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Billing code 64804: SympathectomyMedicare rate & RVUs

Cervicothoracic sympathectomy interrupts sympathetic nerve tissue at the neck–chest junction for selected upper-extremity conditions.

CMS RVU26DEffective Oct 1, 2026109 payment localities

Medicare pays $1,199.43 for 64804 nationally in a facility.

Medicare rate · 64804

Sympathectomy

Swap in your local Medicare rate.

Work RVUs
15.51
Total RVUs
35.91
Global days
090

National rate · 2026

$1,199.43

Facility setting, before claim adjustments.

See every locality for 64804 → · 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 64804 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 64804 covers

Cervicothoracic sympathectomy interrupts or removes sympathetic nerve tissue at the junction of the cervical and thoracic regions. Surgeons may perform it for severe upper-extremity hyperhidrosis or selected vasospastic or pain conditions when targeted interruption of sympathetic outflow is intended. The operation is generally performed in an operating room. The operative report should identify the side and sympathetic structures treated.

Report 64804 when the documented operative work is at the cervicothoracic level, rather than cervical-only, lower thoracic or lumbar, or limited to a hand artery. Document the indication, laterality, anatomic extent, and technique to support the level treated. The 90-day global includes the day-before preoperative visit and 90 days of related postoperative care. For bilateral work, modifier 50 is paid at 150%. When multiple procedures occur in one session, the highest-valued procedure is paid in full and others at 50%. Assistant-at-surgery services may be paid; co-surgeon payment requires supporting documentation, and team surgery 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 64804 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

64804 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$1,046.76
Alaska*Unavailable$1,390.46
ArizonaUnavailable$1,153.62
ArkansasUnavailable$1,028.21
AtlantaUnavailable$1,252.29
AustinUnavailable$1,202.41
BakersfieldUnavailable$1,168.30
Baltimore/Surr. CntysUnavailable$1,293.28
BeaumontUnavailable$1,142.25
BrazoriaUnavailable$1,151.35

64804 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
64804 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 64804 rate is calculated

Each of 64804’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 · 64804

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 15.51Practice expense 13.86Malpractice 6.54

35.9100 adjusted RVUs×$33.4009 conversion factor=$1,199.43

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

Payment rules and modifiers for 64804

64804 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 64804

Sympathectomy

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 · 64804

Sympathectomy

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

64804 without 50 · national facility

$1,199.43

Sympathectomy

64804-50 · Bilateral: 150%

$1,799.15

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

64804 compared with similar codes

Compare codes

64804 vs 64802 vs 64809 vs 64818 vs 64820: national Medicare rates

Swap in your local Medicare rate.

  • 64804
    Sympathectomy · 15.51 wRVU
    —
  • 64802
    Cervical sympathectomy · 10.11 wRVU
    —
  • 64809
    Sympathectomy · 14.34 wRVU
    —
  • 64818
    Sympathectomy · 11.06 wRVU
    —
  • 64820
    Sympathectomy · 10.47 wRVU
    —

How to choose

64802Cervical sympathectomy
64802 describes cervical-level sympathectomy. Choose 64804 when the operative work is documented at the cervicothoracic level.
64809Sympathectomy
64809 applies to thoracolumbar sympathectomy, not work at the cervicothoracic junction.
64818Sympathectomy
64818 is for lumbar sympathectomy. Select 64804 for cervicothoracic-level work.
64820Sympathectomy
64820 concerns sympathectomy of a digital artery; 64804 is for sympathetic-chain work at the cervicothoracic level.

Codes related to 64804

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

Codes related to 64804
CodeHow it relatesNational office range
Same family
64802Cervical sympathectomyCervical sympathectomy; selected when the documented operative level is cervical only.No office rate
64809SympathectomyThoracolumbar sympathectomy; a more inferior sympathetic-chain level.No office rate
64818SympathectomyLumbar sympathectomy; selected for work at the lumbar level.No office rate
Used instead
64820SympathectomySympathectomy limited to a digital artery rather than the cervicothoracic chain.No office rate

64804 billing questions

How do I distinguish 64804 from cervical sympathectomy 64802?

Use the operative anatomy to select the code. Report 64804 for work at the cervicothoracic level and 64802 for cervical-only work.

How is bilateral cervicothoracic work reported?

When the procedure is bilateral, report modifier 50. CMS pays the bilateral procedure at 150%.

What documentation supports 64804?

The operative report should establish the indication, laterality, sympathetic structures treated, and the anatomic level of the procedure.

What postoperative care is included in the global period?

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

How does CMS handle multiple procedures 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 an assistant or co-surgeon be paid?

Assistant-at-surgery services may be paid. Co-surgeon payment requires supporting documentation; team surgery is not permitted.

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 64804PPRRVU2026_Oct_nonQPP.csv, line 7,242 (RVU26D)

Open CMS sourceHow we calculate rates

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