No office rate
Choose 64654 for initial open system implantation; choose 64655 when the procedure revises or replaces a system lead.
On this page
CMS RVU26D · Effective 2026-10-01
64654 System implantation Medicare reimbursement rates in Missouri
Reports the initial open implantation of a battery-powered modulating system, rather than revision, replacement, or removal of an existing system or component. Compare 64654 office and facility rates across CMS payment localities in Missouri.
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 64654 in Missouri?
Missouri has 3 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 3 payment areas shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$543.40–$554.91
3 of 3 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.
Where 64654 pays more and less in Missouri
Neurostimulation surgery
About 64654: Open implantation of battery-powered modulating system
Reports the initial open implantation of a battery-powered modulating system, rather than revision, replacement, or removal of an existing system or component.
This code represents the initial open implantation of a battery-powered modulating system. A surgeon exposes the operative site and implants the system through an open approach. It is distinct from procedures limited to revising or replacing a lead or pulse generator, and from procedures that remove the complete system or one of its components. The operative report should make clear that this is an initial implantation and describe the open approach and implanted system.
Report the service for the initial system implantation, not for later component work. Documentation should distinguish the procedure from lead or pulse-generator revision or replacement and from system or component removal. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When other procedures are performed in the same session, the highest-valued procedure is paid in full and the others at 50%. For bilateral reporting with modifier 50, payment is at 150%. Assistant-at-surgery payment requires documentation of medical necessity; co-surgeons and team surgery are not permitted.
CMS billing rules for 64654
- 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 not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU11.00 · 66%
- Practice expense (office) RVU2.96 · 18%
- Malpractice RVU2.79 · 17%
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.
64654 compared with similar codes
Office rates for Missouri, from the same CMS release.
No office rate
64656 applies to revision or replacement of the pulse generator, not initial open implantation of the system.
No office rate
64657 describes removal of the complete system. It does not describe initial implantation.
No office rate
64658 is for removal of the lead only; 64654 represents initial open system implantation.
Compare 64654 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.
3 of 3 payment localities
Metropolitan Kansas City →
Office / nonfacility
Unavailable
Facility
$551.29
Metropolitan St. Louis →
Office / nonfacility
Unavailable
Facility
$554.91
Rest Of Missouri →
Office / nonfacility
Unavailable
Facility
$543.40
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64654 billing questions
How is this code different from 64655?
64654 is for initial open implantation of the system. Code 64655 describes revision or replacement of a system lead.
When would 64656 be reported instead?
Use 64656 for revision or replacement of the pulse generator, rather than initial open implantation of the system.
Does this code include postoperative care?
CMS assigns a 90-day global period. The day-before preoperative visit and 90 days of related postoperative care are included.
How does CMS pay when another procedure is performed in the same session?
The highest-valued procedure is paid in full, and other procedures are paid at 50% under the standard multiple procedure reduction.
Can modifier 50 be used for a bilateral procedure?
Yes. CMS identifies this as a bilateral procedure and pays 150% when reported with modifier 50.
What supports assistant-at-surgery payment?
The record must document medical necessity for the assistant. Co-surgeons and team surgery are not permitted under the CMS rules for this code.
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.
7,19064647,,Chemodenerv trunk musc 6/>,A,,2.06,3.11,,0.92,,0.50,5.67,3.48,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,19164650,,Chemodenerv eccrine glands,A,,0.68,1.80,,0.21,,0.11,2.59,1.00,0,000,0.00,0.00,0.00,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,19264653,,Chemodenerv eccrine glands,A,,0.86,2.03,,0.26,,0.17,3.06,1.29,0,000,0.00,0.00,0.00,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,19364654,,1st opn implt bat modulj sys,A,,11.00,2.96,NA,2.96,,2.79,16.75,16.75,0,090,0.11,0.76,0.13,2,1,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,19464655,,Revj/rplcmt bat mod sys lead,A,,11.30,5.40,NA,5.40,,2.59,19.29,19.29,0,090,0.11,0.76,0.13,2,1,0,1,1,9,,33.4009,09,0,99,0.00,0.00,0.00
7,19564656,,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