Billing code 64659: Generator removalMedicare rate & RVUs in Oregon
Removal of the pulse generator from a battery-powered neuromodulation system, reported when the generator is removed while the system’s lead remains.
CMS doesn’t publish an office rate for 64659 in Oregon.
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 64659 covers
This service removes the implanted pulse generator from a battery-powered neuromodulation system while leaving the system’s lead in place. A surgeon or other qualified physician accesses the generator, typically in a procedural or operating-room setting, disconnects it from the lead, and removes it. The operative report should identify the system and document that the pulse generator—not the lead or the entire system—was removed.
Choose this code for generator-only removal; use the related removal codes when the lead alone or the complete system is removed. CMS assigns a 90-day global period, which includes the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and the others at 50%. For bilateral procedures reported with modifier 50, CMS pays at 150%. Assistant-at-surgery, co-surgeon, and team-surgery payment requires supporting documentation; assistant payment also requires medical necessity.
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.
Where 64659 pays more and less in Oregon
| Payment locality | Office | Facility |
|---|---|---|
| Portland | Unavailable | $438.84 |
| Rest Of Oregon | Unavailable | $420.44 |
How the 64659 rate is calculated
Each of 64659’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 · 64659
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 8.23Practice expense 2.90Malpractice 2.09
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 64659
64659 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 64659
Generator removal
| 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) | 0 | Not paid without supporting documentation. |
| Co-surgeons (62) | 1 | Permitted with supporting documentation. |
| Team surgery (66) | 1 | Permitted with supporting documentation. |
| 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 · 64659
Generator removal
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
64659 without 50 · national facility
$441.56
Generator removal
64659-50 · Bilateral: 150%
$662.34
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).
64659 compared with similar codes
Compare codes
64659 vs 64656 vs 64657 vs 64658: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 64656Bladder modulation
- Use 64656 for revision or replacement of the pulse generator. Use 64659 when the generator is removed rather than revised or replaced.
- 64657System removal
- 64657 describes removal of the complete system. 64659 is limited to generator removal when the lead remains.
- 64658Lead removal
- 64658 is for lead-only removal. 64659 is for pulse-generator-only removal.
64659 billing questions
How is this different from removal of the complete system?
Report 64659 when only the pulse generator is removed and the lead remains. Removal of both generator and lead is the complete-system service, 64657.
When would 64658 be used instead?
64658 is for removal of the lead alone. Use 64659 when the generator is removed and the lead is left in place.
Can generator removal be reported with lead removal?
If both components are removed as part of complete-system removal, compare the service with 64657 rather than reporting generator-only removal alongside lead-only removal.
What documentation supports 64659?
Document the battery-powered system, removal of the pulse generator, and whether the lead was retained or also removed.
What are the payment rules for multiple procedures and bilateral reporting?
In the same session, CMS pays the highest-valued procedure in full and other procedures at 50%. For bilateral procedures reported with modifier 50, CMS pays at 150%.
Is related postoperative care included?
Yes. The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
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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