Billing code 64822: Arterial sympathectomyMedicare rate & RVUs in Oklahoma
Reports surgical sympathectomy directed at the ulnar artery to address selected cases of hand vasospasm or ischemia, including severe Raynaud presentations.
CMS doesn’t publish an office rate for 64822 in Oklahoma.
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 64822 covers
Code 64822 represents surgical periarterial sympathectomy directed at the ulnar artery in the upper extremity. The surgeon removes or disrupts sympathetic nerve fibers accompanying the artery to improve hand blood flow in selected cases of vasospasm or ischemia, such as severe Raynaud presentations or digital tissue loss. Hand or vascular surgeons typically perform the procedure in an operating room; the code is defined by the ulnar artery target, not by the symptom alone.
Report it when the operative record documents sympathectomy of the ulnar artery, distinguishing it from procedures directed at the radial artery, superficial palmar arch, or a digital artery. Document the treated side, indication, and operative work. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. For procedures performed in one session, the highest-valued procedure is paid in full and the others at 50%. Bilateral procedures reported with modifier 50 are paid at 150%. Medicare does not pay an assistant at surgery; co-surgeon and team-surgery billing are 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.
64822 in Oklahoma
| Payment locality | Office | Facility |
|---|---|---|
| Oklahoma | Unavailable | $614.69 |
How the 64822 rate is calculated
Each of 64822’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 · 64822
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 9.10Practice expense 8.73Malpractice 1.94
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 64822
64822 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 64822
Arterial sympathectomy
| 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) | 1 | Bilateral with modifier 50 pays 150% of the fee schedule amount. |
| 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. |
| 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 · 64822
Arterial sympathectomy
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 50 · payment effect
With and without the modifier
64822 without 50 · national facility
$660.34
Arterial sympathectomy
64822-50 · Bilateral: 150%
$990.51
Both sides on one line with modifier 50 are paid at 150% of the fee schedule amount (subject to multiple-procedure rules with other procedures).
64822 compared with similar codes
Compare codes
64822 vs 64820 vs 64821 vs 64823: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 64820Sympathectomy
- Use 64820 when the sympathectomy targets a digital artery. Code 64822 is for the ulnar artery.
- 64821Arterial sympathectomy
- Use 64821 for sympathectomy of the radial artery; use 64822 when the ulnar artery is the operative target.
- 64823Palmar sympathectomy
- Code 64823 is for sympathectomy of the superficial palmar arch, not the ulnar artery.
64822 billing questions
How is this code distinguished from radial artery sympathectomy?
Code 64822 is for sympathectomy directed at the ulnar artery. Use 64821 when the operative target is the radial artery.
When would the superficial palmar artery code be used instead?
Code 64823 identifies sympathectomy directed at the superficial palmar arch. Select the code based on the artery or arterial structure documented as the operative target.
How should bilateral ulnar artery procedures be reported?
Report the bilateral procedure with modifier 50 when appropriate. CMS pays bilateral procedures with modifier 50 at 150%.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
How does the multiple procedure rule affect payment?
When procedures are performed in the same session, CMS pays the highest-valued procedure in full and the other procedures at 50%.
What operative documentation supports code 64822?
Document the ulnar artery as the target of the sympathectomy, the side treated, the clinical indication, and the operative work performed.
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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