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Billing code 64820: SympathectomyMedicare rate & RVUs

Reports microsurgical interruption of sympathetic fibers around a digital artery, typically to improve blood flow in severe finger ischemia or refractory Raynaud symptoms.

CMS RVU26DEffective Oct 1, 2026109 payment localities173 Medicare services in 2024

Medicare pays $699.41 for 64820 nationally in a facility.

Medicare rate · 64820

Sympathectomy

Work RVUs
10.47
Total RVUs
20.94
Global days
090

National rate · 2026

$699.41

Facility setting, before claim adjustments.

See every locality for 64820 →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 64820 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 64820 covers

A hand surgeon or microsurgeon performs a periarterial sympathectomy by removing or disrupting sympathetic fibers surrounding a digital artery while preserving the artery. The operation is used for selected patients with severe digital ischemia, such as persistent Raynaud-related symptoms or ischemic ulcers associated with connective-tissue disease. It is generally performed in an operating room, often in a hospital or ambulatory surgery facility.

Report 64820 when the operative work is directed to a digital artery; the operative note should identify the treated artery and describe the sympathectomy. This major surgery includes 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 others at 50%. The descriptor or anatomy makes modifier 50 inappropriate. Medicare does not pay an assistant at surgery, and 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 64820 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

64820 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$634.65
Alaska*Unavailable$861.98
ArizonaUnavailable$680.87
ArkansasUnavailable$626.67
AtlantaUnavailable$718.66
AustinUnavailable$708.68
BakersfieldUnavailable$706.45
Baltimore/Surr. CntysUnavailable$741.71
BeaumontUnavailable$669.24
BrazoriaUnavailable$684.69

64820 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
64820 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 64820 rate is calculated

Each of 64820’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 · 64820

RVUs × geographic indexes × conversion factor

Work10.47

10.47 RVUs× 1.000 GPCI

Practice expense8.43

8.43 RVUs× 1.000 GPCI

Malpractice2.04

2.04 RVUs× 1.000 GPCI

Adjusted RVUs

20.9400

Conversion factor

$33.4009

Medicare rate

$699.41

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

Payment rules and modifiers for 64820

64820 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 64820

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)0The 150% bilateral adjustment doesn’t apply.
Assistant at surgery (80/81/82/AS)1Not paid (statutory restriction).
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 · 64820

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.

  • 24Unrelated E/M visit by the same physician
  • 79Unrelated procedure (starts its own global period)
  • 58Staged, more extensive, or therapy procedure that was planned
  • 78Unplanned 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 51 · payment effect

With and without the modifier

64820 without 51 · national facility

$699.41

Sympathectomy

64820-51 · Second procedure: 50%

$349.71

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%).

When to use modifier 51

64820 compared with similar codes

Compare codes · National

4 codes, side by side

  • 64820

    Sympathectomy10.47 wRVU

    Not priced

  • 64821

    Arterial sympathectomy9.1 wRVU

    Not priced

  • 64822

    Arterial sympathectomy9.1 wRVU

    Not priced

  • 64823

    Palmar sympathectomy10.67 wRVU

    Not priced

How to choose

64821Arterial sympathectomy
Use 64821 when the sympathectomy is directed to the radial artery. Code 64820 is for work on a digital artery.
64822Arterial sympathectomy
Use 64822 for sympathectomy of the ulnar artery; use 64820 when the treated vessel is a digital artery.
64823Palmar sympathectomy
Code 64823 identifies sympathectomy at the superficial palmar arch. Code 64820 identifies a digital artery site.

Codes related to 64820

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

Codes related to 64820
CodeHow it relatesNational office range
Same family
64821Arterial sympathectomySympathectomy directed to the radial artery rather than a digital artery.No office rate
64822Arterial sympathectomySympathectomy directed to the ulnar artery rather than a digital artery.No office rate
64823Palmar sympathectomySympathectomy directed to the superficial palmar arch rather than a digital artery.No office rate

64820 billing questions

How do I distinguish 64820 from 64821 or 64822?

Choose 64820 for sympathectomy directed to a digital artery. Codes 64821 and 64822 identify the radial and ulnar arteries, respectively.

Does the 90-day global include postoperative visits?

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

Can modifier 50 be used for treatment on both hands?

No. The descriptor or anatomy makes modifier 50 inappropriate; report the procedure according to the digital artery work documented.

How are other procedures in the same session paid?

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

Can an assistant or co-surgeon be reported?

Medicare does not pay an assistant at surgery for this code. Co-surgeons and team surgery are 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 64820PPRRVU2026_Oct_nonQPP.csv, line 7,245 (RVU26D)

Open CMS sourceHow we calculate rates

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