Billing code 64600: Nerve destructionMedicare rate & RVUs in Guam
Reports neurolytic treatment of selected trigeminal nerve branches, such as supraorbital or infraorbital branches, for persistent facial pain or neuralgia.
Medicare pays $570.75 for 64600 in the office in Guam (Hawaii, Guam). Which amount applies depends on the service address.
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 64600 covers
This service uses an injected neurolytic agent to intentionally disrupt a selected trigeminal nerve branch, including the supraorbital, infraorbital, mental, or inferior alveolar branch. It may be performed for persistent facial pain or trigeminal neuralgia when treatment is directed to one of these branches. Pain physicians and other qualified physicians may provide it in an office or facility setting.
Select the code based on the nerve branch treated; document the indication, specific branch and side, neurolytic agent, and procedure performed. CMS assigns this code a 10-day global period, so related postoperative visits during that period are included. 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 multiple-procedure reduction. CMS prices this code as bilateral; modifier 50 does not increase payment. Assistant-at-surgery payment is statutorily restricted, and co-surgeons and team surgery are 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.
64600 in Hawaii, Guam
| Payment locality | Office | Facility |
|---|---|---|
| Hawaii, Guam | $570.75 | $225.54 |
How the 64600 rate is calculated
Each of 64600’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 · 64600
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 3.40Practice expense 11.57Malpractice 0.92
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 64600
64600 has a 10-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 64600
Nerve destruction
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 010 | Minor procedure: the day of the procedure plus 10 days after are included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 2 | Already bilateral by definition: paid once at 100%. |
| Assistant at surgery (80/81/82/AS) | 1 | Not paid (statutory restriction). |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.10/0.80/0.10 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 64600
Nerve destruction
10-day global period ends
Oct 11, 2026
Covers Oct 1, 2026 through Oct 11, 2026 (11 days).
Visit on Oct 31, 2026
After the global period ends: visits and procedures are billed normally.
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
64600 without 51 · national office
$530.74
Nerve destruction
64600-51 · Second procedure: 50%
$265.37
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%).
64600 compared with similar codes
Compare codes
64600 vs 64605 vs 64610 vs 64400 vs 64640: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 64605Trigeminal neurolysis
- Use 64605 for percutaneous neurolytic treatment of proximal second- and third-division trigeminal branches at the foramen ovale or rotundum; use 64600 for its specified peripheral branches.
- 64610Nerve treatment
- Use 64610 for the proximal second- and third-division procedure when performed with imaging guidance. This code covers the listed peripheral trigeminal branches.
- 64400Nerve block
- 64400 describes an anesthetic trigeminal nerve injection or block. This code describes treatment with a neurolytic agent to disrupt a branch.
- 64640Nerve treatment
- 64640 is for neurolytic treatment of other peripheral nerves or branches. Use this code when the treated site is one of its specifically named trigeminal branches.
64600 billing questions
Which trigeminal branches fit this code?
It covers neurolytic treatment of the supraorbital, infraorbital, mental, or inferior alveolar branch. Choose based on the branch actually treated.
How does this differ from 64605 or 64610?
Those codes address percutaneous neurolytic treatment of the second and third trigeminal divisions at the foramen ovale or rotundum. This code is for the listed peripheral branches.
Can a nerve block be reported instead?
Code 64400 describes injection of an anesthetic agent for a trigeminal nerve block. This code is for neurolytic treatment intended to disrupt the targeted branch.
Should modifier 50 be appended for bilateral treatment?
CMS prices this code as bilateral, and modifier 50 does not increase payment. Document the branches and sides treated.
Are related postoperative visits separately payable during the global period?
Related postoperative visits during the 10-day global period are included in this procedure's payment.
What documentation supports code selection?
Record the facial pain indication, the specific trigeminal branch and side, the neurolytic agent, and the treatment performed.
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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