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Billing code 64654: System implantationMedicare rate & RVUs

Reports the initial open implantation of a battery-powered modulating system, rather than revision, replacement, or removal of an existing system or component.

CMS RVU26DEffective Oct 1, 2026109 payment localities

Medicare pays $559.47 for 64654 nationally in a facility.

Medicare rate · 64654

System implantation

Swap in your local Medicare rate.

Work RVUs
11
Total RVUs
16.75
Global days
090

National rate · 2026

$559.47

Facility setting, before claim adjustments.

See every locality for 64654 → · 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 64654 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 64654 covers

This code represents the initial open implantation of a battery-powered modulating system. A surgeon exposes the operative site and implants the system through an open approach. It is distinct from procedures limited to revising or replacing a lead or pulse generator, and from procedures that remove the complete system or one of its components. The operative report should make clear that this is an initial implantation and describe the open approach and implanted system.

Report the service for the initial system implantation, not for later component work. Documentation should distinguish the procedure from lead or pulse-generator revision or replacement and from system or component removal. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When other procedures are performed in the same session, the highest-valued procedure is paid in full and the others at 50%. For bilateral reporting with modifier 50, payment is at 150%. Assistant-at-surgery payment requires documentation of medical necessity; 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 64654 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

64654 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$506.66
Alaska*Unavailable$707.75
ArizonaUnavailable$542.98
ArkansasUnavailable$500.33
AtlantaUnavailable$580.88
AustinUnavailable$555.31
BakersfieldUnavailable$539.50
Baltimore/Surr. CntysUnavailable$594.65
BeaumontUnavailable$543.95
BrazoriaUnavailable$541.01

64654 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
64654 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 64654 rate is calculated

Each of 64654’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 · 64654

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 11.00Practice expense 2.96Malpractice 2.79

16.7500 adjusted RVUs×$33.4009 conversion factor=$559.47

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

Payment rules and modifiers for 64654

64654 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 64654

System implantation

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)0Not permitted.
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 · 64654

System implantation

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 50 · payment effect

With and without the modifier

64654 without 50 · national facility

$559.47

System implantation

64654-50 · Bilateral: 150%

$839.21

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

64654 compared with similar codes

Compare codes

64654 vs 64655 vs 64656 vs 64657 vs 64658: national Medicare rates

Swap in your local Medicare rate.

  • 64654
    System implantation · 11 wRVU
    —
  • 64655
    BAT lead revision · 11.3 wRVU
    —
  • 64656
    Bladder modulation · 8.01 wRVU
    —
  • 64657
    System removal · 12.13 wRVU
    —
  • 64658
    Lead removal · 8.95 wRVU
    —

How to choose

64655BAT lead revision
Choose 64654 for initial open system implantation; choose 64655 when the procedure revises or replaces a system lead.
64656Bladder modulation
64656 applies to revision or replacement of the pulse generator, not initial open implantation of the system.
64657System removal
64657 describes removal of the complete system. It does not describe initial implantation.
64658Lead removal
64658 is for removal of the lead only; 64654 represents initial open system implantation.

Codes related to 64654

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

Codes related to 64654
CodeHow it relatesNational office range
Same family
64655BAT lead revisionAddresses revision or replacement of a system lead, not initial system implantation.No office rate
64656Bladder modulationAddresses revision or replacement of the system pulse generator.No office rate
64657System removalDescribes removal of the complete battery-powered modulating system.No office rate
64658Lead removalDescribes removal of the system lead only.No office rate
64659Generator removalDescribes removal of the pulse generator only.No office rate

64654 billing questions

How is this code different from 64655?

64654 is for initial open implantation of the system. Code 64655 describes revision or replacement of a system lead.

When would 64656 be reported instead?

Use 64656 for revision or replacement of the pulse generator, rather than initial open implantation of the system.

Does this code include postoperative care?

CMS assigns a 90-day global period. The day-before preoperative visit and 90 days of related postoperative care are included.

How does CMS pay when another procedure is performed in the same session?

The highest-valued procedure is paid in full, and other procedures are paid at 50% under the standard multiple procedure reduction.

Can modifier 50 be used for a bilateral procedure?

Yes. CMS identifies this as a bilateral procedure and pays 150% when reported with modifier 50.

What supports assistant-at-surgery payment?

The record must document medical necessity for the assistant. Co-surgeons and team surgery are not permitted under the CMS rules for this code.

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 64654PPRRVU2026_Oct_nonQPP.csv, line 7,193 (RVU26D)

Open CMS sourceHow we calculate rates

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