Billing code 64809: SympathectomyMedicare rate & RVUs in Delaware
Surgical interruption of the thoracolumbar sympathetic chain is reported when the operative treatment targets this chain rather than a cervical or lumbar-only level.
CMS doesn’t publish an office rate for 64809 in Delaware.
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 9 sections
What 64809 covers
This operation interrupts sympathetic nerve pathways at thoracic and lumbar levels. It may be considered when reducing sympathetic vasoconstrictor activity is part of surgical treatment for a vascular condition affecting the lower extremity. A surgeon performs the procedure in an operating room; the operative report should identify the treated chain and the extent of the intervention. The thoracolumbar target distinguishes this service from procedures confined to the cervical, cervicothoracic, or lumbar chain, and from sympathectomy of a named distal artery.
Report the code when the documented operative work matches the thoracolumbar chain service. The code has a 90-day global period, including 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 other procedures are subject to the standard 50% reduction. Bilateral reporting with modifier 50 is paid at 150%. An assistant at surgery may be paid; 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.
64809 in Delaware
| Payment locality | Office | Facility |
|---|---|---|
| Delaware | Unavailable | $1,071.27 |
How the 64809 rate is calculated
Each of 64809’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 · 64809
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 14.34Practice expense 12.38Malpractice 6.04
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 64809
64809 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 64809
Sympathectomy
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 090 | Major surgery: the day before, the day of, and 90 days after are included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 1 | Bilateral with modifier 50 pays 150% of the fee schedule amount. |
| Assistant at surgery (80/81/82/AS) | 2 | Paid. |
| Co-surgeons (62) | 1 | Permitted with supporting documentation. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.11/0.76/0.13 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 64809
Sympathectomy
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.
Pre-op dayGlobal period
What modifiers do to the payment
Modifier 50 · payment effect
With and without the modifier
64809 without 50 · national facility
$1,094.21
Sympathectomy
64809-50 · Bilateral: 150%
$1,641.32
Both sides on one line with modifier 50 are paid at 150% of the fee schedule amount (subject to multiple-procedure rules with other procedures).
64809 compared with similar codes
Compare codes
64809 vs 64818 vs 64804 vs 64820: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 64818Sympathectomy
- Choose 64818 when the documented procedure is confined to the lumbar sympathetic chain; 64809 is for a thoracolumbar target.
- 64804Sympathectomy
- 64804 applies to a cervicothoracic chain procedure, not a thoracolumbar one.
- 64820Sympathectomy
- 64820 describes sympathectomy at a digital artery. It is distinct from surgery directed at the thoracolumbar sympathetic chain.
64809 billing questions
How is this different from 64818?
64809 represents a thoracolumbar chain target. Use 64818 when the documented sympathectomy is confined to the lumbar chain.
What documentation supports reporting 64809?
The operative report should establish that the sympathetic chain was treated at thoracic and lumbar levels and describe the extent of the intervention.
Does the code have a global period?
Yes. The 90-day global includes the day-before preoperative visit and 90 days of related postoperative care.
How is bilateral reporting handled?
CMS pays bilateral reporting with modifier 50 at 150%.
Can an assistant or co-surgeon be paid?
An assistant at surgery may be paid. Co-surgeons are paid only with supporting documentation; team surgery is not permitted.
What happens when another procedure is done 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
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