CPT 64596
Global 010Ins/rplcmt prq eltrd ra pn 1
This code does not have a national work RVU on the current Physician Fee Schedule. Pricing may be carrier-determined, non-covered, or tracked via a separate methodology.
CPT 64596 Billing & Documentation Guide
CPT code 64596 (Ins/rplcmt prq eltrd ra pn 1) is classified under Surgery (Endocrine/Nervous/Eye/Ear) with a global period indicator of 010. This code uses the No national RVU payment methodology rather than standard RVU-based Physician Fee Schedule pricing. Refer to the methodology notice above for billing implications.
When billing 64596, 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 64596 with related codes; this code has 10 PTP bundling relationships on file (see table below).
Payment Status & Global Period
Carrier-priced (MAC determines payment locally)
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 64596 for the same patient on the same date triggers automatic line denial unless an appropriate modifier and supporting documentation justify the higher quantity.
NCCI Bundling Edits, CPT 64596
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 64596 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 0788T | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 0789T | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 11000 | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 11004 | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 11005 | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 11006 | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 11042 | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 11043 | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 11044 | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 35231 | Column 1 (primary), can be billed with modifier | Yes | CPT Manual or CMS manual coding instruction |
Frequently Asked Questions, CPT 64596
What does CPT code 64596 mean? +
CPT code 64596 represents: Ins/rplcmt prq eltrd ra pn 1. It's in the Surgery (Endocrine/Nervous/Eye/Ear) category with a global period of 010.
What is the Medicare reimbursement for CPT 64596? +
This code does not have a national work RVU on the current Physician Fee Schedule. Pricing may be carrier-determined, non-covered, or tracked via a separate methodology.
What modifiers can I use with CPT 64596? +
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 64596? +
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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