No office rate
Both involve suboccipital cranial-nerve surgery, but select based on the exact operative service described in the code and documented in the report.
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CMS RVU26D · Effective 2026-10-01
61458 Nerve decompression Medicare reimbursement rates in Iowa
Reports suboccipital exposure and exploration of a cranial nerve with decompression, commonly for microvascular compression causing trigeminal neuralgia or hemifacial spasm. Compare 61458 office and facility rates across CMS payment localities in Iowa.
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 61458 in Iowa?
Iowa 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
$1671.89
1 of 1 localities have a supported rate.
Payment area: Iowa
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.
Neurosurgery
About 61458: Suboccipital cranial nerve decompression
Reports suboccipital exposure and exploration of a cranial nerve with decompression, commonly for microvascular compression causing trigeminal neuralgia or hemifacial spasm.
This service involves a suboccipital craniectomy to expose and explore a cranial nerve and relieve compression, commonly during microvascular decompression for trigeminal neuralgia or hemifacial spasm. A neurosurgeon identifies the symptomatic nerve and compressive structure, often an offending vessel, and performs the decompression. The procedure is generally performed in an operating room under general anesthesia; nerve decompression, rather than tumor removal or nerve division, defines the service.
Select the code from the operative work, not the diagnosis alone. Documentation should identify the suboccipital exposure, nerve explored, cause of compression, decompression performed, and any distinct additional procedures. The 90-day global includes the day-before preoperative visit and related postoperative care through day 90. For multiple procedures in one session, the highest-valued procedure is paid in full and others at 50%. Modifier 50 is inappropriate for this descriptor and anatomy. An assistant at surgery may be paid; co-surgeon payment requires supporting documentation, and team-surgery payment is not permitted.
CMS billing rules for 61458
- 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 adjustment does not apply; the descriptor or anatomy makes modifier 50 inappropriate.
- 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 RVU28.12 · 48%
- Practice expense (office) RVU18.84 · 32%
- Malpractice RVU11.83 · 20%
1.2K
Medicare services in 2024 · #2871 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.
61458 compared with similar codes
Office rates for Iowa, from the same CMS release.
No office rate
61460 describes sectioning one or more cranial nerves. This code is for exploration and decompression rather than nerve division.
No office rate
64716 describes intratemporal facial-nerve decompression. This code describes cranial-nerve exploration and decompression through a suboccipital approach.
Compare 61458 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
Iowa →
Office / nonfacility
Unavailable
Facility
$1671.89
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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 61458 in Iowa.
PPRRVU2026_Oct_nonQPP.csv
6,774
- Code
- 61458
- Physician work
- 28.12
- Practice expense
- 18.84
- Malpractice
- 11.83
GPCI2026.csv
53
- Locality
- Iowa
- Physician work
- 1.000
- Practice expense
- 0.915
- Malpractice
- 0.397
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 28.12 | × 1.000 | 28.1200 |
| Practice expense | 18.84 | × 0.915 | 17.2386 |
| Malpractice | 11.83 | × 0.397 | 4.6965 |
| Total RVUs | 50.0551 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Iowa$1671.89
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 28.12 | 1 |
| Practice expense | 18.84 | 0.915 |
| Malpractice | 11.83 | 0.397 |
(28.12 × 1 + 18.84 × 0.915 + 11.83 × 0.397) × $33.4009 = $1671.89
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.
61458 billing questions
How is this code distinguished from nerve sectioning?
Use this code when the operative service explores and decompresses a cranial nerve through a suboccipital approach. A procedure that divides one or more cranial nerves is described by a different code, such as 61460.
What documentation supports reporting this service?
The operative report should describe the suboccipital exposure, the nerve explored, the source of compression, and the maneuver used to decompress it. The diagnosis by itself does not establish that this procedure was performed.
Can modifier 50 be used for decompression of nerves on both sides?
Modifier 50 is inappropriate for this code’s descriptor and anatomy. Report the procedure performed as described rather than treating it as a bilateral procedure.
How are other same-session procedures paid?
When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and the others are paid at 50%. Related care within the 90-day global period is included as specified in the global package.
Can an assistant or co-surgeon be reported?
An assistant at surgery may be paid. Co-surgeon payment requires supporting documentation; team-surgery payment is not permitted.
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.
6,77161343,,Crnec sopl crv lam dcmprn,A,,31.06,19.43,NA,19.43,,12.75,63.24,63.24,0,090,0.11,0.76,0.13,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,77261345,,Oth cranial dcmprn pst fossa,A,,28.50,19.03,NA,19.03,,12.04,59.57,59.57,0,090,0.11,0.76,0.13,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,77361450,,Crnec stpl sctj cmprn/dcmprn,A,,27.00,17.45,NA,17.45,,11.41,55.86,55.86,0,090,0.11,0.76,0.13,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,77461458,,Crnec sopl xpl/dcmpr crl nrv,A,,28.12,18.84,NA,18.84,,11.83,58.79,58.79,0,090,0.11,0.76,0.13,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,77561460,,Crnec sopl sctj 1+crnl nrv,A,,29.48,19.38,NA,19.38,,12.46,61.32,61.32,0,090,0.11,0.76,0.13,2,0,2,2,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,77661500,,Crnec exc tum/bone les skull,A,,18.70,11.62,NA,11.62,,5.57,35.89,35.89,0,090,0.11,0.76,0.13,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,77761501,,Craniectomy f/osteomyelitis,A,,15.94,10.99,NA,10.99,,4.69,31.62,31.62,0,090,0.11,0.76,0.13,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5006102,IL,15,SUBURBAN CHICAGO,1.007,1.027,1.772
5106102,IL,99,REST OF ILLINOIS,1.000,0.913,1.563
5208102,IN,00,INDIANA,1.000,0.927,0.486
5305102,IA,00,IOWA,1.000,0.915,0.397
5405202,KS,00,KANSAS,1.000,0.904,0.504
5515102,KY,00,KENTUCKY,1.000,0.889,0.915
5607202,LA,01,NEW ORLEANS,1.000,0.941,1.136