Billing code 64605: Trigeminal neurolysisMedicare rate & RVUs in Guam
Reports neurolytic treatment directed to the second and third trigeminal nerve divisions for facial pain, with documentation identifying the treated nerve targets and technique.
Medicare pays $1,183.08 for 64605 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 64605 covers
This service uses a neurolytic technique to interrupt pain signaling in the second and third divisions of the trigeminal nerve. It may be performed for selected patients with severe, persistent facial neuralgia, including pain in the midface or jaw, after less invasive treatment has not provided adequate relief. Pain-management physicians and other clinicians trained in trigeminal procedures typically perform it in an office-based procedure room or facility setting. The operative record should identify the treated divisions or branches, the side, the neurolytic method, and the clinical indication.
Report the code when the documented service is neurolytic treatment of the specified trigeminal targets, rather than a temporary nerve block or treatment of a different nerve. It has a 10-day global period, which includes related postoperative visits during that period. 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. For bilateral treatment, modifier 50 is paid at 150%. Assistant-at-surgery payment requires documentation of medical necessity; 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.
64605 in Hawaii, Guam
| Payment locality | Office | Facility |
|---|---|---|
| Hawaii, Guam | $1,183.08 | $413.29 |
How the 64605 rate is calculated
Each of 64605’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 · 64605
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 5.51Practice expense 25.12Malpractice 2.33
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 64605
64605 has a 10-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 64605
Trigeminal neurolysis
| 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) | 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) | 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 · 64605
Trigeminal neurolysis
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 50 · payment effect
With and without the modifier
64605 without 50 · national office
$1,100.89
Trigeminal neurolysis
64605-50 · Bilateral: 150%
$1,651.34
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).
64605 compared with similar codes
Compare codes
64605 vs 64600 vs 64610 vs 64400 vs 64640: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 64600Nerve destruction
- Use 64600 for neurolysis of peripheral trigeminal branches such as supraorbital, infraorbital, or mental branches. This code is for the second and third trigeminal divisions.
- 64610Nerve treatment
- Both codes concern trigeminal neurolysis. Choose based on the documented target and the specific service represented by the applicable code descriptor.
- 64400Nerve block
- Code 64400 represents an anesthetic trigeminal nerve injection; this code represents neurolytic treatment.
- 64640Nerve treatment
- Code 64640 concerns neurolysis of another peripheral nerve or branch, not the specified trigeminal divisions.
64605 billing questions
How is this code distinguished from 64600?
This code is for neurolytic treatment involving the second and third trigeminal divisions. Code 64600 describes treatment of peripheral trigeminal branches, such as the supraorbital, infraorbital, or mental branches.
Is a temporary trigeminal nerve block reported with this code?
No. A temporary anesthetic block is a different service; this code represents neurolytic treatment. The record should support the neurolytic method and the trigeminal targets treated.
What documentation supports reporting bilateral treatment?
Document the treated trigeminal targets and side for each side treated. CMS lists bilateral payment with modifier 50 at 150%.
Are related postoperative visits included?
Related postoperative visits during the 10-day global period are included in the procedure's global package.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment requires documentation of medical necessity. Co-surgeons and team surgery are not permitted for this code.
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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