Billing code 64590: Neurostimulator generatorMedicare rate & RVUs
Reports placement or replacement of an implanted pulse generator or receiver for peripheral, sacral, or gastric neurostimulation, including connection to an electrode array.
Medicare pays $428.20 for 64590 nationally in the office and $266.87 in a hospital or facility. Local office rates run $382.84–$540.26.
Medicare rate · 64590
Neurostimulator generator
Swap in your local Medicare rate.
- Work RVUs
- 4.97
- Total RVUs
- 12.82
- Global days
- 010
National rate · 2026
$428.20
Office setting, before claim adjustments.
See every locality for 64590 → · 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
What 64590 covers
This service places or replaces the implanted power unit that drives a peripheral, sacral, or gastric neurostimulator. The surgeon or other qualified proceduralist typically creates or reopens a pocket, positions the generator or receiver, and connects it to the implanted electrode array. Examples include generator replacement for a patient receiving sacral neuromodulation for urinary or bowel symptoms, or for gastric stimulation for gastroparesis. The work is commonly performed in an operating room or procedure facility; the generator procedure is distinct from placing or revising the nerve electrode.
Report this code when the implanted generator or receiver is inserted or replaced, not for lead work alone. The operative report should identify the device, the reason for insertion or replacement, the pocket and connection work, and any electrode-array procedure performed. Medicare includes related postoperative visits for 10 days. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and others at 50%. Modifier 50 is inappropriate for this service. Medicare does not pay an assistant at surgery; co-surgeon payment requires supporting documentation, and team-surgery billing 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 64590 pays more and less
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
109 payment localities
$382.84 to $540.26
109 of 109 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Alabama | $387.89 | $246.73 |
| Alaska* | $515.71 | $343.90 |
| Arizona | $417.32 | $260.99 |
| Arkansas | $382.84 | $244.26 |
| Atlanta | $437.40 | $273.50 |
| Austin | $439.55 | $268.86 |
| Bakersfield | $444.65 | $267.84 |
| Baltimore/Surr. Cntys | $453.99 | $280.89 |
| Beaumont | $405.07 | $258.26 |
| Brazoria | $422.02 | $262.15 |
| Chicago | $462.13 | $299.99 |
| Chico | $442.54 | $265.72 |
| Colorado | $440.07 | $268.42 |
| Connecticut | $454.95 | $281.20 |
| Dallas | $425.28 | $264.60 |
| Dc + Md/Va Suburbs | $482.25 | $292.21 |
| Delaware | $423.71 | $264.32 |
| Detroit | $436.60 | $280.92 |
| East St. Louis | $433.90 | $285.48 |
| El Centro | $442.66 | $265.85 |
| Fort Lauderdale | $450.99 | $287.57 |
| Fort Worth | $423.22 | $264.15 |
| Fresno | $442.54 | $265.72 |
| Galveston | $423.67 | $263.47 |
| Hanford-Corcoran | $442.54 | $265.72 |
| Hawaii, Guam | $450.52 | $267.09 |
| Houston | $437.03 | $276.83 |
| Idaho | $396.32 | $247.90 |
| Indiana | $398.31 | $248.76 |
| Iowa | $393.28 | $245.67 |
| Kansas | $393.28 | $247.44 |
| Kentucky | $399.73 | $256.31 |
| Los Angeles-Long Beach-Anaheim (Los Angeles/Orange Cnty) | $470.33 | $279.48 |
| Madera | $442.54 | $265.72 |
| Manhattan | $491.64 | $304.18 |
| Merced | $442.54 | $265.72 |
| Metropolitan Boston | $478.46 | $285.84 |
| Metropolitan Kansas City | $413.13 | $261.65 |
| Metropolitan Philadelphia | $445.64 | $277.70 |
| Metropolitan St. Louis | $416.83 | $263.25 |
| Miami | $475.23 | $307.29 |
| Minnesota | $417.93 | $251.93 |
| Mississippi | $388.78 | $249.88 |
| Modesto | $442.54 | $265.72 |
| Montana** | $428.15 | $266.82 |
| Napa | $502.29 | $289.66 |
| Nebraska | $394.72 | $245.82 |
| Nevada** | $424.37 | $262.88 |
| New Hampshire | $434.90 | $266.96 |
| New Mexico | $413.36 | $265.43 |
| New Orleans | $417.48 | $265.68 |
| North Carolina | $403.46 | $252.95 |
| North Dakota** | $413.72 | $252.39 |
| Northern Nj | $478.37 | $291.23 |
| Nyc Suburbs/Long Island | $504.67 | $312.85 |
| Ohio | $407.70 | $260.41 |
| Oklahoma | $397.32 | $253.25 |
| Oxnard-Thousand Oaks-Ventura | $466.94 | $276.25 |
| Portland | $451.01 | $271.78 |
| Poughkpsie/N Nyc Suburbs | $463.38 | $286.73 |
| Puerto Rico | $430.45 | $267.35 |
| Queens | $492.88 | $302.20 |
| Redding | $442.54 | $265.72 |
| Rest Of California | $442.54 | $265.72 |
| Rest Of Florida | $430.00 | $275.77 |
| Rest Of Georgia | $407.20 | $263.29 |
| Rest Of Illinois | $421.24 | $273.95 |
| Rest Of Louisiana | $399.83 | $257.05 |
| Rest Of Maine | $399.96 | $251.54 |
| Rest Of Maryland | $430.71 | $267.45 |
| Rest Of Massachusetts | $438.51 | $268.63 |
| Rest Of Michigan | $410.66 | $263.36 |
| Rest Of Missouri | $394.75 | $255.68 |
| Rest Of New Jersey | $459.08 | $282.92 |
| Rest Of New York | $409.07 | $255.81 |
| Rest Of Oregon | $420.01 | $259.33 |
| Rest Of Pennsylvania | $407.36 | $259.26 |
| Rest Of Texas | $413.71 | $260.61 |
| Rest Of Washington | $437.13 | $267.26 |
| Rhode Island | $436.57 | $269.92 |
| Riverside-San Bernardino-Ontario | $450.43 | $273.62 |
| Sacramento-Roseville-Folsom | $461.63 | $274.00 |
| Salinas | $459.84 | $272.87 |
| San Diego-Chula Vista-Carlsbad | $468.62 | $275.68 |
| San Francisco-Oakland-Berkeley (Marin Cnty) | $528.28 | $300.81 |
| San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty) | $527.45 | $299.98 |
| San Jose-Sunnyvale-Santa Clara (San Benito Cnty) | $540.26 | $307.63 |
| San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty) | $536.87 | $304.24 |
| San Luis Obispo-Paso Robles | $452.76 | $269.01 |
| Santa Cruz-Watsonville | $471.50 | $275.49 |
| Santa Maria-Santa Barbara | $461.01 | $272.90 |
| Santa Rosa-Petaluma | $476.09 | $277.98 |
| Seattle (King Cnty) | $486.02 | $288.07 |
| South Carolina | $406.47 | $257.40 |
| South Dakota** | $412.01 | $250.68 |
| Southern Maine | $417.06 | $257.19 |
| Stockton | $442.54 | $265.72 |
| Suburban Chicago | $454.61 | $288.92 |
| Tennessee | $395.27 | $248.62 |
| Utah | $411.44 | $259.80 |
| Vallejo | $501.09 | $288.46 |
| Vermont | $413.78 | $254.06 |
| Virgin Islands | $430.45 | $267.35 |
| Virginia | $416.99 | $258.40 |
| Visalia | $442.54 | $265.72 |
| West Virginia | $407.55 | $267.36 |
| Wisconsin | $401.34 | $246.79 |
| Wyoming** | $421.86 | $260.53 |
| Yuba City | $442.54 | $265.72 |
64590 rates by state
Office rate range in each state. Select a state to see its payment localities.
Explore a state
Local rates. Clear comparisons.
Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.
$382.84
$515.71
Color shows the midpoint of each state’s locality range.
View every state and territory as a table
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | $515.71 | 1 |
| AL | $387.89 | 1 |
| AR | $382.84 | 1 |
| AZ | $417.32 | 1 |
| CA | $442.54–$540.26 | 29 |
| CO | $440.07 | 1 |
| CT | $454.95 | 1 |
| DC | $482.25 | 1 |
| DE | $423.71 | 1 |
| FL | $430.00–$475.23 | 3 |
| GA | $407.20–$437.40 | 2 |
| GU | $450.52 | 1 |
| HI | $450.52 | 1 |
| IA | $393.28 | 1 |
| ID | $396.32 | 1 |
| IL | $421.24–$462.13 | 4 |
| IN | $398.31 | 1 |
| KS | $393.28 | 1 |
| KY | $399.73 | 1 |
| LA | $399.83–$417.48 | 2 |
| MA | $438.51–$478.46 | 2 |
| MD | $430.71–$482.25 | 3 |
| ME | $399.96–$417.06 | 2 |
| MI | $410.66–$436.60 | 2 |
| MN | $417.93 | 1 |
| MO | $394.75–$416.83 | 3 |
| MS | $388.78 | 1 |
| MT | $428.15 | 1 |
| NC | $403.46 | 1 |
| ND | $413.72 | 1 |
| NE | $394.72 | 1 |
| NH | $434.90 | 1 |
| NJ | $459.08–$478.37 | 2 |
| NM | $413.36 | 1 |
| NV | $424.37 | 1 |
| NY | $409.07–$504.67 | 5 |
| OH | $407.70 | 1 |
| OK | $397.32 | 1 |
| OR | $420.01–$451.01 | 2 |
| PA | $407.36–$445.64 | 2 |
| PR | $430.45 | 1 |
| RI | $436.57 | 1 |
| SC | $406.47 | 1 |
| SD | $412.01 | 1 |
| TN | $395.27 | 1 |
| TX | $405.07–$439.55 | 8 |
| UT | $411.44 | 1 |
| VA | $416.99–$482.25 | 2 |
| VI | $430.45 | 1 |
| VT | $413.78 | 1 |
| WA | $437.13–$486.02 | 2 |
| WI | $401.34 | 1 |
| WV | $407.55 | 1 |
| WY | $421.86 | 1 |
How the 64590 rate is calculated
Each of 64590’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 · 64590
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 4.97Practice expense 7.12Malpractice 0.73
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 64590
64590 has a 10-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 64590
Neurostimulator generator
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 010 | Minor procedure: the day of the procedure plus 10 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) | 1 | Not paid (statutory restriction). |
| 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) | 0.10/0.80/0.10 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 64590
Neurostimulator generator
10-day global period ends
Oct 11, 2026
Covers Oct 1, 2026 through Oct 11, 2026 (11 days).
Visit on Oct 31, 2026
After the global period ends: visits and procedures are billed normally.
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
64590 without 51 · national office
$428.20
Neurostimulator generator
64590-51 · Second procedure: 50%
$214.10
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%).
64590 compared with similar codes
Compare codes
64590 vs 64595 vs 64585 vs 64581: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 64595Generator revision
- Choose 64590 for generator or receiver insertion or replacement. Choose 64595 for revision or removal of that unit.
- 64585Lead revision/removal
- 64585 addresses revision or removal of a peripheral neurostimulator electrode array. It does not represent work on the generator or receiver.
- 64581Sacral nerve lead
- 64581 reports open implantation of a sacral nerve electrode array. Use 64590 for the implanted generator or receiver, which may be placed during the same encounter.
64590 billing questions
How is this different from 64595?
64590 is for inserting or replacing the generator or receiver. Use 64595 when the generator or receiver is revised or removed without insertion or replacement.
Does this code include placement of the electrode array?
No. This code represents generator or receiver work; electrode-array placement, revision, or removal is a separate service when performed and supported by the operative documentation.
Can it be reported with a sacral electrode-array code?
It may be reported with 64561 or 64581 when the electrode array and implanted generator are placed during the same permanent implantation encounter. The record should describe both services.
What documentation supports generator replacement?
Document the existing device and its indication, why replacement was performed, the generator or receiver work, and its connection to the electrode array.
Should modifier 50 be used for bilateral treatment?
No. Modifier 50 is inappropriate for this generator or receiver service.
Are postoperative visits included?
Related postoperative visits during the 10-day global period are included in the service.
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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