No office rate
Use 64820 when the sympathectomy targets a digital artery. Code 64822 is for the ulnar artery.
On this page
CMS RVU26D · Effective 2026-10-01
64822 Arterial sympathectomy Medicare reimbursement rates in Kentucky
Reports surgical sympathectomy directed at the ulnar artery to address selected cases of hand vasospasm or ischemia, including severe Raynaud presentations. Compare 64822 office and facility rates across CMS payment localities in Kentucky.
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 64822 in Kentucky?
Kentucky 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
$622.46
1 of 1 localities have a supported rate.
Payment area: Kentucky
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.
Hand surgery
About 64822: Ulnar artery sympathectomy
Reports surgical sympathectomy directed at the ulnar artery to address selected cases of hand vasospasm or ischemia, including severe Raynaud presentations.
Code 64822 represents surgical periarterial sympathectomy directed at the ulnar artery in the upper extremity. The surgeon removes or disrupts sympathetic nerve fibers accompanying the artery to improve hand blood flow in selected cases of vasospasm or ischemia, such as severe Raynaud presentations or digital tissue loss. Hand or vascular surgeons typically perform the procedure in an operating room; the code is defined by the ulnar artery target, not by the symptom alone.
Report it when the operative record documents sympathectomy of the ulnar artery, distinguishing it from procedures directed at the radial artery, superficial palmar arch, or a digital artery. Document the treated side, indication, and operative work. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. For procedures performed in one session, the highest-valued procedure is paid in full and the others at 50%. Bilateral procedures reported with modifier 50 are paid at 150%. Medicare does not pay an assistant at surgery; co-surgeon and team-surgery billing are not permitted.
CMS billing rules for 64822
- 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%
80
Medicare services in 2024 · #5055 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.
64822 compared with similar codes
Office rates for Kentucky, from the same CMS release.
No office rate
Use 64821 for sympathectomy of the radial artery; use 64822 when the ulnar artery is the operative target.
No office rate
Code 64823 is for sympathectomy of the superficial palmar arch, not the ulnar artery.
Compare 64822 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
Kentucky →
Office / nonfacility
Unavailable
Facility
$622.46
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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 64822 in Kentucky.
PPRRVU2026_Oct_nonQPP.csv
7,247
- Code
- 64822
- Physician work
- 9.10
- Practice expense
- 8.73
- Malpractice
- 1.94
GPCI2026.csv
55
- Locality
- Kentucky
- Physician work
- 1.000
- Practice expense
- 0.889
- Malpractice
- 0.915
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 9.10 | × 1.000 | 9.1000 |
| Practice expense | 8.73 | × 0.889 | 7.7610 |
| Malpractice | 1.94 | × 0.915 | 1.7751 |
| Total RVUs | 18.6361 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Kentucky$622.46
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 9.1 | 1 |
| Practice expense | 8.73 | 0.889 |
| Malpractice | 1.94 | 0.915 |
(9.1 × 1 + 8.73 × 0.889 + 1.94 × 0.915) × $33.4009 = $622.46
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.
64822 billing questions
How is this code distinguished from radial artery sympathectomy?
Code 64822 is for sympathectomy directed at the ulnar artery. Use 64821 when the operative target is the radial artery.
When would the superficial palmar artery code be used instead?
Code 64823 identifies sympathectomy directed at the superficial palmar arch. Select the code based on the artery or arterial structure documented as the operative target.
How should bilateral ulnar artery procedures be reported?
Report the bilateral procedure with modifier 50 when appropriate. CMS pays bilateral procedures with modifier 50 at 150%.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
How does the multiple procedure rule affect payment?
When procedures are performed in the same session, CMS pays the highest-valued procedure in full and the other procedures at 50%.
What operative documentation supports code 64822?
Document the ulnar artery as the target of the sympathectomy, the side treated, the clinical indication, and the operative work performed.
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.
7,24464818,,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
7,25064832,,Repair nerve add-on,A,,5.51,1.85,NA,1.85,,1.07,8.43,8.43,0,ZZZ,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
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
5707202,LA,99,REST OF LOUISIANA,1.000,0.885,0.958
5814112,ME,03,SOUTHERN MAINE,1.000,0.991,0.631