No office rate
Choose 64820 for sympathectomy of a digital artery; choose 64821 when the radial artery is treated.
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CMS RVU26D · Effective 2026-10-01
64821 Arterial sympathectomy Medicare reimbursement rates in Iowa
Reports surgical sympathectomy along the radial artery, typically to address hand or digital ischemia associated with vasospasm or impaired circulation. Compare 64821 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 64821 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
$596.48
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.
Peripheral nerve surgery
About 64821: Radial artery sympathectomy
Reports surgical sympathectomy along the radial artery, typically to address hand or digital ischemia associated with vasospasm or impaired circulation.
The surgeon interrupts sympathetic nerve fibers associated with the radial artery, generally by exposing the vessel and treating its surrounding nerve-bearing tissue. Hand surgeons and other surgeons treating upper-extremity ischemia may perform this operation in a hospital or ambulatory surgical setting. Clinical situations can include persistent hand or finger ischemia, painful vasospasm, or digital ulceration when the radial artery is selected as the operative site.
Report this code when the operative work is directed to the radial artery; distinguish it from sympathectomy involving the digital artery, ulnar artery, or superficial palmar arch. The operative report should identify the treated vessel, side, indication, and procedure performed. This is major surgery with a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. For same-session multiple procedures, the highest-valued procedure is paid in full and others at 50%. Bilateral reporting with modifier 50 is paid at 150%. Medicare does not pay an assistant at surgery; co-surgeons and team surgery are not permitted.
CMS billing rules for 64821
- 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
- Statutory restriction: assistant at surgery is not paid.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU9.10 · 46%
- Practice expense (office) RVU8.73 · 44%
- Malpractice RVU1.94 · 10%
130
Medicare services in 2024 · #4676 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.
64821 compared with similar codes
Office rates for Iowa, from the same CMS release.
Compare 64821 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
$596.48
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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 64821 in Iowa.
PPRRVU2026_Oct_nonQPP.csv
7,246
- Code
- 64821
- Physician work
- 9.10
- Practice expense
- 8.73
- Malpractice
- 1.94
GPCI2026.csv
53
- Locality
- Iowa
- Physician work
- 1.000
- Practice expense
- 0.915
- Malpractice
- 0.397
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 9.10 | × 1.000 | 9.1000 |
| Practice expense | 8.73 | × 0.915 | 7.9880 |
| Malpractice | 1.94 | × 0.397 | 0.7702 |
| Total RVUs | 17.8581 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Iowa$596.48
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 9.1 | 1 |
| Practice expense | 8.73 | 0.915 |
| Malpractice | 1.94 | 0.397 |
(9.1 × 1 + 8.73 × 0.915 + 1.94 × 0.397) × $33.4009 = $596.48
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.
64821 billing questions
How do I distinguish this code from digital artery sympathectomy?
Use this code when the operative sympathectomy is performed along the radial artery. Code 64820 identifies sympathectomy directed to a digital artery.
When is ulnar artery sympathectomy the better choice?
Use 64822 when the ulnar artery is the vessel treated. The operative report should make the treated artery clear.
What documentation supports reporting this code?
Document the clinical reason for surgery, the side, the radial artery as the operative site, and the specific sympathectomy performed.
How is bilateral surgery reported?
For bilateral procedures, modifier 50 applies; CMS payment is 150% under the stated bilateral rule.
Are related postoperative visits separately included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
Can an assistant or co-surgeon be paid for this procedure?
Medicare payment for an assistant at surgery is barred. Co-surgeons and team surgery are 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.
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
7,24864823,,Sympathectomy supfc palmar,A,,10.67,9.22,NA,9.22,,2.27,22.16,22.16,0,090,0.11,0.76,0.13,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,24964831,,Repair of digit nerve,A,,8.93,8.64,NA,8.64,,1.70,19.27,19.27,0,090,0.11,0.76,0.13,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
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