Billing code 64890: Nerve graftMedicare rate & RVUs in Guam
Reports reconstruction of a hand or foot nerve gap with a single-strand graft measuring less than 4 cm, including harvesting the graft.
CMS doesn’t publish an office rate for 64890 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 64890 covers
This service bridges a short defect in a nerve in the hand or foot using one graft strand. It may be performed when an injury or surgical removal leaves a gap that prevents direct nerve repair without tension. A surgeon places the graft between the nerve ends to support continuity and later nerve regeneration. The operative work includes harvesting the graft. Peripheral nerve, hand, plastic, and orthopedic surgeons may perform the procedure, generally in an operating room setting.
Report this code when the operative documentation supports the hand or foot location, a single graft strand, and a graft length under 4 cm. The note should identify the nerve treated, the defect and graft length, the number of strands, and the graft placement; graft harvesting is part of the service. Medicare assigns a 90-day global period, including the day-before preoperative visit and related postoperative care during that period. When other procedures are performed in the same session, the highest-valued procedure is paid in full and additional procedures are subject to the standard multiple procedure reduction. Modifier 50 is inappropriate for this code. An assistant at surgery may be paid; 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.
64890 in Hawaii, Guam
| Payment locality | Office | Facility |
|---|---|---|
| Hawaii, Guam | Unavailable | $978.61 |
How the 64890 rate is calculated
Each of 64890’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 · 64890
RVUs × geographic indexes × conversion factor
Work15.83
15.83 RVUs× 1.000 GPCI
Practice expense10.13
10.13 RVUs× 1.000 GPCI
Malpractice3.37
3.37 RVUs× 1.000 GPCI
Adjusted RVUs
29.3300
Conversion factor
$33.4009
Medicare rate
$979.65
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 64890
64890 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 64890
Nerve graft
| 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) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 2 | Paid. |
| 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) | 0.11/0.76/0.13 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 64890
Nerve graft
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 51 · payment effect
With and without the modifier
64890 without 51 · national facility
$979.65
Nerve graft
64890-51 · Second procedure: 50%
$489.83
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%).
64890 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 64891Nerve graft
- Use 64891 for a single-strand hand or foot nerve graft over 4 cm; this code is for a graft under 4 cm.
- 64895Nerve graft
- 64895 is for a multiple-strand graft under 4 cm in the hand or foot. This code describes one strand.
- 64892Nerve graft
- 64892 covers a single-strand graft under 4 cm for an arm or leg nerve. This code is specific to the hand or foot.
64890 billing questions
How is this code distinguished from 64891?
Both describe a single-strand graft for a hand or foot nerve. Use 64890 for a graft under 4 cm and 64891 for a graft over 4 cm.
When is 64895 a better fit?
64895 describes a multiple-strand graft for a hand or foot nerve under 4 cm. This code is for one strand.
Can the graft harvest be billed separately?
Graft harvesting is included in this service. Document the harvest and graft placement in the operative report.
What documentation supports the code?
Record the hand or foot nerve treated, the nerve defect, graft length, and use of a single strand. The operative note should describe placement of the graft between the nerve ends.
Can modifier 50 be used for grafts on both sides?
No. CMS identifies bilateral adjustment as inappropriate for this code; modifier 50 should not be used.
How does the 90-day global period affect postoperative care?
The day-before preoperative visit and related postoperative care for 90 days are included in the global period.
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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