No office rate
64856 addresses the brachial plexus. Code 64857 is for a major peripheral nerve in the arm or leg, excluding the sciatic nerve.
On this page
CMS RVU26D · Effective 2026-10-01
64856 Brachial plexus repair Medicare reimbursement rates in Alabama
Report this service for operative repair or transposition of a brachial plexus nerve, such as reconstruction after a traumatic plexus injury. Compare 64856 office and facility rates across CMS payment localities in Alabama.
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.
What does Medicare pay for 64856 in Alabama?
Alabama has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$830.10
1 of 1 localities have a supported rate.
Payment area: Alabama
One mapped payment locality.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Peripheral nerve surgery
About 64856: Brachial plexus repair or transposition
Report this service for operative repair or transposition of a brachial plexus nerve, such as reconstruction after a traumatic plexus injury.
This service covers operative repair or transposition of a brachial plexus nerve. It is commonly performed by a neurosurgeon, plastic surgeon, or orthopedic surgeon with peripheral nerve expertise in a hospital operating room. A typical clinical setting is reconstruction of a traumatic brachial plexus injury when the surgeon repairs or repositions the involved nerve structures.
Choose the code based on the documented anatomy and work performed, not simply the diagnosis of plexus injury. The operative report should identify the brachial plexus structures treated and describe the repair or transposition. This major surgery 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 others at 50%. Modifier 50 is inappropriate for this descriptor and anatomy. Medicare does not pay an assistant at surgery for this service; co-surgeons require supporting documentation, and team surgery is not permitted.
CMS billing rules for 64856
- 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 adjustment does not apply; the descriptor or anatomy makes modifier 50 inappropriate.
- Assistant at surgery
- Statutory restriction: assistant at surgery is not paid.
- Co-surgeons
- Co-surgeons paid only with supporting documentation.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU14.69 · 53%
- Practice expense (office) RVU9.37 · 34%
- Malpractice RVU3.47 · 13%
174
Medicare services in 2024 · #4451 by national volume
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.
64856 compared with similar codes
Office rates for Alabama, from the same CMS release.
No office rate
Choose 64856 for brachial plexus repair or transposition; 64858 is specific to repair of the sciatic nerve.
No office rate
64831 is for repair of one digital nerve in the hand or foot. It is not the code for a brachial plexus injury.
Compare 64856 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
1 of 1 payment localities
Alabama →
Office / nonfacility
Unavailable
Facility
$830.10
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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 64856 in Alabama.
PPRRVU2026_Oct_nonQPP.csv
7,256
- Code
- 64856
- Physician work
- 14.69
- Practice expense
- 9.37
- Malpractice
- 3.47
GPCI2026.csv
4
- Locality
- Alabama
- Physician work
- 1.000
- Practice expense
- 0.875
- Malpractice
- 0.566
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 14.69 | × 1.000 | 14.6900 |
| Practice expense | 9.37 | × 0.875 | 8.1987 |
| Malpractice | 3.47 | × 0.566 | 1.9640 |
| Total RVUs | 24.8528 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Alabama$830.10
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 14.69 | 1 |
| Practice expense | 9.37 | 0.875 |
| Malpractice | 3.47 | 0.566 |
(14.69 × 1 + 9.37 × 0.875 + 3.47 × 0.566) × $33.4009 = $830.10
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.
64856 billing questions
How does this differ from 64857?
Use 64856 for brachial plexus repair or transposition. Code 64857 describes repair of a major peripheral nerve in the arm or leg, excluding the sciatic nerve.
Is this code reported for a digital nerve repair?
No. Code 64856 is for the brachial plexus; a digital nerve repair is represented by 64831 for one digital nerve.
What documentation supports 64856?
The operative report should identify the brachial plexus anatomy treated and describe the repair or transposition performed. A diagnosis of plexus injury alone does not establish the service.
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 for this major surgery.
Can an assistant or co-surgeon be reported?
Medicare does not pay an assistant at surgery for this service. Co-surgeon payment requires supporting documentation, and team surgery is not permitted.
Should modifier 50 be used for bilateral treatment?
Modifier 50 is inappropriate for this code's descriptor and anatomy.
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.
7,25364836,,Repair of hand or foot nerve,A,,11.44,8.73,NA,8.73,,2.44,22.61,22.61,0,090,0.11,0.76,0.13,2,1,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,25464837,,Repair nerve add-on,A,,6.09,1.94,NA,1.94,,1.30,9.33,9.33,0,ZZZ,0.00,0.00,0.00,0,0,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,25564840,,Repair of leg nerve,A,,13.67,9.91,NA,9.91,,2.91,26.49,26.49,0,090,0.11,0.76,0.13,2,1,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,25664856,,Repair/transpose nerve,A,,14.69,9.37,NA,9.37,,3.47,27.53,27.53,0,090,0.11,0.76,0.13,2,0,1,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,25764857,,Repair arm/leg nerve,A,,15.42,9.62,NA,9.62,,3.25,28.29,28.29,0,090,0.11,0.76,0.13,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,25864858,,Repair sciatic nerve,A,,17.37,10.78,NA,10.78,,3.70,31.85,31.85,0,090,0.11,0.76,0.13,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,25964859,,Nerve surgery,A,,4.14,1.32,NA,1.32,,0.89,6.35,6.35,0,ZZZ,0.00,0.00,0.00,0,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1ADDENDUM E. FINAL CY 2026 GEOGRAPHIC PRACTICE COST INDICES (GPCIs) BY STATE AND MEDICARE LOCALITY,,,,,,
2,,,,,,
3Medicare Administrative Contractor (MAC),State,Locality Number,Locality Name,2026 PW GPCI (with 1.0 Floor)***,2026 PE GPCI,2026 MP GPCI
410112,AL,00,ALABAMA,1.000,0.875,0.566
502102,AK,01,ALASKA*,1.500,1.065,0.551
603102,AZ,00,ARIZONA,1.000,0.969,0.856
707102,AR,13,ARKANSAS,1.000,0.859,0.515