No office rate
Choose 64818 when the documented procedure is confined to the lumbar sympathetic chain; 64809 is for a thoracolumbar target.
On this page
CMS RVU26D · Effective 2026-10-01
64809 Sympathectomy Medicare reimbursement rates in Idaho
Surgical interruption of the thoracolumbar sympathetic chain is reported when the operative treatment targets this chain rather than a cervical or lumbar-only level. Compare 64809 office and facility rates across CMS payment localities in Idaho.
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 64809 in Idaho?
Idaho 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
$954.82
1 of 1 localities have a supported rate.
Payment area: Idaho
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.
Nervous system surgery
About 64809: Thoracolumbar sympathetic chain interruption
Surgical interruption of the thoracolumbar sympathetic chain is reported when the operative treatment targets this chain rather than a cervical or lumbar-only level.
This operation interrupts sympathetic nerve pathways at thoracic and lumbar levels. It may be considered when reducing sympathetic vasoconstrictor activity is part of surgical treatment for a vascular condition affecting the lower extremity. A surgeon performs the procedure in an operating room; the operative report should identify the treated chain and the extent of the intervention. The thoracolumbar target distinguishes this service from procedures confined to the cervical, cervicothoracic, or lumbar chain, and from sympathectomy of a named distal artery.
Report the code when the documented operative work matches the thoracolumbar chain service. The code has a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. 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 50% reduction. Bilateral reporting with modifier 50 is paid at 150%. An assistant at surgery may be paid; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 64809
- 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 may be paid.
- Co-surgeons
- Co-surgeons paid only with supporting documentation.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU14.34 · 44%
- Practice expense (office) RVU12.38 · 38%
- Malpractice RVU6.04 · 18%
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.
64809 compared with similar codes
Office rates for Idaho, from the same CMS release.
No office rate
64804 applies to a cervicothoracic chain procedure, not a thoracolumbar one.
No office rate
64820 describes sympathectomy at a digital artery. It is distinct from surgery directed at the thoracolumbar sympathetic chain.
Compare 64809 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
Idaho →
Office / nonfacility
Unavailable
Facility
$954.82
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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 64809 in Idaho.
PPRRVU2026_Oct_nonQPP.csv
7,243
- Code
- 64809
- Physician work
- 14.34
- Practice expense
- 12.38
- Malpractice
- 6.04
GPCI2026.csv
47
- Locality
- Idaho
- Physician work
- 1.000
- Practice expense
- 0.920
- Malpractice
- 0.473
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 14.34 | × 1.000 | 14.3400 |
| Practice expense | 12.38 | × 0.920 | 11.3896 |
| Malpractice | 6.04 | × 0.473 | 2.8569 |
| Total RVUs | 28.5865 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Idaho$954.82
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 14.34 | 1 |
| Practice expense | 12.38 | 0.92 |
| Malpractice | 6.04 | 0.473 |
(14.34 × 1 + 12.38 × 0.92 + 6.04 × 0.473) × $33.4009 = $954.82
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.
64809 billing questions
How is this different from 64818?
64809 represents a thoracolumbar chain target. Use 64818 when the documented sympathectomy is confined to the lumbar chain.
What documentation supports reporting 64809?
The operative report should establish that the sympathetic chain was treated at thoracic and lumbar levels and describe the extent of the intervention.
Does the code have a global period?
Yes. The 90-day global includes the day-before preoperative visit and 90 days of related postoperative care.
How is bilateral reporting handled?
CMS pays bilateral reporting with modifier 50 at 150%.
Can an assistant or co-surgeon be paid?
An assistant at surgery may be paid. Co-surgeons are paid only with supporting documentation; team surgery is not permitted.
What happens when another procedure is done 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 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.
7,24064795,,Biopsy of nerve,A,,2.93,1.77,NA,1.77,,0.88,5.58,5.58,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,24164802,,Sympathectomy cervical,A,,10.11,11.95,NA,11.95,,4.26,26.32,26.32,0,090,0.11,0.76,0.13,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,24264804,,Sympathectomy cervicothorac,A,,15.51,13.86,NA,13.86,,6.54,35.91,35.91,0,090,0.11,0.76,0.13,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,24364809,,Sympathectomy thoracolumbar,A,,14.34,12.38,NA,12.38,,6.04,32.76,32.76,0,090,0.11,0.76,0.13,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,24464818,,Sympathectomy lumbar,A,,11.06,8.11,NA,8.11,,2.36,21.53,21.53,0,090,0.11,0.76,0.13,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,24564820,,Sympathectomy digital artery,A,,10.47,8.43,NA,8.43,,2.04,20.94,20.94,0,090,0.11,0.76,0.13,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,24664821,,Sympathectomy radial artery,A,,9.10,8.73,NA,8.73,,1.94,19.77,19.77,0,090,0.11,0.76,0.13,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
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
5006102,IL,15,SUBURBAN CHICAGO,1.007,1.027,1.772