Billing code 64584: Stimulator removalMedicare rate & RVUs in Guam
Reports surgical removal of an implanted hypoglossal nerve stimulation array and pulse generator, commonly performed when an obstructive sleep apnea device must be explanted.
CMS doesn’t publish an office rate for 64584 in Guam.
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 64584 covers
This operation removes the implanted hypoglossal nerve stimulation system, including its electrode array and pulse generator. It is typically performed by an otolaryngologist or another surgeon experienced in sleep-related airway procedures, usually in an operating room. The system is used to stimulate the hypoglossal nerve during sleep for selected patients with obstructive sleep apnea; removal may be needed when the device must be explanted rather than revised or replaced.
Report 64584 when the procedure removes the hypoglossal array and pulse generator, not for initial implantation or revision/replacement. The operative report should identify the hypoglossal system and document the components removed. 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 are subject to the standard 50% reduction. Bilateral reporting with modifier 50 is paid at 150%. Assistant-at-surgery, co-surgeon, and team-surgery payment require the applicable supporting 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.
64584 in Hawaii, Guam
| Payment locality | Office | Facility |
|---|---|---|
| Hawaii, Guam | Unavailable | $632.92 |
How the 64584 rate is calculated
Each of 64584’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 · 64584
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 11.70Practice expense 5.51Malpractice 1.70
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 64584
64584 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 64584
Stimulator removal
| 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 · 64584
Stimulator removal
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
64584 without 50 · national facility
$631.61
Stimulator removal
64584-50 · Bilateral: 150%
$947.42
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).
64584 compared with similar codes
Compare codes
64584 vs 64582 vs 64583 vs 64570 vs 64595: national Medicare rates
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How to choose
- 64582Nerve stimulator implant
- 64582 reports initial implantation of the hypoglossal array and pulse generator; 64584 reports removal of that system.
- 64583Stimulator revision
- 64583 is for revision or replacement of a hypoglossal system. Choose 64584 when the array and pulse generator are removed instead.
- 64570Vagus stimulator removal
- 64570 concerns removal of a vagus nerve stimulation electrode. It is not the code for explanting a hypoglossal nerve system.
- 64595Generator revision
- 64595 addresses revision or removal of specified peripheral, sacral, or gastric neurostimulator generators or receivers; 64584 is specific to the hypoglossal array and pulse generator.
64584 billing questions
How is removal distinguished from revision or replacement?
Use 64584 when removing the hypoglossal nerve array and pulse generator. Code 64583 describes revision or replacement of the hypoglossal system rather than its removal.
Can 64584 be used for removal of a vagus nerve stimulator?
No. Code 64584 is specific to a hypoglossal nerve stimulation system; 64570 describes removal of a vagus nerve stimulation electrode.
What documentation supports reporting 64584?
Document the implanted hypoglossal system and the components removed, identifying the array and pulse generator in the operative report.
Does the 90-day global period include related postoperative care?
Yes. CMS includes the day-before preoperative visit and 90 days of related postoperative care in the global period.
How are other procedures in the same session paid?
Under the standard multiple procedure reduction, the highest-valued procedure is paid in full and other procedures are paid at 50%. Bilateral reporting with modifier 50 is paid at 150%.
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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