Open neuroplasty of a major peripheral nerve in the arm, specifically the brachial plexus, involving incision of scar tissue or decompression to relieve nerve tension.

Verified May 8, 2026 · 6 sources ↓

Medicare: $745.17
Total RVUs: 22.31
Global, days: 90
Region: Shoulder

Drawn from CMSFastrvuAAPCZhealthpublishing

Documentation requirements

What must appear in the operative or office note to support the claim.

Source · Editorial brief grounded in 6 cited references ↓

Specify the nerve(s) treated by name — brachial plexus roots, trunks, or divisions involved
Describe the surgical approach (supraclavicular, infraclavicular, or combined) and incision details
Document findings: nature and extent of scarring, compression, or structural impingement encountered
Detail each distinct surgical step performed — scar excision, nerve freeing, decompression — not just 'neuroplasty performed'
If additional structures were addressed (scalene, omohyoid, rib), document each separately with distinct operative descriptions to support unbundling
Record phrenic nerve identification and preservation when anterior scalene work is performed
Pre-op diagnosis with supporting imaging or EMG/nerve conduction study results in the chart

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 24 Unrelated E/M during global 50 Bilateral procedure 51 Multiple procedures 58 Staged or related 59 Distinct service 62 Co-surgeons 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon LT Left side RT Right side XS Separate structure

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 64713 covers open neuroplasty of a major peripheral nerve of the arm — most commonly the brachial plexus. The surgeon makes an open incision, typically supraclavicular or infraclavicular, to access the nerve, then excises scar tissue, releases compressive structures, or decompresses the nerve to restore function. This is a substantially more complex procedure than simple nerve block or minor neuroplasty codes.

The brachial plexus is the primary target for this code. When thoracic outlet syndrome drives the surgery, the operative field often includes scalene resection, rib resection (first or cervical), and omohyoid division in the same session. Watch NCCI edits carefully: CPT 21615 (cervical/first rib excision) has a bundling relationship with 64713 that requires documentation support to unbundle — the neuroplasty must be a separately identifiable, distinct service beyond what is inherent to the rib excision.

The 90-day global period means all routine post-op follow-up is bundled. For unrelated procedures or E/M visits during that window, append modifier 24 or 79 as appropriate. Bilateral brachial plexus neuroplasty is rare but would require modifier 50 with solid documentation of bilateral pathology.

RVU & reimbursement

Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	11.12
Practice expense RVU	8.61
Malpractice RVU	2.58
Total RVU	22.31
Medicare national rate	$745.17
Global period	90 days

Payment by site of service

Medicare pays different rates by setting. HOPD typically pays substantially more than ASC for the same procedure.

Source · CMS OPPS Addendum B·ASC HCPCS payment rates·2026

Setting	Medicare rate (national)
Office (PFS non-facility) Procedure performed in physician's office	$745.17
HOPD (APC 5431) Hospital outpatient department	$1,995.02
ASC (PI G2) Ambulatory surgical center (freestanding)	$948.66

Common denial reasons

The recurring reasons claims for CPT 64713 get rejected.

Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓

NCCI bundle conflict with CPT 21615 when cervical or first rib excision is billed same-day without modifier 59 or XS and distinct documentation
Medical necessity denial when pre-op workup (EMG, nerve conduction, imaging) is absent from the record
Operative note describes 'neurolysis' generically without identifying the specific nerve, approach, or distinct surgical maneuvers
Global period denial for post-op E/M visits billed without modifier 24 during the 90-day window
Upcoding or downcoding dispute when the note conflates brachial plexus neuroplasty (64713) with lesser nerve revision codes (64708)

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 6 cited references ↓

01What is the global period for CPT 64713?

90 days. All routine post-op care, dressing changes, and follow-up visits are bundled. Unrelated E/M services during the global period need modifier 24; unrelated procedures need modifier 79.

02Can I bill 64713 and 21615 together when I remove a cervical rib and decompress the brachial plexus in the same session?

There is an NCCI bundling relationship between these two codes. To bill both, you need modifier 59 or XS on 21615 and an operative note that clearly documents the neuroplasty as a distinct service — not simply incidental nerve exposure during rib excision. 'Freeing' the brachial plexus of investing scar tissue is generally considered sufficient to support separate reporting when specifically documented.

03Which nerve does CPT 64713 specifically address?

64713 is the code for major peripheral nerve neuroplasty of the arm, with the brachial plexus being the primary clinical target. It is not used for isolated ulnar (64718/64719), median at carpal tunnel (64721), or digital nerve work.

04Is modifier 50 ever appropriate for 64713?

Bilateral brachial plexus neuroplasty is rare, but if documented and medically necessary, modifier 50 applies. Payers vary on whether they want 50 on a single line or LT/RT on separate lines — verify your payer's preference before submitting.

05What ICD-10 diagnoses most commonly support 64713?

Neurogenic thoracic outlet syndrome (G54.2), brachial plexus disorders (G54.0), and traumatic brachial plexus injury (S14 category) are the primary drivers. Payers expect pre-op EMG or nerve conduction study results and imaging in the record to support medical necessity.

06How does the site of service affect payment for 64713?

HOPD and ASC payments differ significantly — see the Site of Service comparison table on this page. The physician's professional fee RVUs are the same regardless of setting, but facility reimbursement varies. Some payers may also have site-of-service payment differentials for the professional component.

Sources & references

Editorial content was developed using the following public sources. Last verified May 8, 2026.

Mira AI Scribe

Mira's AI scribe captures the specific nerve structures addressed (brachial plexus roots, trunks, divisions), the surgical approach by name (supraclavicular, infraclavicular, combined), each distinct intraoperative step (scar excision, nerve decompression, scalene resection), and any adjacent structures encountered (phrenic nerve, omohyoid, rib). This prevents the generic 'neuroplasty performed' operative note that triggers audit flags and NCCI unbundling denials when 21615 is billed on the same date.

See how Mira captures CPT 64713 documentation