No office rate
Use 64821 when the sympathectomy is directed to the radial artery. Code 64820 is for work on a digital artery.
On this page
CMS RVU26D · Effective 2026-10-01
64820 Sympathectomy Medicare reimbursement rates in Colorado
Reports microsurgical interruption of sympathetic fibers around a digital artery, typically to improve blood flow in severe finger ischemia or refractory Raynaud symptoms. Compare 64820 office and facility rates across CMS payment localities in Colorado.
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 64820 in Colorado?
Colorado 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
$706.71
1 of 1 localities have a supported rate.
Payment area: Colorado
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.
Hand surgery
About 64820: Digital artery sympathectomy
Reports microsurgical interruption of sympathetic fibers around a digital artery, typically to improve blood flow in severe finger ischemia or refractory Raynaud symptoms.
A hand surgeon or microsurgeon performs a periarterial sympathectomy by removing or disrupting sympathetic fibers surrounding a digital artery while preserving the artery. The operation is used for selected patients with severe digital ischemia, such as persistent Raynaud-related symptoms or ischemic ulcers associated with connective-tissue disease. It is generally performed in an operating room, often in a hospital or ambulatory surgery facility.
Report 64820 when the operative work is directed to a digital artery; the operative note should identify the treated artery and describe the sympathectomy. This major surgery includes the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and others at 50%. The descriptor or anatomy makes modifier 50 inappropriate. Medicare does not pay an assistant at surgery, and co-surgeons and team surgery are not permitted.
CMS billing rules for 64820
- 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 not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU10.47 · 50%
- Practice expense (office) RVU8.43 · 40%
- Malpractice RVU2.04 · 10%
173
Medicare services in 2024 · #4459 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.
64820 compared with similar codes
Office rates for Colorado, from the same CMS release.
No office rate
Use 64822 for sympathectomy of the ulnar artery; use 64820 when the treated vessel is a digital artery.
No office rate
Code 64823 identifies sympathectomy at the superficial palmar arch. Code 64820 identifies a digital artery site.
Compare 64820 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
Colorado →
Office / nonfacility
Unavailable
Facility
$706.71
Need rates for a whole code list?
Fee-sheet and API access are in early access. Tell us which codes and locations your team needs.
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 64820 in Colorado.
PPRRVU2026_Oct_nonQPP.csv
7,245
- Code
- 64820
- Physician work
- 10.47
- Practice expense
- 8.43
- Malpractice
- 2.04
GPCI2026.csv
37
- Locality
- Colorado
- Physician work
- 1.012
- Practice expense
- 1.064
- Malpractice
- 0.781
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 10.47 | × 1.012 | 10.5956 |
| Practice expense | 8.43 | × 1.064 | 8.9695 |
| Malpractice | 2.04 | × 0.781 | 1.5932 |
| Total RVUs | 21.1584 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Colorado$706.71
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 10.47 | 1.012 |
| Practice expense | 8.43 | 1.064 |
| Malpractice | 2.04 | 0.781 |
(10.47 × 1.012 + 8.43 × 1.064 + 2.04 × 0.781) × $33.4009 = $706.71
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.
64820 billing questions
How do I distinguish 64820 from 64821 or 64822?
Choose 64820 for sympathectomy directed to a digital artery. Codes 64821 and 64822 identify the radial and ulnar arteries, respectively.
Does the 90-day global include postoperative visits?
Yes. The global period includes the day-before preoperative visit and 90 days of related postoperative care.
Can modifier 50 be used for treatment on both hands?
No. The descriptor or anatomy makes modifier 50 inappropriate; report the procedure according to the digital artery work documented.
How are other procedures in the same session paid?
Under the standard multiple procedure reduction, the highest-valued procedure is paid in full and additional procedures are paid at 50%.
Can an assistant or co-surgeon be reported?
Medicare does not pay an assistant at surgery for this code. Co-surgeons and team surgery are 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.
7,24264804,,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
7,24664821,,Sympathectomy radial artery,A,,9.10,8.73,NA,8.73,,1.94,19.77,19.77,0,090,0.11,0.76,0.13,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,24764822,,Sympathectomy ulnar artery,A,,9.10,8.73,NA,8.73,,1.94,19.77,19.77,0,090,0.11,0.76,0.13,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,24864823,,Sympathectomy supfc palmar,A,,10.67,9.22,NA,9.22,,2.27,22.16,22.16,0,090,0.11,0.76,0.13,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3401112,CA,69,VISALIA,1.017,1.096,0.536
3501112,CA,70,YUBA CITY,1.017,1.096,0.536
3601112,CA,75,REST OF CALIFORNIA,1.017,1.096,0.536
3704112,CO,01,COLORADO,1.012,1.064,0.781
3813102,CT,00,CONNECTICUT,1.020,1.077,1.210
3912202,DC,01,DC + MD/VA SUBURBS,1.054,1.178,1.113
4012102,DE,01,DELAWARE,1.005,0.988,0.899