No office rate
64820 is selected for sympathectomy at a digital artery. Use 64823 when the superficial palmar arch is the operative target.
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CMS RVU26D · Effective 2026-10-01
64823 Palmar sympathectomy Medicare reimbursement rates in Pennsylvania
Reports operative sympathectomy at the superficial palmar arch, typically to address severe hand ischemia associated with vasospastic disease. Compare 64823 office and facility rates across CMS payment localities in Pennsylvania.
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
What does Medicare pay for 64823 in Pennsylvania?
Pennsylvania has 2 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 2 payment areas shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$710.74–$773.84
2 of 2 localities have a supported rate.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Vascular surgery
About 64823: Superficial palmar arch sympathectomy
Reports operative sympathectomy at the superficial palmar arch, typically to address severe hand ischemia associated with vasospastic disease.
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.
CMS billing rules for 64823
- Global period
- Major surgery with a 90-day global period: the day-before preoperative visit and 90 days of related postoperative care are included.
- Multiple procedures
- Standard multiple procedure reduction: the highest-valued procedure is paid in full and others at 50% when performed in the same session.
- Bilateral procedures
- Bilateral procedure with modifier 50 is paid at 150%.
- Assistant at surgery
- Statutory restriction: assistant at surgery is not paid.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU10.67 · 48%
- Practice expense (office) RVU9.22 · 42%
- Malpractice RVU2.27 · 10%
44
Medicare services in 2024 · #5440 by national volume
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.
64823 compared with similar codes
Office rates for Pennsylvania, from the same CMS release.
No office rate
64821 describes sympathectomy at the radial artery, not the superficial palmar arch.
No office rate
64822 describes sympathectomy at the ulnar artery. Choose 64823 when the procedure is performed at the superficial palmar arch.
Compare 64823 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
2 of 2 payment localities
Metropolitan Philadelphia →
Office / nonfacility
Unavailable
Facility
$773.84
Rest Of Pennsylvania →
Office / nonfacility
Unavailable
Facility
$710.74
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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 indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
7,24564820,,Sympathectomy digital artery,A,,10.47,8.43,NA,8.43,,2.04,20.94,20.94,0,090,0.11,0.76,0.13,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,24664821,,Sympathectomy radial artery,A,,9.10,8.73,NA,8.73,,1.94,19.77,19.77,0,090,0.11,0.76,0.13,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,24764822,,Sympathectomy ulnar artery,A,,9.10,8.73,NA,8.73,,1.94,19.77,19.77,0,090,0.11,0.76,0.13,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,24864823,,Sympathectomy supfc palmar,A,,10.67,9.22,NA,9.22,,2.27,22.16,22.16,0,090,0.11,0.76,0.13,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,24964831,,Repair of digit nerve,A,,8.93,8.64,NA,8.64,,1.70,19.27,19.27,0,090,0.11,0.76,0.13,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,25064832,,Repair nerve add-on,A,,5.51,1.85,NA,1.85,,1.07,8.43,8.43,0,ZZZ,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,25164834,,Repair of hand or foot nerve,A,,10.54,7.45,NA,7.45,,1.79,19.78,19.78,0,090,0.11,0.76,0.13,2,1,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00