CPT 64435
Global 000 ActiveNjx aa&/strd paracrv nrv
CPT 64435 Billing & Documentation Guide
CPT code 64435 (Njx aa&/strd paracrv 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 1.39, and a malpractice RVU of 0.13, a total non-facility RVU of 2.25 and facility RVU of 1.16. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $77.05, though rates vary from $66.5 to $96.34 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 64435, 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 64435 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 64435 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 64435
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 0.73 | 0.73 |
| Practice Expense RVU | 1.39 | 0.3 |
| Malpractice RVU | 0.13 | 0.13 |
| Total RVU | 2.25 | 1.16 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 64435
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 | $82.55 | $39.47 | $78.01 - $96.34 | 29 |
| Florida | $79.41 | $42.89 | $75.29 - $83.69 | 3 |
| Georgia | $73.91 | $39.18 | $70.97 - $76.84 | 2 |
| Illinois | $77.63 | $42.45 | $73.56 - $81.18 | 4 |
| Michigan | $74.09 | $39.9 | $71.67 - $76.51 | 2 |
| North Carolina | $70.47 | $36.51 | $70.47 - $70.47 | 1 |
| New York | $83.24 | $42.62 | $71.54 - $89.21 | 5 |
| Ohio | $71.15 | $37.91 | $71.15 - $71.15 | 1 |
| Pennsylvania | $74.72 | $39.06 | $71.11 - $78.33 | 2 |
| Texas | $74.26 | $38.41 | $70.67 - $77.4 | 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 64435
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 64435 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 64435
What does CPT code 64435 mean? +
CPT code 64435 represents: Njx aa&/strd paracrv nrv. It's in the Surgery (Endocrine/Nervous/Eye/Ear) category with a global period of 000.
What is the Medicare reimbursement for CPT 64435? +
The 2026 Medicare national average non-facility payment for CPT 64435 is $77.05. Rates range from $66.5 to $96.34 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 64435? +
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 64435? +
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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