No office rate
Use 64866 when the facial nerve is connected to the spinal accessory or hypoglossal nerve; 64868 covers connection to another nerve.
On this page
CMS RVU26D · Effective 2026-10-01
64866 Facial nerve transfer Medicare reimbursement rates in Kentucky
Reports microsurgical connection of the facial nerve to the spinal accessory or hypoglossal nerve to restore motor input in selected cases of facial paralysis. Compare 64866 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 64866 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
$1065.34
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.
Peripheral nerve surgery
About 64866: Facial-to-donor nerve transfer
Reports microsurgical connection of the facial nerve to the spinal accessory or hypoglossal nerve to restore motor input in selected cases of facial paralysis.
This operation redirects motor input to the face by connecting the facial nerve to the spinal accessory or hypoglossal nerve. It is used in selected cases of facial paralysis when the native facial nerve pathway cannot provide useful function. A surgeon with microsurgical nerve expertise, often in otolaryngology, facial plastic and reconstructive surgery, plastic surgery, or neurosurgery, performs the nerve coaptation, generally in an operating room.
Select this code when the operative report identifies the facial nerve and one of these specific donor nerves as the anastomosis partners. Documentation should establish the paralysis indication, relevant nerve anatomy and findings, and the procedure performed. CMS assigns a 90-day global period, including 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 other procedures are subject to the standard 50% reduction. Modifier 50 is inappropriate for this service. An assistant at surgery may be paid; co-surgeons require supporting documentation, and team surgery is not permitted.
CMS billing rules for 64866
- 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 adjustment does not apply; the descriptor or anatomy makes modifier 50 inappropriate.
- Assistant at surgery
- Assistant at surgery may be paid.
- Co-surgeons
- Co-surgeons paid only with supporting documentation.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU16.41 · 49%
- Practice expense (office) RVU14.29 · 42%
- Malpractice RVU3.04 · 9%
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.
64866 compared with similar codes
Office rates for Kentucky, from the same CMS release.
No office rate
64864 is direct repair of the facial nerve outside the skull. 64866 redirects facial nerve input to the spinal accessory or hypoglossal nerve.
No office rate
64865 is direct repair of the facial nerve within the skull. 64866 describes a nerve transfer to one of the specified donor nerves.
Compare 64866 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
$1065.34
Need rates for a whole code list?
Fee-sheet and API access are in early access. Tell us which codes and locations your team needs.
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 64866 in Kentucky.
PPRRVU2026_Oct_nonQPP.csv
7,264
- Code
- 64866
- Physician work
- 16.41
- Practice expense
- 14.29
- Malpractice
- 3.04
GPCI2026.csv
55
- Locality
- Kentucky
- Physician work
- 1.000
- Practice expense
- 0.889
- Malpractice
- 0.915
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 16.41 | × 1.000 | 16.4100 |
| Practice expense | 14.29 | × 0.889 | 12.7038 |
| Malpractice | 3.04 | × 0.915 | 2.7816 |
| Total RVUs | 31.8954 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Kentucky$1065.34
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 16.41 | 1 |
| Practice expense | 14.29 | 0.889 |
| Malpractice | 3.04 | 0.915 |
(16.41 × 1 + 14.29 × 0.889 + 3.04 × 0.915) × $33.4009 = $1065.34
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.
64866 billing questions
How does 64866 differ from 64868?
64866 is for connecting the facial nerve to the spinal accessory or hypoglossal nerve. 64868 is the related code for anastomosis to another nerve.
When would direct facial nerve repair be reported instead?
Codes 64864 and 64865 describe direct facial nerve repair in extracranial and intracranial settings, respectively. Use 64866 when the procedure transfers facial nerve input to the specified donor nerve rather than directly repairing facial nerve continuity.
Can modifier 50 be used for a bilateral procedure?
No. CMS identifies bilateral adjustment as inappropriate for this code; modifier 50 should not be used.
What documentation supports 64866?
The operative report should identify the facial nerve and the spinal accessory or hypoglossal nerve, explain the clinical indication and relevant findings, and describe the nerve connection performed.
What postoperative care is included in the global period?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
May an assistant or co-surgeon be reported?
CMS allows payment for an assistant at surgery. Co-surgeon payment requires supporting documentation; team surgery is 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.
7,26164862,,Repair of low back nerves,A,,20.56,12.11,NA,12.11,,4.38,37.05,37.05,0,090,0.11,0.76,0.13,2,1,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,26264864,,Repair of facial nerve,A,,13.07,7.35,NA,7.35,,2.19,22.61,22.61,0,090,0.11,0.76,0.13,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,26364865,,Repair of facial nerve,A,,15.69,10.39,NA,10.39,,2.30,28.38,28.38,0,090,0.11,0.76,0.13,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,26464866,,Fusion of facial/other nerve,A,,16.41,14.29,NA,14.29,,3.04,33.74,33.74,0,090,0.11,0.76,0.13,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,26564868,,Fusion of facial/other nerve,A,,14.53,9.34,NA,9.34,,2.12,25.99,25.99,0,090,0.11,0.76,0.13,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,26664872,,Subsequent repair of nerve,A,,1.94,0.62,NA,0.62,,0.42,2.98,2.98,0,ZZZ,0.00,0.00,0.00,0,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,26764874,,Repair & revise nerve add-on,A,,2.91,0.93,NA,0.93,,0.61,4.45,4.45,0,ZZZ,0.00,0.00,0.00,0,0,2,1,0,9,,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