CPT 64590
Global 010 ActiveIns/rpl prph sac/gstr npg/r
CPT 64590 Billing & Documentation Guide
CPT code 64590 (Ins/rpl prph sac/gstr npg/r) is classified under Surgery (Endocrine/Nervous/Eye/Ear) with a global period indicator of 010. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 4.97, a non-facility practice expense RVU of 7.12, and a malpractice RVU of 0.73, a total non-facility RVU of 12.82 and facility RVU of 7.99. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $438.46, though rates vary from $382.84 to $540.26 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 64590, 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 64590 with related codes; this code has 10 PTP bundling relationships on file (see table below).
Payment Status & Global Period
Active code (paid under MPFS)
10-day global period (minor procedure: pre-op day + procedure + 10 days post-op)
MUE Limit (Medically Unlikely Edits)
Submitting more than 1 units of 64590 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 64590
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 4.97 | 4.97 |
| Practice Expense RVU | 7.12 | 2.29 |
| Malpractice RVU | 0.73 | 0.73 |
| Total RVU | 12.82 | 7.99 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 64590
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 | $466.57 | $275.68 | $442.54 - $540.26 | 29 |
| Florida | $452.07 | $290.21 | $430 - $475.23 | 3 |
| Georgia | $422.3 | $268.4 | $407.2 - $437.4 | 2 |
| Illinois | $442.97 | $287.09 | $421.24 - $462.13 | 4 |
| Michigan | $423.63 | $272.14 | $410.66 - $436.6 | 2 |
| North Carolina | $403.46 | $252.95 | $403.46 - $403.46 | 1 |
| New York | $472.33 | $292.35 | $409.07 - $504.67 | 5 |
| Ohio | $407.7 | $260.41 | $407.7 - $407.7 | 1 |
| Pennsylvania | $426.5 | $268.48 | $407.36 - $445.64 | 2 |
| Texas | $423.69 | $264.87 | $405.07 - $439.55 | 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 64590
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 64590 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 0213T | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
| 0216T | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
| 0228T | Column 1 (primary), can be billed with modifier | No | Standards of medical/surgical practice |
| 0230T | Column 1 (primary), can be billed with modifier | No | Standards of medical/surgical practice |
| 0282T | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 0283T | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 0284T | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 0285T | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 0333T | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 0424T | Column 1 (primary), can be billed with modifier | No | Mutually exclusive procedures |
Frequently Asked Questions, CPT 64590
What does CPT code 64590 mean? +
CPT code 64590 represents: Ins/rpl prph sac/gstr npg/r. It's in the Surgery (Endocrine/Nervous/Eye/Ear) category with a global period of 010.
What is the Medicare reimbursement for CPT 64590? +
The 2026 Medicare national average non-facility payment for CPT 64590 is $438.46. Rates range from $382.84 to $540.26 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 64590? +
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 64590? +
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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