No office rate
64802 describes cervical-level sympathectomy. Choose 64804 when the operative work is documented at the cervicothoracic level.
On this page
CMS RVU26D · Effective 2026-10-01
64804 Sympathectomy Medicare reimbursement rates in Vermont
Cervicothoracic sympathectomy interrupts sympathetic nerve tissue at the neck–chest junction for selected upper-extremity conditions. Compare 64804 office and facility rates across CMS payment localities in Vermont.
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 64804 in Vermont?
Vermont has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$1086.89
1 of 1 localities have a supported rate.
Payment area: Vermont
One mapped payment locality.
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.
Nervous system surgery
About 64804: Cervicothoracic sympathetic chain surgery
Cervicothoracic sympathectomy interrupts sympathetic nerve tissue at the neck–chest junction for selected upper-extremity conditions.
Cervicothoracic sympathectomy interrupts or removes sympathetic nerve tissue at the junction of the cervical and thoracic regions. Surgeons may perform it for severe upper-extremity hyperhidrosis or selected vasospastic or pain conditions when targeted interruption of sympathetic outflow is intended. The operation is generally performed in an operating room. The operative report should identify the side and sympathetic structures treated.
Report 64804 when the documented operative work is at the cervicothoracic level, rather than cervical-only, lower thoracic or lumbar, or limited to a hand artery. Document the indication, laterality, anatomic extent, and technique to support the level treated. The 90-day global includes the day-before preoperative visit and 90 days of related postoperative care. For bilateral work, modifier 50 is paid at 150%. When multiple procedures occur in one session, the highest-valued procedure is paid in full and others at 50%. Assistant-at-surgery services may be paid; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 64804
- 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 may be paid.
- Co-surgeons
- Co-surgeons paid only with supporting documentation.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU15.51 · 43%
- Practice expense (office) RVU13.86 · 39%
- Malpractice RVU6.54 · 18%
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.
64804 compared with similar codes
Office rates for Vermont, from the same CMS release.
No office rate
64809 applies to thoracolumbar sympathectomy, not work at the cervicothoracic junction.
No office rate
64818 is for lumbar sympathectomy. Select 64804 for cervicothoracic-level work.
No office rate
64820 concerns sympathectomy of a digital artery; 64804 is for sympathetic-chain work at the cervicothoracic level.
Compare 64804 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.
1 of 1 payment localities
Vermont →
Office / nonfacility
Unavailable
Facility
$1086.89
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How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 64804 in Vermont.
PPRRVU2026_Oct_nonQPP.csv
7,242
- Code
- 64804
- Physician work
- 15.51
- Practice expense
- 13.86
- Malpractice
- 6.54
GPCI2026.csv
105
- Locality
- Vermont
- Physician work
- 1.000
- Practice expense
- 0.990
- Malpractice
- 0.506
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 15.51 | × 1.000 | 15.5100 |
| Practice expense | 13.86 | × 0.990 | 13.7214 |
| Malpractice | 6.54 | × 0.506 | 3.3092 |
| Total RVUs | 32.5406 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Vermont$1086.89
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 15.51 | 1 |
| Practice expense | 13.86 | 0.99 |
| Malpractice | 6.54 | 0.506 |
(15.51 × 1 + 13.86 × 0.99 + 6.54 × 0.506) × $33.4009 = $1086.89
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
64804 billing questions
How do I distinguish 64804 from cervical sympathectomy 64802?
Use the operative anatomy to select the code. Report 64804 for work at the cervicothoracic level and 64802 for cervical-only work.
How is bilateral cervicothoracic work reported?
When the procedure is bilateral, report modifier 50. CMS pays the bilateral procedure at 150%.
What documentation supports 64804?
The operative report should establish the indication, laterality, sympathetic structures treated, and the anatomic level of the procedure.
What postoperative care is included in the global period?
The 90-day global includes the day-before preoperative visit and 90 days of related postoperative care.
How does CMS handle multiple procedures in the same session?
The highest-valued procedure is paid in full, and other procedures are paid at 50% under the standard multiple procedure reduction.
Can an assistant or co-surgeon be paid?
Assistant-at-surgery services may be paid. Co-surgeon payment requires supporting documentation; team surgery is not permitted.
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.
7,23964792,,Removal of nerve lesion,A,,15.46,14.34,NA,14.34,,6.52,36.32,36.32,0,090,0.11,0.76,0.13,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,24064795,,Biopsy of nerve,A,,2.93,1.77,NA,1.77,,0.88,5.58,5.58,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,24164802,,Sympathectomy cervical,A,,10.11,11.95,NA,11.95,,4.26,26.32,26.32,0,090,0.11,0.76,0.13,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,24264804,,Sympathectomy cervicothorac,A,,15.51,13.86,NA,13.86,,6.54,35.91,35.91,0,090,0.11,0.76,0.13,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,24364809,,Sympathectomy thoracolumbar,A,,14.34,12.38,NA,12.38,,6.04,32.76,32.76,0,090,0.11,0.76,0.13,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,24464818,,Sympathectomy lumbar,A,,11.06,8.11,NA,8.11,,2.36,21.53,21.53,0,090,0.11,0.76,0.13,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
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
10204412,TX,18,HOUSTON,1.008,0.993,1.376
10304412,TX,99,REST OF TEXAS,1.000,0.949,0.903
10403502,UT,09,UTAH,1.000,0.940,0.898
10514512,VT,50,VERMONT,1.000,0.990,0.506
10611302,VA,00,VIRGINIA,1.000,0.983,0.706
10709202,VI,50,VIRGIN ISLANDS,1.000,1.011,0.985
10802402,WA,02,SEATTLE (KING CNTY),1.050,1.227,0.817