CPT 64473
Global 000 ActiveLwr xtr fscl pln blk uni njx
CPT 64473 Billing & Documentation Guide
CPT code 64473 (Lwr xtr fscl pln blk uni njx) 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 1.31, a non-facility practice expense RVU of 2.6, and a malpractice RVU of 0.12, a total non-facility RVU of 4.03 and facility RVU of 1.64. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $138.71, though rates vary from $120.42 to $175.94 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 64473, 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 64473 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 64473 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 64473
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 1.31 | 1.31 |
| Practice Expense RVU | 2.6 | 0.21 |
| Malpractice RVU | 0.12 | 0.12 |
| Total RVU | 4.03 | 1.64 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 64473
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 | $150.26 | $55.79 | $141.83 - $175.94 | 29 |
| Florida | $138.69 | $58.59 | $132.8 - $144.29 | 3 |
| Georgia | $131.47 | $55.31 | $126 - $136.93 | 2 |
| Illinois | $135.48 | $58.35 | $129.31 - $140.54 | 4 |
| Michigan | $130.95 | $55.98 | $127.57 - $134.32 | 2 |
| North Carolina | $127.34 | $52.86 | $127.34 - $127.34 | 1 |
| New York | $148.16 | $59.1 | $129.07 - $157.25 | 5 |
| Ohio | $127.08 | $54.2 | $127.08 - $127.08 | 1 |
| Pennsylvania | $133.5 | $55.31 | $127.26 - $139.73 | 2 |
| Texas | $133.22 | $54.62 | $126.51 - $139.27 | 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 64473
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 64473 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 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 | Yes | Misuse of Column Two code with Column One code |
| 0464T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0543T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0544T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0569T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0571T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0572T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0573T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
Frequently Asked Questions, CPT 64473
What does CPT code 64473 mean? +
CPT code 64473 represents: Lwr xtr fscl pln blk uni njx. It's in the Surgery (Endocrine/Nervous/Eye/Ear) category with a global period of 000.
What is the Medicare reimbursement for CPT 64473? +
The 2026 Medicare national average non-facility payment for CPT 64473 is $138.71. Rates range from $120.42 to $175.94 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 64473? +
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 64473? +
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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