modifier 51

61458 compared with similar codes

Compare codes

61458 vs 61450 vs 61460 vs 64716: national Medicare rates

Swap in your local Medicare rate.

  • 61458
    Nerve decompression · 28.12 wRVU
    —
  • 61450
    Cranial nerve section · 27 wRVU
    —
  • 61460
    Cranial nerve surgery · 29.48 wRVU
    —
  • 64716
    Cranial nerve surgery · 6.82 wRVU
    —

How to choose

61450Cranial nerve section
Both involve suboccipital cranial-nerve surgery, but select based on the exact operative service described in the code and documented in the report.
61460Cranial nerve surgery
61460 describes sectioning one or more cranial nerves. This code is for exploration and decompression rather than nerve division.
64716Cranial nerve surgery
64716 describes intratemporal facial-nerve decompression. This code describes cranial-nerve exploration and decompression through a suboccipital approach.

Codes related to 61458

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

Codes related to 61458
CodeHow it relatesNational office range
Same family
61450Cranial nerve sectionRelated suboccipital cranial-nerve procedure; distinguish it by the specific work documented.No office rate
61460Cranial nerve surgeryUsed for suboccipital sectioning of one or more cranial nerves rather than decompression.No office rate
Used instead
64716Cranial nerve surgeryCovers intratemporal facial-nerve decompression through a different operative approach.No office rate

61458 billing questions

How is this code distinguished from nerve sectioning?

Use this code when the operative service explores and decompresses a cranial nerve through a suboccipital approach. A procedure that divides one or more cranial nerves is described by a different code, such as 61460.

What documentation supports reporting this service?

The operative report should describe the suboccipital exposure, the nerve explored, the source of compression, and the maneuver used to decompress it. The diagnosis by itself does not establish that this procedure was performed.

Can modifier 50 be used for decompression of nerves on both sides?

Modifier 50 is inappropriate for this code’s descriptor and anatomy. Report the procedure performed as described rather than treating it as a bilateral procedure.

How are other same-session procedures paid?

When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and the others are paid at 50%. Related care within the 90-day global period is included as specified in the global package.

Can an assistant or co-surgeon be reported?

An assistant at surgery may be paid. Co-surgeon payment requires supporting documentation; team-surgery payment 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
RVUs for 61458PPRRVU2026_Oct_nonQPP.csv, line 6,774 (RVU26D)

Open CMS sourceHow we calculate rates

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