No office rate
Use 64656 for revision or replacement of the pulse generator. Use 64659 when the generator is removed rather than revised or replaced.
On this page
CMS RVU26D · Effective 2026-10-01
64659 Generator removal Medicare reimbursement rates in Iowa
Removal of the pulse generator from a battery-powered neuromodulation system, reported when the generator is removed while the system’s lead remains. Compare 64659 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 64659 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
$391.23
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 64659: Battery-powered neurostimulator generator removal
Removal of the pulse generator from a battery-powered neuromodulation system, reported when the generator is removed while the system’s lead remains.
This service removes the implanted pulse generator from a battery-powered neuromodulation system while leaving the system’s lead in place. A surgeon or other qualified physician accesses the generator, typically in a procedural or operating-room setting, disconnects it from the lead, and removes it. The operative report should identify the system and document that the pulse generator—not the lead or the entire system—was removed.
Choose this code for generator-only removal; use the related removal codes when the lead alone or the complete system is removed. CMS assigns a 90-day global period, which includes 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 the others at 50%. For bilateral procedures reported with modifier 50, CMS pays at 150%. Assistant-at-surgery, co-surgeon, and team-surgery payment requires supporting documentation; assistant payment also requires medical necessity.
CMS billing rules for 64659
- 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 RVU8.23 · 62%
- Practice expense (office) RVU2.90 · 22%
- Malpractice RVU2.09 · 16%
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.
64659 compared with similar codes
Office rates for Iowa, from the same CMS release.
Compare 64659 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
$391.23
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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 64659 in Iowa.
PPRRVU2026_Oct_nonQPP.csv
7,198
- Code
- 64659
- Physician work
- 8.23
- Practice expense
- 2.90
- Malpractice
- 2.09
GPCI2026.csv
53
- Locality
- Iowa
- Physician work
- 1.000
- Practice expense
- 0.915
- Malpractice
- 0.397
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 8.23 | × 1.000 | 8.2300 |
| Practice expense | 2.90 | × 0.915 | 2.6535 |
| Malpractice | 2.09 | × 0.397 | 0.8297 |
| Total RVUs | 11.7132 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Iowa$391.23
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 8.23 | 1 |
| Practice expense | 2.9 | 0.915 |
| Malpractice | 2.09 | 0.397 |
(8.23 × 1 + 2.9 × 0.915 + 2.09 × 0.397) × $33.4009 = $391.23
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.
64659 billing questions
How is this different from removal of the complete system?
Report 64659 when only the pulse generator is removed and the lead remains. Removal of both generator and lead is the complete-system service, 64657.
When would 64658 be used instead?
64658 is for removal of the lead alone. Use 64659 when the generator is removed and the lead is left in place.
Can generator removal be reported with lead removal?
If both components are removed as part of complete-system removal, compare the service with 64657 rather than reporting generator-only removal alongside lead-only removal.
What documentation supports 64659?
Document the battery-powered system, removal of the pulse generator, and whether the lead was retained or also removed.
What are the payment rules for multiple procedures and bilateral reporting?
In the same session, CMS pays the highest-valued procedure in full and other procedures at 50%. For bilateral procedures reported with modifier 50, CMS pays at 150%.
Is related postoperative care included?
Yes. The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
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.
7,19564656,,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
7,19964680,,Injection treatment of nerve,A,,2.60,7.52,,1.53,,0.26,10.38,4.39,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,20064681,,Injection treatment of nerve,A,,3.69,9.85,,1.79,,0.30,13.84,5.78,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,20164702,,Revise finger/toe nerve,A,,6.10,7.44,NA,7.44,,1.09,14.63,14.63,0,090,0.11,0.76,0.13,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
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