Billing code 64804: SympathectomyMedicare rate & RVUs in Florida
Cervicothoracic sympathectomy interrupts sympathetic nerve tissue at the neck–chest junction for selected upper-extremity conditions.
CMS doesn’t publish an office rate for 64804 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 64804 covers
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.
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 64804 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 | $1,381.95 |
| Miami | Unavailable | $1,552.40 |
| Rest Of Florida | Unavailable | $1,288.93 |
How the 64804 rate is calculated
Each of 64804’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 · 64804
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 15.51Practice expense 13.86Malpractice 6.54
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 64804
64804 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 64804
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 · 64804
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
64804 without 50 · national facility
$1,199.43
Sympathectomy
64804-50 · Bilateral: 150%
$1,799.15
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).
64804 compared with similar codes
Compare codes
64804 vs 64802 vs 64809 vs 64818 vs 64820: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 64802Cervical sympathectomy
- 64802 describes cervical-level sympathectomy. Choose 64804 when the operative work is documented at the cervicothoracic level.
- 64809Sympathectomy
- 64809 applies to thoracolumbar sympathectomy, not work at the cervicothoracic junction.
- 64818Sympathectomy
- 64818 is for lumbar sympathectomy. Select 64804 for cervicothoracic-level work.
- 64820Sympathectomy
- 64820 concerns sympathectomy of a digital artery; 64804 is for sympathetic-chain work at the cervicothoracic level.
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 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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