No office rate
Choose 64658 when only the lead is removed and the generator remains; 64657 represents removal of the complete system.
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CMS RVU26D · Effective 2026-10-01
64658 Lead removal Medicare reimbursement rates in Texas
Removal of the implanted lead from a battery-powered neuromodulation system when the lead is taken out and the pulse generator is not removed. Compare 64658 office and facility rates across CMS payment localities in Texas.
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 64658 in Texas?
Texas has 8 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 8 payment areas shown below, using the same CMS release.
Office / nonfacility
No 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.
Where 64658 pays more and less in Texas
Neuromodulation surgery
About 64658: Implanted neuromodulation lead removal
Removal of the implanted lead from a battery-powered neuromodulation system when the lead is taken out and the pulse generator is not removed.
This code represents surgical removal of the implanted lead from a battery-powered neuromodulation system, without removal of the pulse generator. For sacral neuromodulation, the lead is placed near the sacral nerves; urologists, urogynecologists, and colorectal surgeons may perform removal when a device is no longer needed, has malfunctioned, or requires a different treatment plan. The operative report should identify the lead removed and the generator’s status.
Report this code when the work is removal of the lead only; removal of the whole system or generator alone corresponds to a different code in the family. Documentation should support the operative work, device components addressed, and laterality when relevant. CMS assigns a 90-day global period, including 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 other procedures are subject to the standard multiple-procedure reduction. Bilateral reporting with modifier 50 is paid at 150%. Assistant-at-surgery, co-surgeon, and team-surgery payment require the specified supporting documentation.
CMS billing rules for 64658
- 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
- Assistant at surgery is paid only with documentation of medical necessity.
- Co-surgeons
- Co-surgeons paid only with supporting documentation.
- Team surgery
- Team surgery paid only with supporting documentation.
Where the value comes from
- Work RVU8.95 · 63%
- Practice expense (office) RVU3.03 · 21%
- Malpractice RVU2.27 · 16%
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.
64658 compared with similar codes
Office rates for Texas, from the same CMS release.
No office rate
64659 is for removal of the pulse generator alone. This code is for removal of the lead alone.
No office rate
64655 represents lead revision or replacement. Use 64658 when the lead is removed without revision or replacement.
Compare 64658 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.
8 of 8 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Austin | Office Unavailable | Facility $473.79 |
| Beaumont | Office Unavailable | Facility $461.47 |
| Brazoria | Office Unavailable | Facility $460.76 |
| Dallas | Office Unavailable | Facility $467.48 |
| Fort Worth | Office Unavailable | Facility $467.46 |
| Galveston | Office Unavailable | Facility $464.60 |
| Houston | Office Unavailable | Facility $506.15 |
| Rest Of Texas | Office Unavailable | Facility $463.45 |
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64658 billing questions
How is this different from removal of the entire system?
Use this code when the lead is removed but the pulse generator remains. Removal of both components is represented by the total-system removal code, 64657.
How is this different from generator-only removal?
This code covers removal of the lead, not the pulse generator. Generator-only removal is reported with 64659.
Can this code describe lead revision or replacement?
No. This code represents lead removal only; revision or replacement of the lead is represented by 64655.
What should the operative report document?
Document the neuromodulation system, the lead removed, whether the pulse generator was retained, and the work performed. Include laterality when relevant.
How does Medicare handle multiple procedures in the same session?
The highest-valued procedure is paid in full, and other procedures are subject to the standard multiple-procedure reduction. The code has a 90-day global period.
What documentation is needed for an assistant or co-surgeon?
Assistant-at-surgery payment requires documentation of medical necessity. Co-surgeon and team-surgery payment require supporting documentation.
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.
7,19464655,,Revj/rplcmt bat mod sys lead,A,,11.30,5.40,NA,5.40,,2.59,19.29,19.29,0,090,0.11,0.76,0.13,2,1,0,1,1,9,,33.4009,09,0,99,0.00,0.00,0.00
7,19564656,,Revj/rplcmt bat mod sys pg,A,,8.01,2.80,NA,2.80,,1.98,12.79,12.79,0,090,0.11,0.76,0.13,2,1,0,1,1,9,,33.4009,09,0,99,0.00,0.00,0.00
7,19664657,,Rmvl bat modulj sys tot sys,A,,12.13,3.76,NA,3.76,,3.04,18.93,18.93,0,090,0.11,0.76,0.13,2,1,0,1,1,9,,33.4009,09,0,99,0.00,0.00,0.00
7,19764658,,Rmvl bat modul sys lead only,A,,8.95,3.03,NA,3.03,,2.27,14.25,14.25,0,090,0.11,0.76,0.13,2,1,0,1,1,9,,33.4009,09,0,99,0.00,0.00,0.00
7,19864659,,Rmvl bat modulj sys pg only,A,,8.23,2.90,NA,2.90,,2.09,13.22,13.22,0,090,0.11,0.76,0.13,2,1,0,1,1,9,,33.4009,09,0,99,0.00,0.00,0.00
7,19964680,,Injection treatment of nerve,A,,2.60,7.52,,1.53,,0.26,10.38,4.39,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,20064681,,Injection treatment of nerve,A,,3.69,9.85,,1.79,,0.30,13.84,5.78,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00