CPT 64420
Global 000 ActiveNjx aa&/strd ntrcost nrv 1
CPT 64420 Billing & Documentation Guide
CPT code 64420 (Njx aa&/strd ntrcost nrv 1) 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 1.05, a non-facility practice expense RVU of 2.03, and a malpractice RVU of 0.09, a total non-facility RVU of 3.17 and facility RVU of 1.57. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $109.12, though rates vary from $94.86 to $138.31 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 64420, 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 64420 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 64420 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 64420
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 1.05 | 1.05 |
| Practice Expense RVU | 2.03 | 0.43 |
| Malpractice RVU | 0.09 | 0.09 |
| Total RVU | 3.17 | 1.57 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 64420
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 | $118.19 | $54.95 | $111.59 - $138.31 | 29 |
| Florida | $108.95 | $55.33 | $104.41 - $113.26 | 3 |
| Georgia | $103.41 | $52.43 | $99.14 - $107.68 | 2 |
| Illinois | $106.45 | $54.82 | $101.67 - $110.36 | 4 |
| Michigan | $102.97 | $52.79 | $100.37 - $105.57 | 2 |
| North Carolina | $100.25 | $50.39 | $100.25 - $100.25 | 1 |
| New York | $116.46 | $56.84 | $101.6 - $123.52 | 5 |
| Ohio | $100.01 | $51.21 | $100.01 - $100.01 | 1 |
| Pennsylvania | $105.02 | $52.67 | $100.16 - $109.87 | 2 |
| Texas | $104.81 | $52.2 | $99.57 - $109.54 | 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 64420
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 64420 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 64420
What does CPT code 64420 mean? +
CPT code 64420 represents: Njx aa&/strd ntrcost nrv 1. It's in the Surgery (Endocrine/Nervous/Eye/Ear) category with a global period of 000.
What is the Medicare reimbursement for CPT 64420? +
The 2026 Medicare national average non-facility payment for CPT 64420 is $109.12. Rates range from $94.86 to $138.31 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 64420? +
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 64420? +
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 June 1, 2026.
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