CPT 64474
Global 000 ActiveLwr xtr fscl pln blk uni nfs
CPT 64474 Billing & Documentation Guide
CPT code 64474 (Lwr xtr fscl pln blk uni nfs) 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 1.63, a non-facility practice expense RVU of 6.19, and a malpractice RVU of 0.15, a total non-facility RVU of 7.97 and facility RVU of 2.04. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $275.62, though rates vary from $234.62 to $361.25 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 64474, 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 64474 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 64474 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 64474
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 1.63 | 1.63 |
| Practice Expense RVU | 6.19 | 0.26 |
| Malpractice RVU | 0.15 | 0.15 |
| Total RVU | 7.97 | 2.04 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 64474
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 | $303.75 | $69.39 | $284.65 - $361.25 | 29 |
| Florida | $271.64 | $72.91 | $259.63 - $282.34 | 3 |
| Georgia | $257.76 | $68.81 | $244.84 - $270.68 | 2 |
| Illinois | $263.99 | $72.6 | $251.04 - $276.04 | 4 |
| Michigan | $255.64 | $69.65 | $248.86 - $262.41 | 2 |
| North Carolina | $250.54 | $65.75 | $250.54 - $250.54 | 1 |
| New York | $294.49 | $73.53 | $254.38 - $313.06 | 5 |
| Ohio | $248.26 | $67.42 | $248.26 - $248.26 | 1 |
| Pennsylvania | $262.81 | $68.8 | $248.98 - $276.63 | 2 |
| Texas | $262.94 | $67.95 | $247.24 - $277.73 | 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 64474
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 64474 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 64474
What does CPT code 64474 mean? +
CPT code 64474 represents: Lwr xtr fscl pln blk uni nfs. It's in the Surgery (Endocrine/Nervous/Eye/Ear) category with a global period of 000.
What is the Medicare reimbursement for CPT 64474? +
The 2026 Medicare national average non-facility payment for CPT 64474 is $275.62. Rates range from $234.62 to $361.25 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 64474? +
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 64474? +
This code has 10 NCCI PTP bundling relationships. See the NCCI Bundling section below for full list.
Get the full PayerReady toolkit
Free access to CPT/ICD-10 lookup, denial appeals, fee comparator, and claim auditing with credentialing enrollment.
Start free →Run this code through our claim audit tool
Check NCCI bundling, MUE limits, and modifier logic before submission.
Try the auditor →Did this page help?
Quick signal so we know what to improve.
If you want a code reference page that doesn't exist yet, email coding@payerready.com.
Tell us what's missing or wrong: coding@payerready.com. We respond within 5 business days.
Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on June 2, 2026.
Powered by 11K CPT · 98K ICD-10 · 860K MPFS rates · 4.5M NCCI edits · 9.5M NPIs. Our data methodology · About our coding team