Billing code 64823: Palmar sympathectomyMedicare rate & RVUs in Oregon
Reports operative sympathectomy at the superficial palmar arch, typically to address severe hand ischemia associated with vasospastic disease.
CMS doesn’t publish an office rate for 64823 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 64823 covers
This operation interrupts or removes sympathetic nerve fibers associated with the superficial palmar arch in the hand. It is generally performed by a hand or vascular surgeon for severe hand ischemia, including ischemia related to vasospastic disease. The operative report should identify the palmar arch as the treatment site; sympathectomy of a digital, radial, or ulnar artery is described by a different code.
Report 64823 for the arch-level procedure, not simply because the operation involves the palm. Document the indication, side, target anatomy, and work performed. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. For bilateral surgery, modifier 50 is paid at 150%. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and others at 50%. Assistant-at-surgery payment is restricted; co-surgeons and team surgery 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.
Where 64823 pays more and less in Oregon
| Payment locality | Office | Facility |
|---|---|---|
| Portland | Unavailable | $760.64 |
| Rest Of Oregon | Unavailable | $716.41 |
How the 64823 rate is calculated
Each of 64823’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 · 64823
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 10.67Practice expense 9.22Malpractice 2.27
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 64823
64823 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 64823
Palmar 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 · 64823
Palmar 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
64823 without 50 · national facility
$740.16
Palmar sympathectomy
64823-50 · Bilateral: 150%
$1,110.24
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).
64823 compared with similar codes
Compare codes
64823 vs 64820 vs 64821 vs 64822: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 64820Sympathectomy
- 64820 is selected for sympathectomy at a digital artery. Use 64823 when the superficial palmar arch is the operative target.
- 64821Arterial sympathectomy
- 64821 describes sympathectomy at the radial artery, not the superficial palmar arch.
- 64822Arterial sympathectomy
- 64822 describes sympathectomy at the ulnar artery. Choose 64823 when the procedure is performed at the superficial palmar arch.
64823 billing questions
How does 64823 differ from 64820?
64823 identifies sympathectomy at the superficial palmar arch. 64820 is for sympathectomy at a digital artery, so select by the operative target rather than the general hand location.
When is 64821 or 64822 more appropriate?
Use 64821 when the sympathectomy targets the radial artery and 64822 when it targets the ulnar artery. The operative report should support the specific vessel or arch treated.
How should bilateral palmar arch procedures be reported?
Report the bilateral procedure with modifier 50. CMS pays bilateral 64823 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.
Can an assistant or co-surgeon be billed for 64823?
Assistant-at-surgery payment is subject to a statutory restriction. CMS does not permit co-surgeons or team surgery 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 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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