No office rate
64582 reports initial implantation of the hypoglossal array and pulse generator; 64584 reports removal of that system.
On this page
CMS RVU26D · Effective 2026-10-01
64584 Stimulator removal Medicare reimbursement rates in Massachusetts
Reports surgical removal of an implanted hypoglossal nerve stimulation array and pulse generator, commonly performed when an obstructive sleep apnea device must be explanted. Compare 64584 office and facility rates across CMS payment localities in Massachusetts.
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 64584 in Massachusetts?
Massachusetts has 2 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 2 payment areas shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$636.09–$677.09
2 of 2 localities have a supported rate.
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 64584: Hypoglossal stimulator system removal
Reports surgical removal of an implanted hypoglossal nerve stimulation array and pulse generator, commonly performed when an obstructive sleep apnea device must be explanted.
This operation removes the implanted hypoglossal nerve stimulation system, including its electrode array and pulse generator. It is typically performed by an otolaryngologist or another surgeon experienced in sleep-related airway procedures, usually in an operating room. The system is used to stimulate the hypoglossal nerve during sleep for selected patients with obstructive sleep apnea; removal may be needed when the device must be explanted rather than revised or replaced.
Report 64584 when the procedure removes the hypoglossal array and pulse generator, not for initial implantation or revision/replacement. The operative report should identify the hypoglossal system and document the components removed. 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 are subject to the standard 50% reduction. Bilateral reporting with modifier 50 is paid at 150%. Assistant-at-surgery, co-surgeon, and team-surgery payment require the applicable supporting documentation.
CMS billing rules for 64584
- 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 RVU11.70 · 62%
- Practice expense (office) RVU5.51 · 29%
- Malpractice RVU1.70 · 9%
106
Medicare services in 2024 · #4836 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.
64584 compared with similar codes
Office rates for Massachusetts, from the same CMS release.
No office rate
64583 is for revision or replacement of a hypoglossal system. Choose 64584 when the array and pulse generator are removed instead.
No office rate
64570 concerns removal of a vagus nerve stimulation electrode. It is not the code for explanting a hypoglossal nerve system.
$357.21–$391.06
64595 addresses revision or removal of specified peripheral, sacral, or gastric neurostimulator generators or receivers; 64584 is specific to the hypoglossal array and pulse generator.
Compare 64584 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.
2 of 2 payment localities
Metropolitan Boston →
Office / nonfacility
Unavailable
Facility
$677.09
Rest Of Massachusetts →
Office / nonfacility
Unavailable
Facility
$636.09
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64584 billing questions
How is removal distinguished from revision or replacement?
Use 64584 when removing the hypoglossal nerve array and pulse generator. Code 64583 describes revision or replacement of the hypoglossal system rather than its removal.
Can 64584 be used for removal of a vagus nerve stimulator?
No. Code 64584 is specific to a hypoglossal nerve stimulation system; 64570 describes removal of a vagus nerve stimulation electrode.
What documentation supports reporting 64584?
Document the implanted hypoglossal system and the components removed, identifying the array and pulse generator in the operative report.
Does the 90-day global period include related postoperative care?
Yes. CMS includes the day-before preoperative visit and 90 days of related postoperative care in the global period.
How are other procedures in the same session paid?
Under the standard multiple procedure reduction, the highest-valued procedure is paid in full and other procedures are paid at 50%. Bilateral reporting with modifier 50 is paid at 150%.
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.
7,15564581,,Opn impltj nea sacral nerve,A,,11.90,3.97,NA,3.97,,1.73,17.60,17.60,0,090,0.11,0.76,0.13,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,15664582,,Opn mpltj hpglsl nstm ary pg,A,,13.65,6.00,NA,6.00,,1.99,21.64,21.64,0,090,0.11,0.76,0.13,2,1,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,15764583,,Rev/rplct hpglsl nstm ary pg,A,,14.14,6.11,NA,6.11,,2.06,22.31,22.31,0,090,0.11,0.76,0.13,2,1,0,1,1,9,,33.4009,09,0,99,0.00,0.00,0.00
7,15864584,,Rmvl hpglsl nstim ary pg,A,,11.70,5.51,NA,5.51,,1.70,18.91,18.91,0,090,0.11,0.76,0.13,2,1,0,1,1,9,,33.4009,09,0,99,0.00,0.00,0.00
7,15964585,,Rev/rmv perph nstim eltrd ra,A,,2.06,5.19,,1.72,,0.29,7.54,4.07,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,16064590,,Ins/rpl prph sac/gstr npg/r,A,,4.97,7.12,,2.29,,0.73,12.82,7.99,0,010,0.10,0.80,0.10,2,0,1,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,16164595,,Rev/rmv prph sac/gstr npg/r,A,,3.70,6.17,,2.03,,0.55,10.42,6.28,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00