No office rate
64802 describes cervical-level sympathectomy. Choose 64804 when the operative work is documented at the cervicothoracic level.
On this page
CMS RVU26D · Effective 2026-10-01
64804 in Madera
Office / nonfacility
Not available in this setting
Base rate per service
Facility setting
$1151.32
Base rate per service
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
Nervous system surgery
About 64804: Cervicothoracic sympathetic chain surgery
Cervicothoracic sympathectomy interrupts sympathetic nerve tissue at the neck–chest junction for selected upper-extremity conditions.
Cervicothoracic sympathectomy interrupts or removes sympathetic nerve tissue at the junction of the cervical and thoracic regions. Surgeons may perform it for severe upper-extremity hyperhidrosis or selected vasospastic or pain conditions when targeted interruption of sympathetic outflow is intended. The operation is generally performed in an operating room. The operative report should identify the side and sympathetic structures treated.
Report 64804 when the documented operative work is at the cervicothoracic level, rather than cervical-only, lower thoracic or lumbar, or limited to a hand artery. Document the indication, laterality, anatomic extent, and technique to support the level treated. The 90-day global includes the day-before preoperative visit and 90 days of related postoperative care. For bilateral work, modifier 50 is paid at 150%. When multiple procedures occur in one session, the highest-valued procedure is paid in full and others at 50%. Assistant-at-surgery services may be paid; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 64804
- Global period
- Major surgery with a 90-day global period: the day-before preoperative visit and 90 days of related postoperative care are included.
- Multiple procedures
- Standard multiple procedure reduction: the highest-valued procedure is paid in full and others at 50% when performed in the same session.
- Bilateral procedures
- Bilateral procedure with modifier 50 is paid at 150%.
- Assistant at surgery
- Assistant at surgery may be paid.
- Co-surgeons
- Co-surgeons paid only with supporting documentation.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU15.51 · 43%
- Practice expense (office) RVU13.86 · 39%
- Malpractice RVU6.54 · 18%
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.
64804 compared with similar codes
Office rates for Madera, from the same CMS release.
No office rate
64809 applies to thoracolumbar sympathectomy, not work at the cervicothoracic junction.
No office rate
64818 is for lumbar sympathectomy. Select 64804 for cervicothoracic-level work.
No office rate
64820 concerns sympathectomy of a digital artery; 64804 is for sympathetic-chain work at the cervicothoracic level.
The same code, a different location
How does Madera compare?
64804 across payment areas
Same release and payment basis · bars start at $0
Madera · This locality
Unavailable
Unavailable
No comparable rate is available in this setting.
Unavailable
No comparable rate is available in this setting.
Unavailable
No comparable rate is available in this setting.
Unavailable
No comparable rate is available in this setting.
Unavailable
No comparable rate is available in this setting.
No comparable rate is available in this setting.
Other payment areas listed in California appear first, followed by selected cross-country examples. The chart compares amounts, not distance.
The code’s RVUs stay the same in these comparisons. Geographic adjustments to work, practice expense and malpractice change the dollar amount. A city name alone may not identify the payment area for a service address.
Compare all 108 other payment areas
Merced
California · 64804
Office
Unavailable
Facility
$1151.32
No comparable office rate is available.
Modesto
California · 64804
Office
Unavailable
Facility
$1151.32
No comparable office rate is available.
Napa
California · 64804
Office
Unavailable
Facility
$1271.80
No comparable office rate is available.
Oxnard-Thousand Oaks-Ventura
California · 64804
Office
Unavailable
Facility
$1215.83
No comparable office rate is available.
Redding
California · 64804
Office
Unavailable
Facility
$1151.32
No comparable office rate is available.
Rest Of California
California · 64804
Office
Unavailable
Facility
$1151.32
No comparable office rate is available.
Riverside-San Bernardino-Ontario
California · 64804
Office
Unavailable
Facility
$1221.08
No comparable office rate is available.
Sacramento-Roseville-Folsom
California · 64804
Office
Unavailable
Facility
$1192.18
No comparable office rate is available.
Salinas
California · 64804
Office
Unavailable
Facility
$1187.74
No comparable office rate is available.
San Diego-Chula Vista-Carlsbad
California · 64804
Office
Unavailable
Facility
$1205.66
No comparable office rate is available.
San Francisco-Oakland-Berkeley (Marin Cnty)
California · 64804
Office
Unavailable
Facility
$1320.27
No comparable office rate is available.
San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty)
California · 64804
Office
Unavailable
Facility
$1312.84
No comparable office rate is available.
San Jose-Sunnyvale-Santa Clara (San Benito Cnty)
California · 64804
Office
Unavailable
Facility
$1359.67
No comparable office rate is available.
San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty)
California · 64804
Office
Unavailable
Facility
$1329.31
No comparable office rate is available.
San Luis Obispo-Paso Robles
California · 64804
Office
Unavailable
Facility
$1171.22
No comparable office rate is available.
Santa Cruz-Watsonville
California · 64804
Office
Unavailable
Facility
$1208.48
No comparable office rate is available.
Santa Maria-Santa Barbara
California · 64804
Office
Unavailable
Facility
$1189.42
No comparable office rate is available.
Santa Rosa-Petaluma
California · 64804
Office
Unavailable
Facility
$1219.16
No comparable office rate is available.
Stockton
California · 64804
Office
Unavailable
Facility
$1151.32
No comparable office rate is available.
Vallejo
California · 64804
Office
Unavailable
Facility
$1261.10
No comparable office rate is available.
Visalia
California · 64804
Office
Unavailable
Facility
$1151.32
No comparable office rate is available.
Yuba City
California · 64804
Office
Unavailable
Facility
$1151.32
No comparable office rate is available.
Dc + Md/Va Suburbs
District of Columbia · 64804
Office
Unavailable
Facility
$1334.49
No comparable office rate is available.
Miami
Florida · 64804
Office
Unavailable
Facility
$1552.40
No comparable office rate is available.
Chicago
Illinois · 64804
Office
Unavailable
Facility
$1488.25
No comparable office rate is available.
Manhattan
New York · 64804
Office
Unavailable
Facility
$1435.58
No comparable office rate is available.
Alaska*
Alaska · 64804
Office
Unavailable
Facility
$1390.46
No comparable office rate is available.
Alabama
Alabama · 64804
Office
Unavailable
Facility
$1046.76
No comparable office rate is available.
Arkansas
Arkansas · 64804
Office
Unavailable
Facility
$1028.21
No comparable office rate is available.
Arizona
Arizona · 64804
Office
Unavailable
Facility
$1153.62
No comparable office rate is available.
Colorado
Colorado · 64804
Office
Unavailable
Facility
$1187.43
No comparable office rate is available.
Connecticut
Connecticut · 64804
Office
Unavailable
Facility
$1291.31
No comparable office rate is available.
Delaware
Delaware · 64804
Office
Unavailable
Facility
$1174.40
No comparable office rate is available.
Fort Lauderdale
Florida · 64804
Office
Unavailable
Facility
$1381.95
No comparable office rate is available.
Rest Of Florida
Florida · 64804
Office
Unavailable
Facility
$1288.93
No comparable office rate is available.
Atlanta
Georgia · 64804
Office
Unavailable
Facility
$1252.29
No comparable office rate is available.
Rest Of Georgia
Georgia · 64804
Office
Unavailable
Facility
$1191.37
No comparable office rate is available.
Hawaii, Guam
Hawaii · 64804
Office
Unavailable
Facility
$1170.88
No comparable office rate is available.
Iowa
Iowa · 64804
Office
Unavailable
Facility
$1028.36
No comparable office rate is available.
Idaho
Idaho · 64804
Office
Unavailable
Facility
$1047.27
No comparable office rate is available.
East St. Louis
Illinois · 64804
Office
Unavailable
Facility
$1383.89
No comparable office rate is available.
Rest Of Illinois
Illinois · 64804
Office
Unavailable
Facility
$1282.13
No comparable office rate is available.
Suburban Chicago
Illinois · 64804
Office
Unavailable
Facility
$1384.19
No comparable office rate is available.
Indiana
Indiana · 64804
Office
Unavailable
Facility
$1053.35
No comparable office rate is available.
Kansas
Kansas · 64804
Office
Unavailable
Facility
$1046.64
No comparable office rate is available.
Kentucky
Kentucky · 64804
Office
Unavailable
Facility
$1129.47
No comparable office rate is available.
New Orleans
Louisiana · 64804
Office
Unavailable
Facility
$1201.82
No comparable office rate is available.
Rest Of Louisiana
Louisiana · 64804
Office
Unavailable
Facility
$1137.01
No comparable office rate is available.
Metropolitan Boston
Massachusetts · 64804
Office
Unavailable
Facility
$1286.45
No comparable office rate is available.
Rest Of Massachusetts
Massachusetts · 64804
Office
Unavailable
Facility
$1187.91
No comparable office rate is available.
Baltimore/Surr. Cntys
Maryland · 64804
Office
Unavailable
Facility
$1293.28
No comparable office rate is available.
Rest Of Maryland
Maryland · 64804
Office
Unavailable
Facility
$1192.25
No comparable office rate is available.
Rest Of Maine
Maine · 64804
Office
Unavailable
Facility
$1079.82
No comparable office rate is available.
Southern Maine
Maine · 64804
Office
Unavailable
Facility
$1114.65
No comparable office rate is available.
Detroit
Michigan · 64804
Office
Unavailable
Facility
$1333.07
No comparable office rate is available.
Rest Of Michigan
Michigan · 64804
Office
Unavailable
Facility
$1187.33
No comparable office rate is available.
Minnesota
Minnesota · 64804
Office
Unavailable
Facility
$1059.07
No comparable office rate is available.
Metropolitan Kansas City
Missouri · 64804
Office
Unavailable
Facility
$1166.16
No comparable office rate is available.
Metropolitan St. Louis
Missouri · 64804
Office
Unavailable
Facility
$1177.64
No comparable office rate is available.
Rest Of Missouri
Missouri · 64804
Office
Unavailable
Facility
$1129.86
No comparable office rate is available.
Mississippi
Mississippi · 64804
Office
Unavailable
Facility
$1078.06
No comparable office rate is available.
Montana**
Montana · 64804
Office
Unavailable
Facility
$1198.99
No comparable office rate is available.
North Carolina
North Carolina · 64804
Office
Unavailable
Facility
$1089.55
No comparable office rate is available.
North Dakota**
North Dakota · 64804
Office
Unavailable
Facility
$1069.67
No comparable office rate is available.
Nebraska
Nebraska · 64804
Office
Unavailable
Facility
$1027.91
No comparable office rate is available.
New Hampshire
New Hampshire · 64804
Office
Unavailable
Facility
$1191.10
No comparable office rate is available.
Northern Nj
New Jersey · 64804
Office
Unavailable
Facility
$1320.99
No comparable office rate is available.
Rest Of New Jersey
New Jersey · 64804
Office
Unavailable
Facility
$1283.93
No comparable office rate is available.
New Mexico
New Mexico · 64804
Office
Unavailable
Facility
$1204.91
No comparable office rate is available.
Nevada**
Nevada · 64804
Office
Unavailable
Facility
$1163.41
No comparable office rate is available.
Nyc Suburbs/Long Island
New York · 64804
Office
Unavailable
Facility
$1507.28
No comparable office rate is available.
Poughkpsie/N Nyc Suburbs
New York · 64804
Office
Unavailable
Facility
$1312.59
No comparable office rate is available.
Queens
New York · 64804
Office
Unavailable
Facility
$1413.39
No comparable office rate is available.
Rest Of New York
New York · 64804
Office
Unavailable
Facility
$1111.40
No comparable office rate is available.
Ohio
Ohio · 64804
Office
Unavailable
Facility
$1160.90
No comparable office rate is available.
Oklahoma
Oklahoma · 64804
Office
Unavailable
Facility
$1101.18
No comparable office rate is available.
Portland
Oregon · 64804
Office
Unavailable
Facility
$1203.18
No comparable office rate is available.
Rest Of Oregon
Oregon · 64804
Office
Unavailable
Facility
$1132.70
No comparable office rate is available.
Metropolitan Philadelphia
Pennsylvania · 64804
Office
Unavailable
Facility
$1269.89
No comparable office rate is available.
Rest Of Pennsylvania
Pennsylvania · 64804
Office
Unavailable
Facility
$1149.45
No comparable office rate is available.
Puerto Rico
Puerto Rico · 64804
Office
Unavailable
Facility
$1201.24
No comparable office rate is available.
Rhode Island
Rhode Island · 64804
Office
Unavailable
Facility
$1200.95
No comparable office rate is available.
South Carolina
South Carolina · 64804
Office
Unavailable
Facility
$1131.48
No comparable office rate is available.
South Dakota**
South Dakota · 64804
Office
Unavailable
Facility
$1054.38
No comparable office rate is available.
Tennessee
Tennessee · 64804
Office
Unavailable
Facility
$1056.16
No comparable office rate is available.
Austin
Texas · 64804
Office
Unavailable
Facility
$1202.41
No comparable office rate is available.
Beaumont
Texas · 64804
Office
Unavailable
Facility
$1142.25
No comparable office rate is available.
Brazoria
Texas · 64804
Office
Unavailable
Facility
$1151.35
No comparable office rate is available.
Dallas
Texas · 64804
Office
Unavailable
Facility
$1171.22
No comparable office rate is available.
Fort Worth
Texas · 64804
Office
Unavailable
Facility
$1169.43
No comparable office rate is available.
Galveston
Texas · 64804
Office
Unavailable
Facility
$1162.76
No comparable office rate is available.
Houston
Texas · 64804
Office
Unavailable
Facility
$1282.46
No comparable office rate is available.
Rest Of Texas
Texas · 64804
Office
Unavailable
Facility
$1154.63
No comparable office rate is available.
Utah
Utah · 64804
Office
Unavailable
Facility
$1149.37
No comparable office rate is available.
Virginia
Virginia · 64804
Office
Unavailable
Facility
$1127.33
No comparable office rate is available.
Virgin Islands
United States Virgin Islands · 64804
Office
Unavailable
Facility
$1201.24
No comparable office rate is available.
Vermont
Vermont · 64804
Office
Unavailable
Facility
$1086.89
No comparable office rate is available.
Rest Of Washington
Washington · 64804
Office
Unavailable
Facility
$1178.49
No comparable office rate is available.
Seattle (King Cnty)
Washington · 64804
Office
Unavailable
Facility
$1290.44
No comparable office rate is available.
Wisconsin
Wisconsin · 64804
Office
Unavailable
Facility
$1028.82
No comparable office rate is available.
West Virginia
West Virginia · 64804
Office
Unavailable
Facility
$1232.93
No comparable office rate is available.
Wyoming**
Wyoming · 64804
Office
Unavailable
Facility
$1142.63
No comparable office rate is available.
See how rates vary across the country
64804 · Office / nonfacility · Non-QP. Choose a state to explore its payment localities. A range means the amount varies within that state.
Explore a state
Local rates. Clear comparisons.
Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.
View all state and territory rates as a table
| State / territory | Rate range | Localities |
|---|---|---|
| AK | No published base rate | 1 |
| AL | No published base rate | 1 |
| AR | No published base rate | 1 |
| AZ | No published base rate | 1 |
| CA | No published base rate | 29 |
| CO | No published base rate | 1 |
| CT | No published base rate | 1 |
| DC | No published base rate | 1 |
| DE | No published base rate | 1 |
| FL | No published base rate | 3 |
| GA | No published base rate | 2 |
| GU | No published base rate | 1 |
| HI | No published base rate | 1 |
| IA | No published base rate | 1 |
| ID | No published base rate | 1 |
| IL | No published base rate | 4 |
| IN | No published base rate | 1 |
| KS | No published base rate | 1 |
| KY | No published base rate | 1 |
| LA | No published base rate | 2 |
| MA | No published base rate | 2 |
| MD | No published base rate | 3 |
| ME | No published base rate | 2 |
| MI | No published base rate | 2 |
| MN | No published base rate | 1 |
| MO | No published base rate | 3 |
| MS | No published base rate | 1 |
| MT | No published base rate | 1 |
| NC | No published base rate | 1 |
| ND | No published base rate | 1 |
| NE | No published base rate | 1 |
| NH | No published base rate | 1 |
| NJ | No published base rate | 2 |
| NM | No published base rate | 1 |
| NV | No published base rate | 1 |
| NY | No published base rate | 5 |
| OH | No published base rate | 1 |
| OK | No published base rate | 1 |
| OR | No published base rate | 2 |
| PA | No published base rate | 2 |
| PR | No published base rate | 1 |
| RI | No published base rate | 1 |
| SC | No published base rate | 1 |
| SD | No published base rate | 1 |
| TN | No published base rate | 1 |
| TX | No published base rate | 8 |
| UT | No published base rate | 1 |
| VA | No published base rate | 2 |
| VI | No published base rate | 1 |
| VT | No published base rate | 1 |
| WA | No published base rate | 2 |
| WI | No published base rate | 1 |
| WV | No published base rate | 1 |
| WY | No published base rate | 1 |
Where does this rate apply?
Madera is a Medicare payment area. Our Census mapping connects it to 17 cities and communities in California, including the examples shown here.
Some communities span more than one payment area. Follow a city link to compare all of its mapped areas, or check the service-location ZIP above for an address-level starting point.
Use this rate
What is a percentage of Medicare worth?
Turn a percentage into dollars for 64804 in Madera. This uses the base rate on this page, so the locality and release stay consistent.
Reference amount per service
$1266.45
$1151.32 × 110% = $1266.45
A contract may specify another Medicare year or additional adjustments. This is percentage arithmetic on the displayed base rate, not a claim adjudication.
Working with a whole code list?
Compare an offer across your annual code mix, including an older Medicare schedule or flat per-code rates.
How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 64804 in Madera.
PPRRVU2026_Oct_nonQPP.csv
7,242
- Code
- 64804
- Physician work
- 15.51
- Practice expense
- 13.86
- Malpractice
- 6.54
GPCI2026.csv
14
- Locality
- Madera
- Physician work
- 1.017
- Practice expense
- 1.096
- Malpractice
- 0.536
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 15.51 | × 1.017 | 15.7737 |
| Practice expense | 13.86 | × 1.096 | 15.1906 |
| Malpractice | 6.54 | × 0.536 | 3.5054 |
| Total RVUs | 34.4697 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Madera$1151.32
Open 64804 in the RVU calculator →
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 15.51 | 1.017 |
| Practice expense | 13.86 | 1.096 |
| Malpractice | 6.54 | 0.536 |
(15.51 × 1.017 + 13.86 × 1.096 + 6.54 × 0.536) × $33.4009 = $1151.32
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
How this rate has changed
64804 · Office / nonfacility
Rate unavailable
Effective 2026-10-01
A rate is unavailable in one of these releases, so a change cannot be calculated.
One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.
What changed, release by release
Explore release dates and calculate this code in an earlier period →
Each row uses the accepted CMS release effective on that date and the same contractor and locality identifiers. Missing rates stay visible. Historical boundaries may differ; verify the service address for an older claim.
Inspect every release and its CMS source
| Effective from | Office / nonfacility | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | Not available in this setting | $1151.32 | RVU26D |
| 2026-07-01 | Not available in this setting | $1151.32 | RVU26C |
| 2026-04-01 | Not available in this setting | $1151.32 | RVU26B |
| 2026-01-01 | Not available in this setting | $1151.50 | RVU26A |
| 2025-10-01 | Not available in this setting | $1143.75 | RVU25D |
| 2025-07-01 | Not available in this setting | $1143.75 | RVU25C |
| 2025-04-01 | Not available in this setting | $1143.75 | RVU25B |
| 2025-01-01 | Not available in this setting | $1143.75 | RVU25A |
64804 billing questions
How do I distinguish 64804 from cervical sympathectomy 64802?
Use the operative anatomy to select the code. Report 64804 for work at the cervicothoracic level and 64802 for cervical-only work.
How is bilateral cervicothoracic work reported?
When the procedure is bilateral, report modifier 50. CMS pays the bilateral procedure at 150%.
What documentation supports 64804?
The operative report should establish the indication, laterality, sympathetic structures treated, and the anatomic level of the procedure.
What postoperative care is included in the global period?
The 90-day global includes the day-before preoperative visit and 90 days of related postoperative care.
How does CMS handle multiple procedures in the same session?
The highest-valued procedure is paid in full, and other procedures are paid at 50% under the standard multiple procedure reduction.
Can an assistant or co-surgeon be paid?
Assistant-at-surgery services may be paid. 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 indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
7,23964792,,Removal of nerve lesion,A,,15.46,14.34,NA,14.34,,6.52,36.32,36.32,0,090,0.11,0.76,0.13,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,24064795,,Biopsy of nerve,A,,2.93,1.77,NA,1.77,,0.88,5.58,5.58,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,24164802,,Sympathectomy cervical,A,,10.11,11.95,NA,11.95,,4.26,26.32,26.32,0,090,0.11,0.76,0.13,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,24264804,,Sympathectomy cervicothorac,A,,15.51,13.86,NA,13.86,,6.54,35.91,35.91,0,090,0.11,0.76,0.13,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,24364809,,Sympathectomy thoracolumbar,A,,14.34,12.38,NA,12.38,,6.04,32.76,32.76,0,090,0.11,0.76,0.13,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,24464818,,Sympathectomy lumbar,A,,11.06,8.11,NA,8.11,,2.36,21.53,21.53,0,090,0.11,0.76,0.13,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,24564820,,Sympathectomy digital artery,A,,10.47,8.43,NA,8.43,,2.04,20.94,20.94,0,090,0.11,0.76,0.13,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1101112,CA,56,FRESNO,1.017,1.096,0.536
1201112,CA,57,HANFORD-CORCORAN,1.017,1.096,0.536
1301182,CA,18,LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY),1.041,1.183,0.664
1401112,CA,58,MADERA,1.017,1.096,0.536
1501112,CA,59,MERCED,1.017,1.096,0.536
1601112,CA,60,MODESTO,1.017,1.096,0.536
1701112,CA,51,NAPA,1.063,1.318,0.508