No office rate
64568 is for initial implantation of the vagus nerve electrode array and pulse generator. Choose 64569 for operative revision or replacement of an electrode array in an existing system.
On this page
CMS RVU26D · Effective 2026-10-01
64569 Vagus nerve electrode Medicare reimbursement rates in Iowa
Reports operative revision or replacement of an implanted vagus nerve stimulation electrode, including reconnecting it to an existing pulse generator. Compare 64569 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 64569 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
$648.85
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.
Neurostimulator surgery
About 64569: Vagus nerve electrode revision or replacement
Reports operative revision or replacement of an implanted vagus nerve stimulation electrode, including reconnecting it to an existing pulse generator.
This service covers an operation to revise or replace the electrode array attached to the vagus nerve in a patient with an implanted vagus nerve stimulation system. The surgeon may address a displaced, damaged, or malfunctioning electrode and reconnect the revised or replacement array to the existing pulse generator. It is typically performed in an operating room by a surgeon experienced with implanted neurostimulation systems, often for a patient receiving vagus nerve stimulation for epilepsy or another established indication.
Report the code when the electrode array itself is revised or replaced, rather than for initial system implantation, generator-only work, or electrode removal alone. The operative report should identify the electrode work performed and document the existing system and connection. The service has a 90-day global period, which includes the day-before preoperative visit and related postoperative care during that period. If 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. Modifier 50 reports bilateral surgery and is paid at 150%. Assistant-at-surgery, co-surgeon, and team-surgery payment requires the applicable medical-necessity or supporting documentation.
CMS billing rules for 64569
- 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 is paid only with documentation of medical necessity.
- Co-surgeons
- Co-surgeons paid only with supporting documentation.
- Team surgery
- Team surgery paid only with supporting documentation.
Where the value comes from
- Work RVU10.73 · 48%
- Practice expense (office) RVU7.89 · 35%
- Malpractice RVU3.72 · 17%
114
Medicare services in 2024 · #4780 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.
64569 compared with similar codes
Office rates for Iowa, from the same CMS release.
No office rate
64570 is for removal of the vagus nerve electrode array. 64569 applies when the electrode is revised or replaced.
No office rate
Use the applicable generator code when pulse-generator work is performed without electrode-array revision or replacement. 64569 addresses the vagus nerve electrode array.
Compare 64569 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
$648.85
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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 64569 in Iowa.
PPRRVU2026_Oct_nonQPP.csv
7,151
- Code
- 64569
- Physician work
- 10.73
- Practice expense
- 7.89
- Malpractice
- 3.72
GPCI2026.csv
53
- Locality
- Iowa
- Physician work
- 1.000
- Practice expense
- 0.915
- Malpractice
- 0.397
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 10.73 | × 1.000 | 10.7300 |
| Practice expense | 7.89 | × 0.915 | 7.2194 |
| Malpractice | 3.72 | × 0.397 | 1.4768 |
| Total RVUs | 19.4262 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Iowa$648.85
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 10.73 | 1 |
| Practice expense | 7.89 | 0.915 |
| Malpractice | 3.72 | 0.397 |
(10.73 × 1 + 7.89 × 0.915 + 3.72 × 0.397) × $33.4009 = $648.85
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.
64569 billing questions
How is this different from initial vagus nerve stimulator implantation?
Use 64569 for revision or replacement of an electrode array in an existing system. Initial implantation of the vagus nerve electrode array and pulse generator is reported with 64568.
Does this code include replacement of the pulse generator?
The service concerns the electrode array and its connection to an existing pulse generator. When the operation is limited to generator replacement or revision, consider the applicable generator code instead.
When is 64570 more appropriate?
64570 describes removal of the vagus nerve electrode array. Use 64569 when the electrode array is revised or replaced rather than simply removed.
What documentation supports reporting 64569?
The operative report should describe the existing vagus nerve stimulation system and the specific electrode-array revision or replacement performed, including its connection to the pulse generator.
How are multiple procedures and bilateral surgery handled?
For procedures in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard multiple-procedure reduction. Modifier 50 identifies bilateral surgery and is paid at 150%.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and related postoperative care during the 90 days after surgery.
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.
7,14864566,,Neuroeltrd stim post tibial,A,,0.59,2.85,,0.12,,0.07,3.51,0.78,0,000,0.00,0.00,0.00,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,14964567,,Perq elec nrv field stimj cn,A,,1.50,35.45,,0.33,,0.16,37.11,1.99,0,XXX,0.00,0.00,0.00,0,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,15064568,,Opn impltj crnl nrv nea&pg,A,,8.78,7.88,NA,7.88,,3.10,19.76,19.76,0,090,0.11,0.76,0.13,2,1,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,15164569,,Revise/repl vagus n eltrd,A,,10.73,7.89,NA,7.89,,3.72,22.34,22.34,0,090,0.11,0.76,0.13,2,1,0,1,1,9,,33.4009,09,0,99,0.00,0.00,0.00
7,15264570,,Remove vagus n eltrd,A,,8.87,10.33,NA,10.33,,3.74,22.94,22.94,0,090,0.11,0.76,0.13,2,1,0,1,1,9,,33.4009,09,0,99,0.00,0.00,0.00
7,15364575,,Opn impltj nea perph nerve,A,,4.31,3.79,NA,3.79,,0.69,8.79,8.79,0,090,0.11,0.76,0.13,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,15464580,,Opn impltj nea neuromuscular,A,,4.09,4.24,NA,4.24,,1.10,9.43,9.43,0,090,0.11,0.76,0.13,2,0,2,0,0,9,,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