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Billing code 64868: Nerve anastomosisMedicare rate & RVUs

Reports operative joining of the facial nerve with another nerve as a reconstructive procedure, rather than repair of a nerve gap with a graft.

CMS RVU26DEffective Oct 1, 2026109 payment localities40 Medicare services in 2024

Medicare pays $868.09 for 64868 nationally in a facility.

Medicare rate · 64868

Nerve anastomosis

Work RVUs
14.53
Total RVUs
25.99
Global days
090

National rate · 2026

$868.09

Facility setting, before claim adjustments.

See every locality for 64868 →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 64868 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 64868 covers

The surgeon microsurgically joins the facial nerve with another nerve to restore a pathway for nerve signals, typically during reconstruction for facial nerve injury or loss of function. The operation is performed by a surgeon experienced in peripheral nerve or facial nerve reconstruction, usually in an operating room. The operative report should identify the nerves joined and describe the anastomosis performed.

Report this code for the facial-to-other-nerve joining procedure, not simply for direct repair of a divided facial nerve or for a nerve graft. Medicare assigns a 90-day global period, including the day-before preoperative visit and related postoperative care. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard multiple-procedure reduction. Modifier 50 is inappropriate. Assistant-at-surgery payment may be made; 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 64868 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

64868 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$798.36
Alaska*Unavailable$1,099.23
ArizonaUnavailable$848.22
ArkansasUnavailable$789.76
AtlantaUnavailable$888.77
AustinUnavailable$879.08
BakersfieldUnavailable$879.57
Baltimore/Surr. CntysUnavailable$915.41
BeaumontUnavailable$834.99
BrazoriaUnavailable$853.59

64868 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
64868 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 64868 rate is calculated

Each of 64868’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 · 64868

RVUs × geographic indexes × conversion factor

Work14.53

14.53 RVUs× 1.000 GPCI

Practice expense9.34

9.34 RVUs× 1.000 GPCI

Malpractice2.12

2.12 RVUs× 1.000 GPCI

Adjusted RVUs

25.9900

Conversion factor

$33.4009

Medicare rate

$868.09

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

Payment rules and modifiers for 64868

64868 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 64868

Nerve anastomosis

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 · 64868

Nerve anastomosis

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

64868 without 51 · national facility

$868.09

Nerve anastomosis

64868-51 · Second procedure: 50%

$434.05

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

64868 compared with similar codes

Compare codes · National

5 codes, side by side

  • 64868

    Nerve anastomosis14.53 wRVU

    Not priced

  • 64866

    Facial nerve transfer16.41 wRVU

    Not priced

  • 64864

    Facial nerve repair13.07 wRVU

    Not priced

  • 64865

    Facial nerve repair15.69 wRVU

    Not priced

  • 64885

    Nerve graft17.16 wRVU

    Not priced

How to choose

64866Facial nerve transfer
Both are facial nerve fusion codes. Confirm the operative service and applicable code distinction in the current billing code descriptor before selecting between them.
64864Facial nerve repair
Use 64864 for direct extracranial facial nerve repair; use 64868 when the documented operation joins the facial nerve with another nerve.
64865Facial nerve repair
64865 describes direct intracranial facial nerve repair, not an anastomosis joining the facial nerve with another nerve.
64885Nerve graft
64885 describes a head-and-neck nerve graft service. Choose it when the documented procedure is grafting rather than the facial-to-other-nerve joining represented by 64868.

Codes related to 64868

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

Codes related to 64868
CodeHow it relatesNational office range
Same family
64866Facial nerve transferRelated facial nerve fusion code in the same nerve-surgery family.No office rate
Used instead
64864Facial nerve repairFacial nerve repair when the operative service is direct extracranial repair.No office rate
64865Facial nerve repairFacial nerve repair when the operative service is direct intracranial repair.No office rate
64885Nerve graftNerve graft procedure in the head or neck, distinguished from nerve anastomosis.No office rate
64886Nerve graftLonger head-and-neck nerve graft procedure rather than nerve anastomosis.No office rate

64868 billing questions

How is this different from direct facial nerve repair?

This code represents joining the facial nerve with another nerve. Codes 64864 and 64865 describe facial nerve repair in extracranial and intracranial locations, respectively.

What should the operative note document?

Document the facial nerve and the other nerve joined, the anastomosis performed, and the clinical reason for reconstruction.

Can modifier 50 be used for bilateral work?

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

How does the 90-day global period affect postoperative billing?

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

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.

What happens 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.

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 64868PPRRVU2026_Oct_nonQPP.csv, line 7,265 (RVU26D)

Open CMS sourceHow we calculate rates

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