Billing code 64681: Plexus neurolysisMedicare rate & RVUs in Guam
Reports neurolytic injection of the superior hypogastric plexus to interrupt visceral pain signaling, commonly for persistent pelvic or lower abdominal pain.
Medicare pays $503.12 for 64681 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 64681 covers
This service uses a neurolytic agent to interrupt pain signaling through the superior hypogastric plexus, a target associated with pelvic and lower abdominal visceral pain. Interventional pain physicians, anesthesiologists, and other clinicians who perform image-guided pain procedures may provide it, often for persistent pain related to pelvic malignancy. Radiologic monitoring may be used during the procedure.
Select this code when the treated target is the superior hypogastric plexus and the purpose is neurolysis, rather than a temporary anesthetic block or treatment of a different nerve. The procedure note should identify the target, neurolytic treatment, and any imaging used. The 10-day global period includes related postoperative visits during that period. When multiple procedures are performed in one session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Modifier 50 is inappropriate for this target. Medicare does not pay an assistant at surgery; 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.
64681 in Hawaii, Guam
| Payment locality | Office | Facility |
|---|---|---|
| Hawaii, Guam | $503.12 | $197.03 |
How the 64681 rate is calculated
Each of 64681’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 · 64681
RVUs × geographic indexes × conversion factor
Work3.69
3.69 RVUs× 1.000 GPCI
Practice expense9.85
9.85 RVUs× 1.000 GPCI
Malpractice0.30
0.30 RVUs× 1.000 GPCI
Adjusted RVUs
13.8400
Conversion factor
$33.4009
Medicare rate
$462.27
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 64681
64681 has a 10-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 64681
Plexus 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) | 0 | The 150% bilateral adjustment doesn’t apply. |
| 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 · 64681
Plexus 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 51 · payment effect
With and without the modifier
64681 without 51 · national office
$462.27
Plexus neurolysis
64681-51 · Second procedure: 50%
$231.14
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%).
64681 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 64680Celiac neurolysis
- 64680 treats the celiac plexus; 64681 applies to neurolytic treatment of the superior hypogastric plexus.
- 64517Plexus block
- 64517 describes an anesthetic injection of the superior hypogastric plexus for a block. Choose 64681 for neurolytic treatment.
- 64640Nerve treatment
- 64640 is for neurolytic treatment of another peripheral nerve or branch. Use 64681 when the treated structure is the superior hypogastric plexus.
64681 billing questions
How is this different from a superior hypogastric plexus block?
This code is for neurolytic treatment intended to interrupt plexus signaling. A temporary anesthetic injection for a block is reported with 64517.
When should 64680 be used instead?
64680 is for neurolytic treatment of the celiac plexus. Use 64681 when the treated target is the superior hypogastric plexus.
Is radiologic monitoring included in the service?
The code covers the neurolytic treatment with or without radiologic monitoring. Document the target and treatment, including imaging used.
Should modifier 50 be reported for treatment on both sides?
No. Modifier 50 is inappropriate for this plexus target.
Are related postoperative visits separately reported during the global period?
Related postoperative visits for 10 days are included in the procedure's global period.
How does Medicare handle another procedure performed in the same session?
The highest-valued procedure is paid in full, and other procedures are subject to the standard multiple procedure reduction.
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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