Billing code 64868: Nerve anastomosisMedicare rate & RVUs in Ohio
Reports operative joining of the facial nerve with another nerve as a reconstructive procedure, rather than repair of a nerve gap with a graft.
CMS doesn’t publish an office rate for 64868 in Ohio.
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 64868 covers
The surgeon microsurgically joins the facial nerve with another nerve to restore a pathway for nerve signals, typically during reconstruction for facial nerve injury or loss of function. The operation is performed by a surgeon experienced in peripheral nerve or facial nerve reconstruction, usually in an operating room. The operative report should identify the nerves joined and describe the anastomosis performed.
Report this code for the facial-to-other-nerve joining procedure, not simply for direct repair of a divided facial nerve or for a nerve graft. Medicare assigns a 90-day global period, including the day-before preoperative visit and 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 multiple-procedure reduction. Modifier 50 is inappropriate. Assistant-at-surgery payment may be made; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
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.
64868 in Ohio
| Payment locality | Office | Facility |
|---|---|---|
| Ohio | Unavailable | $841.51 |
How the 64868 rate is calculated
Each of 64868’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 · 64868
RVUs × geographic indexes × conversion factor
Work14.53
14.53 RVUs× 1.000 GPCI
Practice expense9.34
9.34 RVUs× 1.000 GPCI
Malpractice2.12
2.12 RVUs× 1.000 GPCI
Adjusted RVUs
25.9900
Conversion factor
$33.4009
Medicare rate
$868.09
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 64868
64868 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 64868
Nerve anastomosis
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 090 | Major surgery: the day before, the day of, and 90 days after are included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 2 | Paid. |
| Co-surgeons (62) | 1 | Permitted with supporting documentation. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.11/0.76/0.13 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 64868
Nerve anastomosis
90-day global period ends
Dec 30, 2026
Covers Sep 30, 2026 through Dec 30, 2026 (92 days, including the day before surgery).
Visit on Oct 31, 2026
Day 30 of the 90-day post-op period: related follow-up care is included in the surgical payment.
Pre-op dayGlobal period
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
64868 without 51 · national facility
$868.09
Nerve anastomosis
64868-51 · Second procedure: 50%
$434.05
When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).
64868 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 64866Facial nerve transfer
- Both are facial nerve fusion codes. Confirm the operative service and applicable code distinction in the current billing code descriptor before selecting between them.
- 64864Facial nerve repair
- Use 64864 for direct extracranial facial nerve repair; use 64868 when the documented operation joins the facial nerve with another nerve.
- 64865Facial nerve repair
- 64865 describes direct intracranial facial nerve repair, not an anastomosis joining the facial nerve with another nerve.
- 64885Nerve graft
- 64885 describes a head-and-neck nerve graft service. Choose it when the documented procedure is grafting rather than the facial-to-other-nerve joining represented by 64868.
64868 billing questions
How is this different from direct facial nerve repair?
This code represents joining the facial nerve with another nerve. Codes 64864 and 64865 describe facial nerve repair in extracranial and intracranial locations, respectively.
What should the operative note document?
Document the facial nerve and the other nerve joined, the anastomosis performed, and the clinical reason for reconstruction.
Can modifier 50 be used for bilateral work?
No. CMS identifies bilateral adjustment as inappropriate for this code.
How does the 90-day global period affect postoperative billing?
The day-before preoperative visit and 90 days of related postoperative care are included in the global period.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment may be made. Co-surgeon payment requires supporting documentation; team surgery is not permitted.
What happens when other procedures are performed in the same session?
The highest-valued procedure is paid in full, and other procedures are subject to the standard multiple-procedure reduction.
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
Show the CMS file lines behind this rate
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