Excision of a nerve lesion (tumor or mass) arising from a cutaneous somatic nerve — the nerve supply to a defined skin region.

Verified May 8, 2026 · 5 sources ↓

Medicare: $411.83
Total RVUs: 12.33
Global, days: 90
Region: General

Drawn from CMSFastrvuAAPCAAOS

Documentation requirements

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

Source · Editorial brief grounded in 5 cited references ↓

Identify the specific cutaneous somatic nerve involved by name and anatomic location
Document the etiology of the lesion (trauma, prior surgery, amputation, spontaneous) to support medical necessity
Record lesion size, character, and depth as encountered intraoperatively
Describe the surgical approach: incision site, nerve isolation technique, and method of excision
Submit pathology report confirming excised specimen was sent for analysis — payers commonly require this
If multiple lesions excised same session, document each as a distinct anatomic site in the operative note

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 25 Significant separate E/M 51 Multiple procedures 58 Staged or related 59 Distinct service 76 Repeat, same physician 77 Repeat, another physician 78 Unplanned return — related 79 Unrelated during global LT Left side RT Right side XS Separate structure

What this code covers

Source · Editorial summary grounded in 5 cited references ↓

CPT 64774 covers surgical removal of a benign or pathological growth — such as a neuroma or neurofibroma — from a somatic nerve supplying the skin. The lesion may result from trauma, prior surgery, or amputation. The procedure involves identifying the involved cutaneous nerve, isolating the lesion, and excising it, with the goal of relieving pain or correcting a palpable nerve mass.

The code carries a 90-day global period, so all routine follow-up visits, wound checks, and dressing changes through day 90 are bundled. Any E/M service unrelated to the nerve excision during that window requires modifier 24. If a separately identifiable problem is addressed on the same day as surgery, modifier 25 applies to the E/M.

Multiple lesions excised from distinct nerves at separate anatomic sites on the same operative session can each be reported — use modifier 59 or XS to document distinct lesions or sites. Only one removal code applies per lesion per NCCI policy; if removal is begun by one method and converted to another, only the completed procedure is reported.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	5.66
Practice expense RVU	5.48
Malpractice RVU	1.19
Total RVU	12.33
Medicare national rate	$411.83
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	$411.83
HOPD (APC 5431) Hospital outpatient department	$1,995.02
ASC (PI A2) Ambulatory surgical center (freestanding)	$948.66

Common denial reasons

The recurring reasons claims for CPT 64774 get rejected.

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

Medical necessity not established — missing documentation of conservative treatment failure or functional impairment
Operative note does not name the specific nerve or anatomic location, triggering specificity-based denials
Multiple same-session lesion excisions billed without modifier 59 or XS to distinguish separate sites
Global period conflict — E/M billed within 90 days without modifier 24 when visit is related to the original procedure
Missing or delayed pathology report required by payer for lesion excision claims

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 5 cited references ↓

01What distinguishes 64774 from soft-tissue or skin lesion excision codes like 11400-11406?

64774 is used when the lesion originates from or is directly attached to a somatic (cutaneous) nerve — such as a traumatic neuroma or nerve sheath tumor. Skin lesion excision codes apply to lesions arising from skin and subcutaneous tissue without nerve involvement. The operative note must confirm nerve origin to support 64774.

02Can 64774 be billed for excision of a neuroma at an amputation stump?

Yes. Traumatic neuromas resulting from amputation are a recognized indication. Document the amputation history, the specific nerve involved, symptoms (pain, hypersensitivity), and failure of conservative management before surgical excision.

03Can multiple 64774 units be billed if more than one nerve lesion is excised during the same session?

Yes, if each lesion is on a distinct nerve at a distinct anatomic site. Bill the highest-RVU service first, append modifier 51 to subsequent units, and add modifier 59 or XS to document separate sites. NCCI policy prohibits reporting multiple units for a single lesion excision.

04What is the global period for 64774, and what does it cover?

64774 carries a 90-day global period. It bundles the surgery, the day-before visit, and all routine postoperative care through day 90. Unrelated E/M services in that window need modifier 24; a new, unrelated surgical procedure requires modifier 79.

05Is a pathology report required for 64774?

CMS does not mandate it universally, but many commercial payers require histopathologic confirmation that excised tissue was submitted. Send the specimen routinely and note in the operative report that tissue was sent for pathology to avoid post-payment audits and retrospective denials.

06How does site of service affect reimbursement for 64774?

Payment differs meaningfully between office, ASC, and HOPD settings. The physician component is reduced when performed in a facility setting (ASC or HOPD) because the facility receives a separate payment. See the Site of Service comparison table on this page for the 2026 figures.

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 nerve name, anatomic site, lesion etiology (trauma, amputation, prior surgery), lesion size, and excision technique directly from the surgeon's dictation. That specificity prevents the most common denial trigger — operative notes that identify a 'skin lesion' without naming the underlying somatic nerve or documenting why surgical excision was medically necessary.

See how Mira captures CPT 64774 documentation