CPT 64408
Global 000 ActiveNjx aa&/strd vagus nrv
CPT 64408 Billing & Documentation Guide
CPT code 64408 (Njx aa&/strd vagus 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 0.73, a non-facility practice expense RVU of 1.55, and a malpractice RVU of 0.11, a total non-facility RVU of 2.39 and facility RVU of 1.16. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $82.06, though rates vary from $70.75 to $103.69 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 64408, 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 64408 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 64408 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 64408
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 0.73 | 0.73 |
| Practice Expense RVU | 1.55 | 0.32 |
| Malpractice RVU | 0.11 | 0.11 |
| Total RVU | 2.39 | 1.16 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 64408
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 | $88.51 | $39.9 | $83.51 - $103.69 | 29 |
| Florida | $83.48 | $42.26 | $79.4 - $87.57 | 3 |
| Georgia | $78.21 | $39.02 | $74.94 - $81.47 | 2 |
| Illinois | $81.51 | $41.82 | $77.39 - $85.02 | 4 |
| Michigan | $78.17 | $39.59 | $75.8 - $80.54 | 2 |
| North Carolina | $75.03 | $36.7 | $75.03 - $75.03 | 1 |
| New York | $88.29 | $42.46 | $76.15 - $94.32 | 5 |
| Ohio | $75.35 | $37.84 | $75.35 - $75.35 | 1 |
| Pennsylvania | $79.24 | $39 | $75.38 - $83.1 | 2 |
| Texas | $78.9 | $38.45 | $74.91 - $82.46 | 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 64408
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 64408 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 64408
What does CPT code 64408 mean? +
CPT code 64408 represents: Njx aa&/strd vagus nrv. It's in the Surgery (Endocrine/Nervous/Eye/Ear) category with a global period of 000.
What is the Medicare reimbursement for CPT 64408? +
The 2026 Medicare national average non-facility payment for CPT 64408 is $82.06. Rates range from $70.75 to $103.69 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 64408? +
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 64408? +
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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