Billing code 64569: Vagus nerve electrodeMedicare rate & RVUs in Texas
Reports operative revision or replacement of an implanted vagus nerve stimulation electrode, including reconnecting it to an existing pulse generator.
CMS doesn’t publish an office rate for 64569 in Texas.
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 64569 covers
This service covers an operation to revise or replace the electrode array attached to the vagus nerve in a patient with an implanted vagus nerve stimulation system. The surgeon may address a displaced, damaged, or malfunctioning electrode and reconnect the revised or replacement array to the existing pulse generator. It is typically performed in an operating room by a surgeon experienced with implanted neurostimulation systems, often for a patient receiving vagus nerve stimulation for epilepsy or another established indication.
Report the code when the electrode array itself is revised or replaced, rather than for initial system implantation, generator-only work, or electrode removal alone. The operative report should identify the electrode work performed and document the existing system and connection. The service has a 90-day global period, which includes the day-before preoperative visit and related postoperative care during that period. If multiple procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Modifier 50 reports bilateral surgery and is paid at 150%. Assistant-at-surgery, co-surgeon, and team-surgery payment requires the applicable medical-necessity or supporting documentation.
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 64569 pays more and less in Texas
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
8 of 8 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Austin | Unavailable | $748.01 |
| Beaumont | Unavailable | $713.64 |
| Brazoria | Unavailable | $719.34 |
| Dallas | Unavailable | $730.70 |
| Fort Worth | Unavailable | $729.68 |
| Galveston | Unavailable | $725.83 |
| Houston | Unavailable | $793.92 |
| Rest Of Texas | Unavailable | $720.68 |
How the 64569 rate is calculated
Each of 64569’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 · 64569
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 10.73Practice expense 7.89Malpractice 3.72
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 64569
64569 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 64569
Vagus nerve electrode
| 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 · 64569
Vagus nerve electrode
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
64569 without 50 · national facility
$746.18
Vagus nerve electrode
64569-50 · Bilateral: 150%
$1,119.27
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).
64569 compared with similar codes
Compare codes
64569 vs 64568 vs 64570 vs 61885: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 64568Nerve stimulator
- 64568 is for initial implantation of the vagus nerve electrode array and pulse generator. Choose 64569 for operative revision or replacement of an electrode array in an existing system.
- 64570Vagus stimulator removal
- 64570 is for removal of the vagus nerve electrode array. 64569 applies when the electrode is revised or replaced.
- 61885Neurostimulator generator
- Use the applicable generator code when pulse-generator work is performed without electrode-array revision or replacement. 64569 addresses the vagus nerve electrode array.
64569 billing questions
How is this different from initial vagus nerve stimulator implantation?
Use 64569 for revision or replacement of an electrode array in an existing system. Initial implantation of the vagus nerve electrode array and pulse generator is reported with 64568.
Does this code include replacement of the pulse generator?
The service concerns the electrode array and its connection to an existing pulse generator. When the operation is limited to generator replacement or revision, consider the applicable generator code instead.
When is 64570 more appropriate?
64570 describes removal of the vagus nerve electrode array. Use 64569 when the electrode array is revised or replaced rather than simply removed.
What documentation supports reporting 64569?
The operative report should describe the existing vagus nerve stimulation system and the specific electrode-array revision or replacement performed, including its connection to the pulse generator.
How are multiple procedures and bilateral surgery handled?
For procedures 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 identifies bilateral surgery and is paid at 150%.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and related postoperative care during the 90 days after surgery.
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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