Billing code 64656: Bladder modulationMedicare rate & RVUs in Georgia
Revision or replacement of an implanted bladder modulation system’s pulse generator, typically performed when the generator requires surgical correction or replacement.
CMS doesn’t publish an office rate for 64656 in Georgia.
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 64656 covers
This service addresses the implanted pulse generator of a bladder modulation system, such as a sacral neuromodulation system used for urinary dysfunction. A urologist or urogynecologist typically performs the operation in a surgical setting, revising the generator or exchanging it while working with the implanted system’s existing lead. The target is the generator, not a lead-only procedure or removal of the entire system.
Report the code when the operative work revises or replaces the pulse generator; distinguish that work from initial implantation, lead revision, and removal. The operative note should identify the generator work performed, the reason for it, and how the generator relates to the implanted system. CMS assigns 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 other procedures at 50%. Modifier 50 bilateral procedures are paid at 150%. Assistant-at-surgery, co-surgeon, and team-surgery payment requires supporting documentation; assistant payment also requires medical-necessity documentation.
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 64656 pays more and less in Georgia
| Payment locality | Office | Facility |
|---|---|---|
| Atlanta | Unavailable | $442.79 |
| Rest Of Georgia | Unavailable | $429.79 |
How the 64656 rate is calculated
Each of 64656’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 · 64656
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 8.01Practice expense 2.80Malpractice 1.98
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 64656
64656 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 64656
Bladder modulation
| 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) | 0 | Not paid without supporting documentation. |
| Co-surgeons (62) | 1 | Permitted with supporting documentation. |
| Team surgery (66) | 1 | Permitted with supporting documentation. |
| 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 · 64656
Bladder modulation
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
64656 without 50 · national facility
$427.20
Bladder modulation
64656-50 · Bilateral: 150%
$640.80
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).
64656 compared with similar codes
Compare codes
64656 vs 64654 vs 64655 vs 64657 vs 64659: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 64654System implantation
- Choose 64654 for initial open implantation of the pulse generator. Choose 64656 when the generator is revised or replaced after implantation.
- 64655BAT lead revision
- 64655 covers revision or replacement of the lead; 64656 covers revision or replacement of the pulse generator.
- 64657System removal
- 64657 is for removal of the complete system. Use 64656 when the service revises or replaces the generator rather than removing the entire system.
- 64659Generator removal
- 64659 describes pulse-generator removal alone. Code 64656 describes revision or replacement of the generator, not removal alone.
64656 billing questions
How does this code differ from 64655?
This code is for revision or replacement of the pulse generator. Code 64655 is for revision or replacement of the system lead.
Can this code be reported for the initial generator implant?
No. Code 64654 describes initial open implantation of a bladder modulation system pulse generator; this code describes later revision or replacement.
Is removal of the generator included?
Use the removal code that matches the documented extent of removal. Code 64659 describes removal of the pulse generator alone, while 64657 describes removal of the complete system.
What should the operative note document?
Identify the pulse generator as the component revised or replaced, describe the work performed, and explain its relationship to the implanted system. Distinguish generator work from lead revision or complete system removal.
How does the 90-day global period affect postoperative visits?
The day-before preoperative visit and 90 days of related postoperative care are included in the global period.
When is assistant-at-surgery payment supported?
CMS payment for an assistant at surgery requires documentation of medical necessity. Co-surgeon and team-surgery payment also require supporting documentation.
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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