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CPT code 64569: Vagus nerve electrode2026 Medicare rate & RVUs

Reports operative revision or replacement of an implanted vagus nerve stimulation electrode, including reconnecting it to an existing pulse generator.

CMS RVU26DEffective Oct 1, 2026109 payment localities114 Medicare services in 2024

Medicare pays $746.18 for 64569 nationally in a facility.

Medicare rate · 64569

Vagus nerve electrode

Work RVUs
10.73
Total RVUs
22.34
Global days
090

National rate · 2026

$746.18

Facility setting, before claim adjustments.

See every locality for 64569 →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 64569 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 64569 covers

This service covers an operation to revise or replace the electrode array attached to the vagus nerve in a patient with an implanted vagus nerve stimulation system. The surgeon may address a displaced, damaged, or malfunctioning electrode and reconnect the revised or replacement array to the existing pulse generator. It is typically performed in an operating room by a surgeon experienced with implanted neurostimulation systems, often for a patient receiving vagus nerve stimulation for epilepsy or another established indication.

Report the code when the electrode array itself is revised or replaced, rather than for initial system implantation, generator-only work, or electrode removal alone. The operative report should identify the electrode work performed and document the existing system and connection. The service has a 90-day global period, which includes the day-before preoperative visit and related postoperative care during that period. If 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 reports bilateral surgery and is paid at 150%. Assistant-at-surgery, co-surgeon, and team-surgery payment requires the applicable medical-necessity or supporting documentation.

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 64569 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

64569 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$659.31
Alaska*Unavailable$886.71
ArizonaUnavailable$720.11
ArkansasUnavailable$648.76
AtlantaUnavailable$776.44
AustinUnavailable$748.01
BakersfieldUnavailable$729.70
Baltimore/Surr. CntysUnavailable$800.60
BeaumontUnavailable$713.64
BrazoriaUnavailable$719.34

64569 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
64569 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 64569 rate is calculated

Each of 64569’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 · 64569

RVUs × geographic indexes × conversion factor

Work10.73

10.73 RVUs× 1.000 GPCI

Practice expense7.89

7.89 RVUs× 1.000 GPCI

Malpractice3.72

3.72 RVUs× 1.000 GPCI

Adjusted RVUs

22.3400

Conversion factor

$33.4009

Medicare rate

$746.18

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

Payment rules and modifiers for 64569

64569 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 64569

Vagus nerve electrode

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)1Bilateral with modifier 50 pays 150% of the fee schedule amount.
Assistant at surgery (80/81/82/AS)0Not paid without supporting documentation.
Co-surgeons (62)1Permitted with supporting documentation.
Team surgery (66)1Permitted with supporting documentation.
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 · 64569

Vagus nerve electrode

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.

  • 24Unrelated E/M visit by the same physician
  • 79Unrelated procedure (starts its own global period)
  • 58Staged, more extensive, or therapy procedure that was planned
  • 78Unplanned 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 50 · payment effect

With and without the modifier

64569 without 50 · national facility

$746.18

Vagus nerve electrode

64569-50 · Bilateral: 150%

$1,119.27

Both sides on one line with modifier 50 are paid at 150% of the fee schedule amount (subject to multiple-procedure rules with other procedures).

When to use modifier 50

64569 compared with similar codes

Compare codes · National

4 codes, side by side

  • 64569

    Vagus nerve electrode10.73 wRVU

    Not priced

  • 64568

    Nerve stimulator8.78 wRVU

    Not priced

  • 64570

    Vagus stimulator removal8.87 wRVU

    Not priced

  • 61885

    Neurostimulator generator5.9 wRVU

    Not priced

How to choose

64568Nerve stimulator
64568 is for initial implantation of the vagus nerve electrode array and pulse generator. Choose 64569 for operative revision or replacement of an electrode array in an existing system.
64570Vagus stimulator removal
64570 is for removal of the vagus nerve electrode array. 64569 applies when the electrode is revised or replaced.
61885Neurostimulator generator
Use the applicable generator code when pulse-generator work is performed without electrode-array revision or replacement. 64569 addresses the vagus nerve electrode array.

Codes related to 64569

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

Codes related to 64569
CodeHow it relatesNational office range
Same family
64568Nerve stimulatorInitial implantation of a vagus nerve electrode array and pulse generator, rather than revision or replacement.No office rate
64570Vagus stimulator removalRemoval of a vagus nerve electrode array without the revision or replacement described here.No office rate
Used instead
61885Neurostimulator generatorUse for applicable cranial neurostimulator pulse-generator work when the electrode array is not being revised or replaced.No office rate
61888Neurostimulator surgeryAddresses revision or removal of an implanted neurostimulator pulse generator or receiver, rather than the vagus nerve electrode array.No office rate

64569 billing questions

How is this different from initial vagus nerve stimulator implantation?

Use 64569 for revision or replacement of an electrode array in an existing system. Initial implantation of the vagus nerve electrode array and pulse generator is reported with 64568.

Does this code include replacement of the pulse generator?

The service concerns the electrode array and its connection to an existing pulse generator. When the operation is limited to generator replacement or revision, consider the applicable generator code instead.

When is 64570 more appropriate?

64570 describes removal of the vagus nerve electrode array. Use 64569 when the electrode array is revised or replaced rather than simply removed.

What documentation supports reporting 64569?

The operative report should describe the existing vagus nerve stimulation system and the specific electrode-array revision or replacement performed, including its connection to the pulse generator.

How are multiple procedures and bilateral surgery handled?

For procedures in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard multiple-procedure reduction. Modifier 50 identifies bilateral surgery and is paid at 150%.

What postoperative care is included?

The 90-day global period includes the day-before preoperative visit and related postoperative care during the 90 days after surgery.

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 64569PPRRVU2026_Oct_nonQPP.csv, line 7,151 (RVU26D)

Open CMS sourceHow we calculate rates

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