CPT code 64581: Sacral nerve lead2026 Medicare rate & RVUs in Washington
Reports open placement of a neurostimulator electrode array at a sacral nerve, including a sacral nerve stimulation test lead, for neuromodulation treatment.
CMS doesn’t publish an office rate for 64581 in Washington.
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 64581 covers
This code covers an open surgical approach to place a neurostimulator electrode array at a sacral nerve, including placement of a sacral nerve stimulation test lead. Urologists, urogynecologists, and colorectal surgeons may perform the procedure for conditions such as urinary urgency incontinence, nonobstructive urinary retention, or fecal incontinence. It is typically performed in an operating room or other surgical setting.
Report the code when the documented approach is open and the electrode array is placed at a sacral nerve; a percutaneous approach is coded differently. The operative note should identify the approach, target nerve, and electrode placement. If a pulse generator is also implanted, that generator service is reported separately. The service has a 90-day global period, including the day-before preoperative visit and related postoperative care. When multiple procedures are performed in the same session, the highest-valued is paid in full and others at 50%. Modifier 50 is inappropriate. Medicare does not pay an assistant at surgery for this service; 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 64581 pays more and less in Washington
| Payment locality | Office | Facility |
|---|---|---|
| Rest Of Washington | Unavailable | $586.24 |
| Seattle (King Cnty) | Unavailable | $627.26 |
How the 64581 rate is calculated
Each of 64581’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 · 64581
RVUs × geographic indexes × conversion factor
Work11.90
11.90 RVUs× 1.000 GPCI
Practice expense3.97
3.97 RVUs× 1.000 GPCI
Malpractice1.73
1.73 RVUs× 1.000 GPCI
Adjusted RVUs
17.6000
Conversion factor
$33.4009
Medicare rate
$587.86
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 64581
64581 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 64581
Sacral nerve lead
| 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) | 0 | The 150% bilateral adjustment doesn’t apply. |
| 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 · 64581
Sacral nerve lead
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 51 · payment effect
With and without the modifier
64581 without 51 · national facility
$587.86
Sacral nerve lead
64581-51 · Second procedure: 50%
$293.93
When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).
64581 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 64561Sacral nerve lead
- Both address sacral nerve electrode placement, but 64581 is for an open approach and 64561 is for percutaneous placement.
- 64590Neurostimulator generator
- 64581 covers placement of the electrode array; 64590 covers insertion or replacement of the pulse generator or receiver.
- 64575Nerve stimulation
- 64575 describes open electrode-array implantation at a peripheral nerve other than the sacral nerve; 64581 identifies the sacral nerve target.
64581 billing questions
How is this different from 64561?
64581 describes open placement of the sacral nerve electrode array. Use 64561 when the array is placed percutaneously.
Can the pulse generator be reported separately?
Yes. If a pulse generator is implanted in the same session, report that distinct service with 64590; 64581 covers the electrode array placement.
Should modifier 50 be appended for bilateral work?
No. The CMS bilateral adjustment does not apply, and modifier 50 is inappropriate for this code.
What does the 90-day global period include?
It includes the day-before preoperative visit and 90 days of related postoperative care.
Can an assistant surgeon or co-surgeon be reported?
Medicare does not pay an assistant at surgery for this service. Co-surgeons and team surgery are 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 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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