64822 Arterial sympathectomy Medicare reimbursement rates in Washington

Code 64822 represents surgical periarterial sympathectomy directed at the ulnar artery in the upper extremity. The surgeon removes or disrupts sympathetic nerve fibers accompanying the artery to improve hand blood flow in selected cases of vasospasm or ischemia, such as severe Raynaud presentations or digital tissue loss. Hand or vascular surgeons typically perform the procedure in an operating room; the code is defined by the ulnar artery target, not by the symptom alone.

Report it when the operative record documents sympathectomy of the ulnar artery, distinguishing it from procedures directed at the radial artery, superficial palmar arch, or a digital artery. Document the treated side, indication, and operative work. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. For procedures performed in one session, the highest-valued procedure is paid in full and the others at 50%. Bilateral procedures reported with modifier 50 are paid at 150%. Medicare does not pay an assistant at surgery; co-surgeon and team-surgery billing are not permitted.