FeeBase
Log inGet started
Menu

Billing code 64746: Phrenic neurotomyMedicare rate & RVUs

Reports surgical incision of the phrenic nerve, which supplies the diaphragm, including selected operations to interrupt nerve signaling for refractory hiccups.

CMS RVU26DEffective Oct 1, 2026109 payment localities

Medicare pays $433.88 for 64746 nationally in a facility.

Medicare rate · 64746

Phrenic neurotomy

Swap in your local Medicare rate.

Work RVUs
6.4
Total RVUs
12.99
Global days
090

National rate · 2026

$433.88

Facility setting, before claim adjustments.

See every locality for 64746 → · 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 64746 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 64746 covers

This operation incises the phrenic nerve, the nerve that drives the diaphragm. A surgeon may perform it in an operating room to interrupt phrenic signaling in a selected case, such as intractable hiccups. The operative report should identify the phrenic nerve and side treated, describe the nerve procedure, and document the clinical reason for interrupting its function.

Report the code for the phrenic nerve procedure, not for work on a different nerve such as the vagus or a spinal nerve. The service has a 90-day global period: the day-before preoperative visit and related postoperative care during that period are included. When other 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%. An assistant at surgery may be paid; 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 64746 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

64746 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$389.64
Alaska*Unavailable$527.26
ArizonaUnavailable$420.94
ArkansasUnavailable$384.23
AtlantaUnavailable$448.05
AustinUnavailable$437.76
BakersfieldUnavailable$432.72
Baltimore/Surr. CntysUnavailable$462.24
BeaumontUnavailable$415.10
BrazoriaUnavailable$422.19

64746 rates by state

Office rate range in each state. Select a state to see its payment localities.

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

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.

View every state and territory as a table
64746 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 64746 rate is calculated

Each of 64746’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 · 64746

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 6.40Practice expense 4.97Malpractice 1.62

12.9900 adjusted RVUs×$33.4009 conversion factor=$433.88

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

Payment rules and modifiers for 64746

64746 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 64746

Phrenic neurotomy

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)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 · 64746

Phrenic neurotomy

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

64746 without 50 · national facility

$433.88

Phrenic neurotomy

64746-50 · Bilateral: 150%

$650.82

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

64746 compared with similar codes

Compare codes

64746 vs 64760 vs 64772 vs 64771: national Medicare rates

Swap in your local Medicare rate.

  • 64746
    Phrenic neurotomy · 6.4 wRVU
    —
  • 64760
    Vagus nerve surgery · 7.4 wRVU
    —
  • 64772
    Spinal nerve surgery · 7.64 wRVU
    —
  • 64771
    Cranial nerve transection · 7.95 wRVU
    —

How to choose

64760Vagus nerve surgery
Choose 64746 for the phrenic nerve supplying the diaphragm; 64760 targets the vagus nerve.
64772Spinal nerve surgery
Code 64746 identifies the phrenic nerve, while 64772 identifies a spinal nerve as the operative target.
64771Cranial nerve transection
64746 concerns the phrenic nerve. Code 64771 describes severing a cranial nerve, a different nerve target and procedure.

Codes related to 64746

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

Codes related to 64746
CodeHow it relatesNational office range
Same family
64755Vagal nerve surgeryNerve-incision sibling for nerves associated with the stomach rather than the diaphragm.No office rate
64760Vagus nerve surgeryNerve-incision sibling targeting the vagus nerve.No office rate
64772Spinal nerve surgeryNerve-incision sibling targeting a spinal nerve.No office rate

64746 billing questions

What documentation supports reporting this code?

Document the phrenic nerve as the operative target, the side treated, the incision or neurotomy performed, and the clinical indication. The operative note should distinguish this work from a procedure on another nerve.

How does this differ from 64760?

64746 is for the phrenic nerve, which supplies the diaphragm. Code 64760 is for incision of the vagus nerve.

How is bilateral surgery reported?

For bilateral phrenic nerve surgery, report modifier 50; CMS pays the bilateral procedure at 150%.

Are related postoperative visits separately included?

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

Can an assistant or co-surgeon be reported?

Assistant-at-surgery payment may be made. Co-surgeon payment requires supporting documentation, while team-surgery billing is not permitted.

What happens when another procedure is performed in the same session?

CMS pays the highest-valued procedure in full and applies the standard multiple-procedure reduction to the other procedures.

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 64746PPRRVU2026_Oct_nonQPP.csv, line 7,222 (RVU26D)

Open CMS sourceHow we calculate rates

Did this answer your question about what 64746 pays?

Tell us what you were actually trying to work out. We’ll answer you directly, or build the page that does.

Fee sheets

Put 64746 and the rest of your codes on one sheet

Build a fee sheet from your own code list at your locality, put your payer contracts beside Medicare, and see what changed each quarter.

Build my fee sheetOr price your code list free →