Billing code 61458: Nerve decompressionMedicare rate & RVUs in Florida
Reports suboccipital exposure and exploration of a cranial nerve with decompression, commonly for microvascular compression causing trigeminal neuralgia or hemifacial spasm.
CMS doesn’t publish an office rate for 61458 in Florida.
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 61458 covers
This service involves a suboccipital craniectomy to expose and explore a cranial nerve and relieve compression, commonly during microvascular decompression for trigeminal neuralgia or hemifacial spasm. A neurosurgeon identifies the symptomatic nerve and compressive structure, often an offending vessel, and performs the decompression. The procedure is generally performed in an operating room under general anesthesia; nerve decompression, rather than tumor removal or nerve division, defines the service.
Select the code from the operative work, not the diagnosis alone. Documentation should identify the suboccipital exposure, nerve explored, cause of compression, decompression performed, and any distinct additional procedures. The 90-day global includes the day-before preoperative visit and related postoperative care through day 90. For multiple procedures in one session, the highest-valued procedure is paid in full and others at 50%. Modifier 50 is inappropriate for this descriptor and anatomy. An assistant at surgery may be paid; co-surgeon payment requires supporting documentation, and team-surgery payment 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.
Where 61458 pays more and less in Florida
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
| Payment locality | Office | Facility |
|---|---|---|
| Fort Lauderdale | Unavailable | $2,291.09 |
| Miami | Unavailable | $2,593.60 |
| Rest Of Florida | Unavailable | $2,134.70 |
How the 61458 rate is calculated
Each of 61458’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 · 61458
RVUs × geographic indexes × conversion factor
Work28.12
28.12 RVUs× 1.000 GPCI
Practice expense18.84
18.84 RVUs× 1.000 GPCI
Malpractice11.83
11.83 RVUs× 1.000 GPCI
Adjusted RVUs
58.7900
Conversion factor
$33.4009
Medicare rate
$1,963.64
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 61458
61458 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 61458
Nerve decompression
| 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) | 0 | The 150% bilateral adjustment doesn’t apply. |
| 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 · 61458
Nerve decompression
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 51 · payment effect
With and without the modifier
61458 without 51 · national facility
$1,963.64
Nerve decompression
61458-51 · Second procedure: 50%
$981.82
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%).
61458 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 61450Cranial nerve section
- Both involve suboccipital cranial-nerve surgery, but select based on the exact operative service described in the code and documented in the report.
- 61460Cranial nerve surgery
- 61460 describes sectioning one or more cranial nerves. This code is for exploration and decompression rather than nerve division.
- 64716Cranial nerve surgery
- 64716 describes intratemporal facial-nerve decompression. This code describes cranial-nerve exploration and decompression through a suboccipital approach.
61458 billing questions
How is this code distinguished from nerve sectioning?
Use this code when the operative service explores and decompresses a cranial nerve through a suboccipital approach. A procedure that divides one or more cranial nerves is described by a different code, such as 61460.
What documentation supports reporting this service?
The operative report should describe the suboccipital exposure, the nerve explored, the source of compression, and the maneuver used to decompress it. The diagnosis by itself does not establish that this procedure was performed.
Can modifier 50 be used for decompression of nerves on both sides?
Modifier 50 is inappropriate for this code’s descriptor and anatomy. Report the procedure performed as described rather than treating it as a bilateral procedure.
How are other same-session procedures paid?
When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and the others are paid at 50%. Related care within the 90-day global period is included as specified in the global package.
Can an assistant or co-surgeon be reported?
An assistant at surgery may be paid. Co-surgeon payment requires supporting documentation; team-surgery payment 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 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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