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Billing code 64861: Nerve repairMedicare rate & RVUs

Repair of an injured brachial plexus by nerve suturing, reported for operative reconstruction when the surgical work involves the plexus itself.

CMS RVU26DEffective Oct 1, 2026109 payment localities

Medicare pays $1,512.06 for 64861 nationally in a facility.

Medicare rate · 64861

Nerve repair

Swap in your local Medicare rate.

Work RVUs
20.37
Total RVUs
45.27
Global days
090

National rate · 2026

$1,512.06

Facility setting, before claim adjustments.

See every locality for 64861 → · 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 64861 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 64861 covers

This service repairs an injured brachial plexus by surgically joining nerve tissue. It is typically performed in an operating room by a surgeon experienced in peripheral nerve reconstruction, such as a neurosurgeon or plastic surgeon. A common clinical setting is operative treatment of a traumatic plexus injury; the operative report should identify the plexus structures treated and describe the repair performed.

Report 64861 when the operative work is on the brachial plexus, rather than a separate major peripheral nerve in the arm or leg. Documentation should establish the injury, operative findings, structures repaired, and laterality. The code has a 90-day global period, including the day-before preoperative visit and related postoperative care. With other procedures in the same session, the highest-valued procedure is paid in full and others at 50%. Bilateral reporting with modifier 50 is paid at 150%. Assistant-at-surgery payment may be allowed; 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 64861 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

64861 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$1,319.44
Alaska*Unavailable$1,758.83
ArizonaUnavailable$1,453.86
ArkansasUnavailable$1,296.09
AtlantaUnavailable$1,580.49
AustinUnavailable$1,512.31
BakersfieldUnavailable$1,465.10
Baltimore/Surr. CntysUnavailable$1,630.71
BeaumontUnavailable$1,442.66
BrazoriaUnavailable$1,449.48

64861 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.

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View every state and territory as a table
64861 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 64861 rate is calculated

Each of 64861’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 · 64861

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 20.37Practice expense 16.31Malpractice 8.59

45.2700 adjusted RVUs×$33.4009 conversion factor=$1,512.06

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

Payment rules and modifiers for 64861

64861 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 64861

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)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 · 64861

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 50 · payment effect

With and without the modifier

64861 without 50 · national facility

$1,512.06

Nerve repair

64861-50 · Bilateral: 150%

$2,268.09

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

64861 compared with similar codes

Compare codes

64861 vs 64856 vs 64858 vs 64872: national Medicare rates

Swap in your local Medicare rate.

  • 64861
    Nerve repair · 20.37 wRVU
    —
  • 64856
    Brachial plexus repair · 14.69 wRVU
    —
  • 64858
    Nerve repair · 17.37 wRVU
    —
  • 64872
    Nerve repair · 1.94 wRVU
    —

How to choose

64856Brachial plexus repair
64861 is specific to the brachial plexus. Choose 64856 when the operative repair is of a major peripheral nerve in the arm or leg.
64858Nerve repair
64858 is for the sciatic nerve. It is not the appropriate choice for repair of the brachial plexus.
64872Nerve repair
64872 identifies subsequent nerve repair. Use 64861 when the operative service is repair of the brachial plexus, not a subsequent repair service.

Codes related to 64861

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

Codes related to 64861
CodeHow it relatesNational office range
Used instead
64856Brachial plexus repairFor repair of a major peripheral nerve in the arm or leg rather than the brachial plexus.No office rate
64857Nerve repairA nearby option for major peripheral nerve repair in the arm or leg.No office rate
64858Nerve repairFor sciatic nerve repair, a different anatomic site.No office rate
64872Nerve repairFor subsequent nerve repair rather than repair of the brachial plexus as the primary service.No office rate
64864Facial nerve repairFor facial nerve repair, not brachial plexus repair.No office rate

64861 billing questions

When should 64861 be chosen over a major peripheral nerve repair code?

Use 64861 when the repaired structure is the brachial plexus. A repair of a separate major nerve in the arm or leg is represented by a different code.

Are related postoperative visits separately reported?

Related postoperative care is included in the 90-day global period, along with the day-before preoperative visit.

How is bilateral brachial plexus repair handled?

For bilateral procedures reported with modifier 50, CMS applies the bilateral payment rule of 150%.

Can an assistant or co-surgeon be reported?

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

What documentation supports 64861?

The operative report should identify the brachial plexus structures involved, describe the injury and findings, and explain the repair performed and its laterality.

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 64861PPRRVU2026_Oct_nonQPP.csv, line 7,260 (RVU26D)

Open CMS sourceHow we calculate rates

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