No office rate
Use 64818 for the lumbar sympathetic chain; use 64809 when the operative target is thoracolumbar.
On this page
CMS RVU26D · Effective 2026-10-01
64818 Sympathectomy Medicare reimbursement rates in Idaho
Reports operative interruption or removal of sympathetic tissue along the lumbar chain for selected lower-extremity vascular or pain conditions. Compare 64818 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 64818 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
$655.91
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.
Peripheral nerve surgery
About 64818: Lumbar sympathetic chain surgery
Reports operative interruption or removal of sympathetic tissue along the lumbar chain for selected lower-extremity vascular or pain conditions.
A lumbar sympathectomy interrupts or removes sympathetic tissue along the lumbar chain to reduce sympathetic effects on the lower extremity. It is performed by a surgeon in an operating room for selected vascular or pain conditions when this intervention is part of the treatment plan. The operative report should identify the lumbar target and the work performed; the indication and treated side should also be clear.
Report 64818 for the lumbar sympathetic target, not for sympathectomy directed at the thoracolumbar region or a distal artery. 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. For bilateral surgery, modifier 50 is paid at 150%. Assistant-at-surgery payment may be available; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 64818
- 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 RVU11.06 · 51%
- Practice expense (office) RVU8.11 · 38%
- Malpractice RVU2.36 · 11%
15
Medicare services in 2024 · #6081 by national volume
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.
64818 compared with similar codes
Office rates for Idaho, from the same CMS release.
No office rate
64820 addresses sympathectomy at a digital artery. It is not the code for lumbar chain surgery.
No office rate
64821 identifies radial artery sympathectomy, a distal arterial target distinct from the lumbar sympathetic chain.
Compare 64818 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
$655.91
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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 64818 in Idaho.
PPRRVU2026_Oct_nonQPP.csv
7,244
- Code
- 64818
- Physician work
- 11.06
- Practice expense
- 8.11
- Malpractice
- 2.36
GPCI2026.csv
47
- Locality
- Idaho
- Physician work
- 1.000
- Practice expense
- 0.920
- Malpractice
- 0.473
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 11.06 | × 1.000 | 11.0600 |
| Practice expense | 8.11 | × 0.920 | 7.4612 |
| Malpractice | 2.36 | × 0.473 | 1.1163 |
| Total RVUs | 19.6375 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Idaho$655.91
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 11.06 | 1 |
| Practice expense | 8.11 | 0.92 |
| Malpractice | 2.36 | 0.473 |
(11.06 × 1 + 8.11 × 0.92 + 2.36 × 0.473) × $33.4009 = $655.91
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.
64818 billing questions
How does 64818 differ from 64809?
64818 is for work directed at the lumbar sympathetic chain. Choose 64809 when the treated sympathetic region is thoracolumbar.
Is a distal artery sympathectomy reported with 64818?
No. Codes such as 64820 describe sympathectomy at a digital artery, rather than the lumbar chain.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
How is bilateral lumbar sympathectomy reported?
For bilateral surgery, report modifier 50; CMS pays the bilateral procedure at 150%.
Can an assistant or co-surgeon be paid?
Assistant-at-surgery payment may be available. Co-surgeon payment requires supporting documentation; team surgery is not permitted.
What happens when another procedure is performed in the same session?
The highest-valued procedure is paid in full, and other procedures are subject to the standard multiple-procedure reduction, with payment at 50%.
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.
7,24164802,,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
7,24764822,,Sympathectomy ulnar 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