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Billing code 64891: Nerve graftMedicare rate & RVUs

Reports microsurgical placement of one nerve-graft strand longer than 4 cm to bridge a nerve gap in the hand or foot.

CMS RVU26DEffective Oct 1, 2026109 payment localities

Medicare pays $1,040.77 for 64891 nationally in a facility.

Medicare rate · 64891

Nerve graft

Swap in your local Medicare rate.

Work RVUs
16.92
Total RVUs
31.16
Global days
090

National rate · 2026

$1,040.77

Facility setting, before claim adjustments.

See every locality for 64891 → · 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 64891 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 64891 covers

A surgeon uses this service to bridge a peripheral nerve gap in the hand or foot when the nerve ends cannot be brought together for direct repair. The graft restores continuity across the defect, such as after traumatic nerve loss or excision of a damaged nerve segment. Hand, plastic, orthopedic, and peripheral nerve surgeons commonly perform the procedure in an operating room using microsurgical technique. The code specifies one graft strand and a graft length exceeding 4 cm at a hand or foot site.

Choose the code from the operative report’s documented anatomic site, number of strands, and graft length; distinguish it from shorter grafts and grafts for other body regions. Documentation should identify the injured or resected nerve, the gap bridged, the graft configuration, and its length. The service has a 90-day global period, including the day-before preoperative visit and 90 days of 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 50% reduction. Assistant-at-surgery payment may be allowed; 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 64891 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

64891 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$944.06
Alaska*Unavailable$1,292.28
ArizonaUnavailable$1,012.40
ArkansasUnavailable$932.23
AtlantaUnavailable$1,072.38
AustinUnavailable$1,048.75
BakersfieldUnavailable$1,038.45
Baltimore/Surr. CntysUnavailable$1,104.31
BeaumontUnavailable$1,000.26
BrazoriaUnavailable$1,015.57

64891 rates by state

Office rate range in each state. Select a state to see its payment localities.

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

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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
64891 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 64891 rate is calculated

Each of 64891’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 · 64891

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 16.92Practice expense 10.63Malpractice 3.61

31.1600 adjusted RVUs×$33.4009 conversion factor=$1,040.77

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

Payment rules and modifiers for 64891

64891 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 64891

Nerve graft

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)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 · 64891

Nerve graft

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

64891 without 51 · national facility

$1,040.77

Nerve graft

64891-51 · Second procedure: 50%

$520.39

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

64891 compared with similar codes

Compare codes

64891 vs 64890 vs 64893 vs 64896: national Medicare rates

Swap in your local Medicare rate.

  • 64891
    Nerve graft · 16.92 wRVU
    —
  • 64890
    Nerve graft · 15.83 wRVU
    —
  • 64893
    Nerve graft · 16.45 wRVU
    —
  • 64896
    Nerve graft · 21.41 wRVU
    —

How to choose

64890Nerve graft
Both are single-strand hand or foot grafts; the documented graft length separates the codes. Use 64890 for a length up to 4 cm and 64891 when it exceeds 4 cm.
64893Nerve graft
Both describe a single-strand graft longer than 4 cm. Choose 64891 for a hand or foot nerve and 64893 for an arm or leg nerve.
64896Nerve graft
Both cover a hand or foot graft longer than 4 cm, but 64896 is for a multiple-strand graft rather than one strand.

Codes related to 64891

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

Codes related to 64891
CodeHow it relatesNational office range
Same family
64890Nerve graftSingle-strand hand or foot nerve graft for a length up to 4 cm.No office rate
64893Nerve graftSingle-strand graft over 4 cm for an arm or leg nerve.No office rate
64892Nerve graftSingle-strand arm or leg graft for a length up to 4 cm.No office rate
64895Nerve graftMultiple-strand hand or foot nerve graft for a length up to 4 cm.No office rate
64896Nerve graftMultiple-strand hand or foot nerve graft over 4 cm.No office rate

64891 billing questions

How is this code distinguished from 64890?

Both describe a single-strand graft for a hand or foot nerve. Select this code when the graft length exceeds 4 cm; 64890 is for a graft up to 4 cm.

When should 64893 be considered instead?

64893 describes a single-strand graft longer than 4 cm for an arm or leg nerve. This code is for a hand or foot site.

What operative details support code selection?

Document the nerve and operative site, the nerve gap being bridged, the use of one graft strand, and graft length exceeding 4 cm.

Can modifier 50 be used for grafting both sides?

CMS bilateral adjustment does not apply to this code, and modifier 50 is inappropriate under the descriptor and anatomy. Document the treated site or sites.

How are assistant and co-surgeon services handled?

Assistant-at-surgery payment may be allowed. Co-surgeons and team surgery are not permitted for this code under the CMS facts.

What postoperative care is included?

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

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 64891PPRRVU2026_Oct_nonQPP.csv, line 7,272 (RVU26D)

Open CMS sourceHow we calculate rates

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