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Billing code 64857: Nerve repairMedicare rate & RVUs

Reports direct repair of a major peripheral nerve in an arm or leg, excluding the sciatic nerve, when the repair does not include transposition.

CMS RVU26DEffective Oct 1, 2026109 payment localities182 Medicare services in 2024

Medicare pays $944.91 for 64857 nationally in a facility.

Medicare rate · 64857

Nerve repair

Swap in your local Medicare rate.

Work RVUs
15.42
Total RVUs
28.29
Global days
090

National rate · 2026

$944.91

Facility setting, before claim adjustments.

See every locality for 64857 → · 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 64857 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 64857 covers

A surgeon uses this code for direct suture repair of a major peripheral nerve in an arm or leg, such as after a traumatic transection. The repair does not include transposition, and the code excludes the sciatic nerve. These procedures are typically performed in an operating room by a surgeon with peripheral nerve expertise, often using magnification to align and join the nerve ends. It is not the code for repair of a small digital nerve in a finger or toe.

The operative report should identify the nerve and site, describe the injury and direct repair, and make clear that transposition was not performed. This major surgery code 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 other procedures are subject to the standard multiple procedure reduction. Bilateral adjustment is inappropriate for this code. Assistant-at-surgery payment may be available; 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 64857 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

64857 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$857.63
Alaska*Unavailable$1,174.58
ArizonaUnavailable$919.32
ArkansasUnavailable$846.96
AtlantaUnavailable$973.42
AustinUnavailable$952.20
BakersfieldUnavailable$943.10
Baltimore/Surr. CntysUnavailable$1,002.34
BeaumontUnavailable$908.29
BrazoriaUnavailable$922.26

64857 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
64857 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 64857 rate is calculated

Each of 64857’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 · 64857

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 15.42Practice expense 9.62Malpractice 3.25

28.2900 adjusted RVUs×$33.4009 conversion factor=$944.91

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

Payment rules and modifiers for 64857

64857 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 64857

Nerve repair

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)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 · 64857

Nerve repair

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 51 · payment effect

With and without the modifier

64857 without 51 · national facility

$944.91

Nerve repair

64857-51 · Second procedure: 50%

$472.46

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

64857 compared with similar codes

Compare codes

64857 vs 64856 vs 64858 vs 64831: national Medicare rates

Swap in your local Medicare rate.

  • 64857
    Nerve repair · 15.42 wRVU
    —
  • 64856
    Brachial plexus repair · 14.69 wRVU
    —
  • 64858
    Nerve repair · 17.37 wRVU
    —
  • 64831
    Digital nerve repair · 8.93 wRVU
    —

How to choose

64856Brachial plexus repair
Choose 64857 when the major arm or leg nerve is repaired without transposition; 64856 describes repair that includes transposition.
64858Nerve repair
64858 is for sciatic nerve repair. 64857 is for a major peripheral nerve in an arm or leg other than the sciatic nerve.
64831Digital nerve repair
64831 applies to repair of a digital nerve. 64857 is for a major peripheral nerve in an arm or leg, not a small finger or toe nerve.

Codes related to 64857

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

Codes related to 64857
CodeHow it relatesNational office range
Used instead
64856Brachial plexus repairMajor peripheral nerve repair when transposition is included.No office rate
64858Nerve repairRepair of the sciatic nerve, which is excluded from 64857.No office rate
64831Digital nerve repairRepair for a digital nerve rather than a major arm or leg nerve.No office rate
64834Nerve repairNerve repair in the hand or foot, rather than a major arm or leg nerve.No office rate

64857 billing questions

How does 64857 differ from 64856?

64857 describes major peripheral nerve repair in an arm or leg without transposition. Use 64856 when the repair includes transposition.

Can 64857 be used for sciatic nerve repair?

No. Sciatic nerve repair is reported with 64858; 64857 is for an eligible major peripheral nerve in an arm or leg other than the sciatic nerve.

Is routine postoperative care separately reported?

The 90-day global period includes related postoperative care, as well as the day-before preoperative visit.

Should modifier 50 be used for repairs on both sides?

No. CMS identifies bilateral adjustment as inappropriate for this code.

Can an assistant or co-surgeon be reported?

Assistant-at-surgery payment may be made. 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 64857PPRRVU2026_Oct_nonQPP.csv, line 7,257 (RVU26D)

Open CMS sourceHow we calculate rates

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