No office rate
Choose 64654 for initial open implantation of the pulse generator. Choose 64656 when the generator is revised or replaced after implantation.
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CMS RVU26D · Effective 2026-10-01
64656 Bladder modulation Medicare reimbursement rates in Iowa
Revision or replacement of an implanted bladder modulation system’s pulse generator, typically performed when the generator requires surgical correction or replacement. Compare 64656 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 64656 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
$379.37
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.
Neuromodulation surgery
About 64656: Bladder modulation pulse generator revision
Revision or replacement of an implanted bladder modulation system’s pulse generator, typically performed when the generator requires surgical correction or replacement.
This service addresses the implanted pulse generator of a bladder modulation system, such as a sacral neuromodulation system used for urinary dysfunction. A urologist or urogynecologist typically performs the operation in a surgical setting, revising the generator or exchanging it while working with the implanted system’s existing lead. The target is the generator, not a lead-only procedure or removal of the entire system.
Report the code when the operative work revises or replaces the pulse generator; distinguish that work from initial implantation, lead revision, and removal. The operative note should identify the generator work performed, the reason for it, and how the generator relates to the implanted system. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and other procedures at 50%. Modifier 50 bilateral procedures are paid at 150%. Assistant-at-surgery, co-surgeon, and team-surgery payment requires supporting documentation; assistant payment also requires medical-necessity documentation.
CMS billing rules for 64656
- 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 RVU8.01 · 63%
- Practice expense (office) RVU2.80 · 22%
- Malpractice RVU1.98 · 15%
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.
64656 compared with similar codes
Office rates for Iowa, from the same CMS release.
No office rate
64655 covers revision or replacement of the lead; 64656 covers revision or replacement of the pulse generator.
No office rate
64657 is for removal of the complete system. Use 64656 when the service revises or replaces the generator rather than removing the entire system.
No office rate
64659 describes pulse-generator removal alone. Code 64656 describes revision or replacement of the generator, not removal alone.
Compare 64656 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
$379.37
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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 64656 in Iowa.
PPRRVU2026_Oct_nonQPP.csv
7,195
- Code
- 64656
- Physician work
- 8.01
- Practice expense
- 2.80
- Malpractice
- 1.98
GPCI2026.csv
53
- Locality
- Iowa
- Physician work
- 1.000
- Practice expense
- 0.915
- Malpractice
- 0.397
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 8.01 | × 1.000 | 8.0100 |
| Practice expense | 2.80 | × 0.915 | 2.5620 |
| Malpractice | 1.98 | × 0.397 | 0.7861 |
| Total RVUs | 11.3581 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Iowa$379.37
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 8.01 | 1 |
| Practice expense | 2.8 | 0.915 |
| Malpractice | 1.98 | 0.397 |
(8.01 × 1 + 2.8 × 0.915 + 1.98 × 0.397) × $33.4009 = $379.37
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.
64656 billing questions
How does this code differ from 64655?
This code is for revision or replacement of the pulse generator. Code 64655 is for revision or replacement of the system lead.
Can this code be reported for the initial generator implant?
No. Code 64654 describes initial open implantation of a bladder modulation system pulse generator; this code describes later revision or replacement.
Is removal of the generator included?
Use the removal code that matches the documented extent of removal. Code 64659 describes removal of the pulse generator alone, while 64657 describes removal of the complete system.
What should the operative note document?
Identify the pulse generator as the component revised or replaced, describe the work performed, and explain its relationship to the implanted system. Distinguish generator work from lead revision or complete system removal.
How does the 90-day global period affect postoperative visits?
The day-before preoperative visit and 90 days of related postoperative care are included in the global period.
When is assistant-at-surgery payment supported?
CMS payment for an assistant at surgery requires documentation of medical necessity. Co-surgeon and team-surgery payment also require supporting documentation.
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.
7,19264653,,Chemodenerv eccrine glands,A,,0.86,2.03,,0.26,,0.17,3.06,1.29,0,000,0.00,0.00,0.00,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,19364654,,1st opn implt bat modulj sys,A,,11.00,2.96,NA,2.96,,2.79,16.75,16.75,0,090,0.11,0.76,0.13,2,1,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,19464655,,Revj/rplcmt bat mod sys lead,A,,11.30,5.40,NA,5.40,,2.59,19.29,19.29,0,090,0.11,0.76,0.13,2,1,0,1,1,9,,33.4009,09,0,99,0.00,0.00,0.00
7,19564656,,Revj/rplcmt bat mod sys pg,A,,8.01,2.80,NA,2.80,,1.98,12.79,12.79,0,090,0.11,0.76,0.13,2,1,0,1,1,9,,33.4009,09,0,99,0.00,0.00,0.00
7,19664657,,Rmvl bat modulj sys tot sys,A,,12.13,3.76,NA,3.76,,3.04,18.93,18.93,0,090,0.11,0.76,0.13,2,1,0,1,1,9,,33.4009,09,0,99,0.00,0.00,0.00
7,19764658,,Rmvl bat modul sys lead only,A,,8.95,3.03,NA,3.03,,2.27,14.25,14.25,0,090,0.11,0.76,0.13,2,1,0,1,1,9,,33.4009,09,0,99,0.00,0.00,0.00
7,19864659,,Rmvl bat modulj sys pg only,A,,8.23,2.90,NA,2.90,,2.09,13.22,13.22,0,090,0.11,0.76,0.13,2,1,0,1,1,9,,33.4009,09,0,99,0.00,0.00,0.00
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