Billing code 64778: Digital neuroma excisionMedicare rate & RVUs in Nevada
Reports excision of a neuroma from an additional digital nerve in the hand or foot during the same session as the primary nerve procedure.
CMS doesn’t publish an office rate for 64778 in Nevada.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 9 sections
What 64778 covers
This add-on represents excision of a neuroma from an additional digital nerve in a finger or toe. A hand, orthopedic, plastic, or podiatric surgeon may perform the work in an operating room when a patient has painful neuromas involving more than one digital nerve, such as after nerve injury or prior surgery. The surgeon identifies and removes the additional affected nerve lesion as part of the operative treatment.
Report 64778 only with the primary digital nerve neuroma excision code, 64776, for an additional nerve treated during the same operative session. The operative note should identify the hand or foot, the distinct digital nerves treated, and the neuroma excised at each site. CMS classifies 64778 as an add-on code: it is billed only with a primary procedure and paid within that procedure’s global period.
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.
64778 in Nevada**
| Payment locality | Office | Facility |
|---|---|---|
| Nevada** | Unavailable | $151.44 |
How the 64778 rate is calculated
Each of 64778’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 64778
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 3.03Practice expense 0.97Malpractice 0.64
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 64778
The CMS indicators that decide how 64778 is paid alongside other services.
CMS payment indicators · 64778
Digital neuroma excision
| Rule | CMS value | What it means |
|---|---|---|
| Global period | ZZZ | Add-on code: falls within the primary procedure’s global period. |
| Multiple procedures | 0 | No multiple-procedure reduction. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 1 | Not paid (statutory restriction). |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
64778 compared with similar codes
Compare codes
64778 vs 64776 vs 64774 vs 64783: national Medicare rates
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How to choose
- 64776Neuroma excision
- 64776 reports the primary digital nerve neuroma excision. Use 64778 only for an additional digital nerve treated in the same operative session.
- 64774Neuroma excision
- 64774 applies to a neuroma of a cutaneous nerve. Choose 64778 when the additional neuroma excised is on a digital nerve in the hand or foot.
- 64783Neuroma excision
- 64783 is an add-on for additional limb nerve neuroma excision outside the digital-nerve use of 64778.
64778 billing questions
When should 64778 be reported instead of 64776?
Use 64776 for the primary digital nerve neuroma excision. Report 64778 for each additional digital nerve neuroma excised in the same session.
Can 64778 be billed by itself?
No. It is an add-on code and must be reported with the primary digital nerve procedure, 64776.
What should the operative note document?
Document the treated hand or foot, identify each distinct digital nerve, and describe the neuroma excised from the additional nerve.
How many units should be reported?
Report the add-on for each additional digital nerve neuroma excised beyond the primary nerve treated under 64776. The record should support each separately treated nerve.
How does the global period affect 64778?
CMS pays this add-on within the global period of its primary procedure. It is not reported as a standalone service.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
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