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Billing code 64658: Lead removalMedicare rate & RVUs

Removal of the implanted lead from a battery-powered neuromodulation system when the lead is taken out and the pulse generator is not removed.

CMS RVU26DEffective Oct 1, 2026109 payment localities

Medicare pays $475.96 for 64658 nationally in a facility.

Medicare rate · 64658

Lead removal

Swap in your local Medicare rate.

Work RVUs
8.95
Total RVUs
14.25
Global days
090

National rate · 2026

$475.96

Facility setting, before claim adjustments.

See every locality for 64658 → · 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 64658 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 64658 covers

This code represents surgical removal of the implanted lead from a battery-powered neuromodulation system, without removal of the pulse generator. For sacral neuromodulation, the lead is placed near the sacral nerves; urologists, urogynecologists, and colorectal surgeons may perform removal when a device is no longer needed, has malfunctioned, or requires a different treatment plan. The operative report should identify the lead removed and the generator’s status.

Report this code when the work is removal of the lead only; removal of the whole system or generator alone corresponds to a different code in the family. Documentation should support the operative work, device components addressed, and laterality when relevant. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard multiple-procedure reduction. Bilateral reporting with modifier 50 is paid at 150%. Assistant-at-surgery, co-surgeon, and team-surgery payment require the specified 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 64658 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

64658 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$430.41
Alaska*Unavailable$597.97
ArizonaUnavailable$461.91
ArkansasUnavailable$424.92
AtlantaUnavailable$493.72
AustinUnavailable$473.79
BakersfieldUnavailable$461.71
Baltimore/Surr. CntysUnavailable$506.10
BeaumontUnavailable$461.47
BrazoriaUnavailable$460.76

64658 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
64658 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 64658 rate is calculated

Each of 64658’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 · 64658

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 8.95Practice expense 3.03Malpractice 2.27

14.2500 adjusted RVUs×$33.4009 conversion factor=$475.96

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

Payment rules and modifiers for 64658

64658 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 64658

Lead removal

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 · 64658

Lead removal

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

64658 without 50 · national facility

$475.96

Lead removal

64658-50 · Bilateral: 150%

$713.94

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

64658 compared with similar codes

Compare codes

64658 vs 64657 vs 64659 vs 64655: national Medicare rates

Swap in your local Medicare rate.

  • 64658
    Lead removal · 8.95 wRVU
    —
  • 64657
    System removal · 12.13 wRVU
    —
  • 64659
    Generator removal · 8.23 wRVU
    —
  • 64655
    BAT lead revision · 11.3 wRVU
    —

How to choose

64657System removal
Choose 64658 when only the lead is removed and the generator remains; 64657 represents removal of the complete system.
64659Generator removal
64659 is for removal of the pulse generator alone. This code is for removal of the lead alone.
64655BAT lead revision
64655 represents lead revision or replacement. Use 64658 when the lead is removed without revision or replacement.

Codes related to 64658

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

Codes related to 64658
CodeHow it relatesNational office range
Same family
64655BAT lead revisionRevision or replacement of the neuromodulation system lead rather than removal alone.No office rate
64657System removalRemoval of the complete battery-powered modulation system.No office rate
64659Generator removalRemoval of the pulse generator alone rather than the lead.No office rate
64654System implantationOpen implantation of a battery-powered modulation system.No office rate

64658 billing questions

How is this different from removal of the entire system?

Use this code when the lead is removed but the pulse generator remains. Removal of both components is represented by the total-system removal code, 64657.

How is this different from generator-only removal?

This code covers removal of the lead, not the pulse generator. Generator-only removal is reported with 64659.

Can this code describe lead revision or replacement?

No. This code represents lead removal only; revision or replacement of the lead is represented by 64655.

What should the operative report document?

Document the neuromodulation system, the lead removed, whether the pulse generator was retained, and the work performed. Include laterality when relevant.

How does Medicare handle multiple procedures in the same session?

The highest-valued procedure is paid in full, and other procedures are subject to the standard multiple-procedure reduction. The code has a 90-day global period.

What documentation is needed for an assistant or co-surgeon?

Assistant-at-surgery payment requires documentation of medical necessity. Co-surgeon and team-surgery payment require supporting documentation.

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 64658PPRRVU2026_Oct_nonQPP.csv, line 7,197 (RVU26D)

Open CMS sourceHow we calculate rates

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