No office rate
Use 64658 when the removal is limited to the lead. This code describes removal of the complete system.
On this page
CMS RVU26D · Effective 2026-10-01
64657 System removal Medicare reimbursement rates in Guam
Removal of an implanted battery-powered modulation system in its entirety, including the system’s implanted components, rather than removal of a lead or generator alone. Compare 64657 office and facility rates across CMS payment localities in Guam.
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
What does Medicare pay for 64657 in Guam?
Guam has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$606.74
1 of 1 localities have a supported rate.
Payment area: Hawaii, Guam
One mapped payment locality.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Neuromodulation surgery
About 64657: Complete battery-powered modulation system removal
Removal of an implanted battery-powered modulation system in its entirety, including the system’s implanted components, rather than removal of a lead or generator alone.
This code is for surgical removal of the complete implanted battery-powered modulation system, not just one component. The procedure may be performed when the system is no longer needed or when the treating team determines that the complete implant must be removed. A surgeon experienced with the implanted system exposes and removes its components in an operating room or another appropriate procedural setting.
Report the complete-system removal when the operative documentation supports removal of the system as a whole; use the component-specific removal codes when only a lead or pulse generator is 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 multiple procedure reduction. Modifier 50 applies to a bilateral procedure, paid at 150%. Assistant-at-surgery, co-surgeon, and team-surgery payment each require supporting documentation; assistant payment specifically requires medical necessity.
CMS billing rules for 64657
- Global period
- Major surgery with a 90-day global period: the day-before preoperative visit and 90 days of related postoperative care are included.
- Multiple procedures
- Standard multiple procedure reduction: the highest-valued procedure is paid in full and others at 50% when performed in the same session.
- Bilateral procedures
- Bilateral procedure with modifier 50 is paid at 150%.
- Assistant at surgery
- Assistant at surgery is paid only with documentation of medical necessity.
- Co-surgeons
- Co-surgeons paid only with supporting documentation.
- Team surgery
- Team surgery paid only with supporting documentation.
Where the value comes from
- Work RVU12.13 · 64%
- Practice expense (office) RVU3.76 · 20%
- Malpractice RVU3.04 · 16%
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.
64657 compared with similar codes
Office rates for Guam, from the same CMS release.
No office rate
Use 64659 when the removal is limited to the pulse generator. This code describes removal of the complete system.
No office rate
64655 describes revision or replacement of the system lead; this code describes removal of the complete system.
No office rate
64656 describes revision or replacement of the pulse generator; this code describes removal of the complete system.
Compare 64657 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
1 of 1 payment localities
Hawaii, Guam →
Office / nonfacility
Unavailable
Facility
$606.74
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How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 64657 in Hawaii, Guam.
PPRRVU2026_Oct_nonQPP.csv
7,196
- Code
- 64657
- Physician work
- 12.13
- Practice expense
- 3.76
- Malpractice
- 3.04
GPCI2026.csv
46
- Locality
- Hawaii, Guam
- Physician work
- 1.000
- Practice expense
- 1.137
- Malpractice
- 0.579
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 12.13 | × 1.000 | 12.1300 |
| Practice expense | 3.76 | × 1.137 | 4.2751 |
| Malpractice | 3.04 | × 0.579 | 1.7602 |
| Total RVUs | 18.1653 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Hawaii, Guam$606.74
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 12.13 | 1 |
| Practice expense | 3.76 | 1.137 |
| Malpractice | 3.04 | 0.579 |
(12.13 × 1 + 3.76 × 1.137 + 3.04 × 0.579) × $33.4009 = $606.74
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
64657 billing questions
When should this code be chosen over a component-removal code?
Use it when the complete implanted system is removed. The neighboring removal codes distinguish removal of the lead alone from removal of the pulse generator alone.
What operative documentation supports complete-system removal?
Document the system components removed and the operative work performed. The record should support removal of the complete implant rather than only a lead or generator.
How is this code different from a revision or replacement code?
This code describes removal of the complete system. The related revision or replacement codes apply when a lead or pulse generator is revised or replaced.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
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% when performed in the same session.
What documentation is needed for assistant or team surgery?
Assistant-at-surgery payment requires documentation of medical necessity. Co-surgeon and team-surgery payment 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 indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
7,19364654,,1st opn implt bat modulj sys,A,,11.00,2.96,NA,2.96,,2.79,16.75,16.75,0,090,0.11,0.76,0.13,2,1,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,19464655,,Revj/rplcmt bat mod sys lead,A,,11.30,5.40,NA,5.40,,2.59,19.29,19.29,0,090,0.11,0.76,0.13,2,1,0,1,1,9,,33.4009,09,0,99,0.00,0.00,0.00
7,19564656,,Revj/rplcmt bat mod sys pg,A,,8.01,2.80,NA,2.80,,1.98,12.79,12.79,0,090,0.11,0.76,0.13,2,1,0,1,1,9,,33.4009,09,0,99,0.00,0.00,0.00
7,19664657,,Rmvl bat modulj sys tot sys,A,,12.13,3.76,NA,3.76,,3.04,18.93,18.93,0,090,0.11,0.76,0.13,2,1,0,1,1,9,,33.4009,09,0,99,0.00,0.00,0.00
7,19764658,,Rmvl bat modul sys lead only,A,,8.95,3.03,NA,3.03,,2.27,14.25,14.25,0,090,0.11,0.76,0.13,2,1,0,1,1,9,,33.4009,09,0,99,0.00,0.00,0.00
7,19864659,,Rmvl bat modulj sys pg only,A,,8.23,2.90,NA,2.90,,2.09,13.22,13.22,0,090,0.11,0.76,0.13,2,1,0,1,1,9,,33.4009,09,0,99,0.00,0.00,0.00
7,19964680,,Injection treatment of nerve,A,,2.60,7.52,,1.53,,0.26,10.38,4.39,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4309102,FL,99,REST OF FLORIDA,1.000,0.956,1.503
4410212,GA,01,ATLANTA,1.003,1.016,1.201
4510212,GA,99,REST OF GEORGIA,1.000,0.892,1.192
4601212,HI,01,"HAWAII, GUAM",1.000,1.137,0.579
4702202,ID,00,IDAHO,1.000,0.920,0.473
4806102,IL,16,CHICAGO,1.007,1.005,2.295
4906102,IL,12,EAST ST. LOUIS,1.000,0.920,2.014