CPT 64405
Global 000 ActiveNjx aa&/strd gr ocpl nrv
CPT 64405 Billing & Documentation Guide
CPT code 64405 (Njx aa&/strd gr ocpl nrv) is classified under Surgery (Endocrine/Nervous/Eye/Ear) with a global period indicator of 000. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 0.92, a non-facility practice expense RVU of 1.23, and a malpractice RVU of 0.21, a total non-facility RVU of 2.36 and facility RVU of 1.38. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $80.24, though rates vary from $69.63 to $97.11 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 64405, ensure documentation supports medical necessity and the specific components required for the code's level of service. For E/M codes, document MDM (medical decision-making) elements: problems addressed, data reviewed, and risk. For procedural codes, document the indication, technique, and any complications. Always verify NCCI edits before bundling 64405 with related codes; this code has 10 PTP bundling relationships on file (see table below).
Payment Status & Global Period
Active code (paid under MPFS)
Endoscopic or minor procedure with related preoperative and postoperative work performed on the same day
MUE Limit (Medically Unlikely Edits)
Submitting more than 1 units of 64405 for the same patient on the same date triggers automatic line denial unless an appropriate modifier and supporting documentation justify the higher quantity.
RVU Breakdown, CPT 64405
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 0.92 | 0.92 |
| Practice Expense RVU | 1.23 | 0.25 |
| Malpractice RVU | 0.21 | 0.21 |
| Total RVU | 2.36 | 1.38 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 64405
State-level averages across all MAC localities. Non-facility rates typically apply to office-based services; facility rates apply to hospital outpatient / inpatient.
| State | Non-Facility | Facility | Range (Non-Fac) | Localities |
|---|---|---|---|---|
| California | $84.25 | $45.51 | $80.04 - $97.11 | 29 |
| Florida | $85.61 | $52.76 | $80.55 - $91.24 | 3 |
| Georgia | $78.37 | $47.14 | $75.74 - $80.99 | 2 |
| Illinois | $83.94 | $52.31 | $79.2 - $88.33 | 4 |
| Michigan | $79.18 | $48.44 | $76.16 - $82.2 | 2 |
| North Carolina | $73.54 | $43 | $73.54 - $73.54 | 1 |
| New York | $87.55 | $51.04 | $74.69 - $94.57 | 5 |
| Ohio | $75.31 | $45.42 | $75.31 - $75.31 | 1 |
| Pennsylvania | $78.75 | $46.68 | $75.07 - $82.42 | 2 |
| Texas | $77.86 | $45.63 | $74.63 - $81.42 | 8 |
Source: CMS PFSRVU 2026 · Updated 2026-04-01. Full locality-level detail available for all 53 states, contact us for custom reports.
NCCI Bundling Edits, CPT 64405
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 64405 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 0178T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0179T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0180T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 01991 | Column 1 (primary), can be billed with modifier | No | Anesthesia service included in surgical procedure |
| 01992 | Column 1 (primary), can be billed with modifier | No | Anesthesia service included in surgical procedure |
| 0333T | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 0464T | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 0543T | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
| 0544T | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
| 0548T | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
Frequently Asked Questions, CPT 64405
What does CPT code 64405 mean? +
CPT code 64405 represents: Njx aa&/strd gr ocpl nrv. It's in the Surgery (Endocrine/Nervous/Eye/Ear) category with a global period of 000.
What is the Medicare reimbursement for CPT 64405? +
The 2026 Medicare national average non-facility payment for CPT 64405 is $80.24. Rates range from $69.63 to $97.11 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 64405? +
Surgery codes commonly use modifier 22 (increased procedural services), 50 (bilateral), 51 (multiple procedures), 52 (reduced services), 58/78/79 (staged, unplanned return, unrelated within global), 62 (co-surgeons), 80/82 (assistant surgeon), and 59 or the X{EPSU} subset for distinct procedural service.
What bundling edits apply to CPT 64405? +
This code has 10 NCCI PTP bundling relationships. See the NCCI Bundling section below for full list.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on May 31, 2026.
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