Unlisted code for a nervous system procedure that has no specific CPT code, priced by the payer case by case from submitted documentation.
- Medicare
- $0.00
- Work RVU
- 0
- Global, days
- Region
- General
Documentation requirements
What must appear in the operative or office note to support the claim.
Source · Editorial brief grounded in 2 cited references ↓
- Detailed operative or procedure note
- Explanation of why no specific code fits
- Comparison CPT code with similar work and time
- Medical necessity and failed prior treatments
- Time, approach, and nerves treated
- Prior authorization if required
Applicable modifiers
Modifiers commonly billed with this code.
Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual
What this code covers
Source · Editorial summary grounded in 2 cited references ↓
64999 is the catch-all for nerve procedures with no specific CPT or Category III code. It has no fixed fee or global period. The payer prices it manually from the operative note and a comparison code you supply.
Ortho practices most often reach for it with newer peripheral nerve procedures, such as nerve procedures in the hand and foot that the CPT book does not describe. Before using it, check whether a specific code or a Category III code now exists. SI joint RFA used to go here and now has 64625. Genicular nerve ablation has its own code too, 64624.
Unlisted claims usually need to be sent with the operative report, a cover letter explaining the procedure, and a comparable code with similar work and time to justify the charge. Expect a longer turnaround. Many payers require prior authorization, and some will deny an unlisted procedure as investigational without one.
RVU & reimbursement
Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.
Source · CMS Physician Fee Schedule, RVU26A · January 2026
| Work RVU | 0 |
| Practice expense RVU | 0 |
| Malpractice RVU | 0 |
| Total RVU | 0 |
| Medicare national rate | $0.00 |
| Global period | 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 | $0.00 |
HOPD (APC 5441) Hospital outpatient department | $313.60 |
Common denial reasons
The recurring reasons claims for CPT 64999 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Specific CPT or Category III code exists for the service
- No operative report or cover letter attached
- Payer considers the procedure investigational
- No comparison code to price against
- Missing prior authorization
- Charge not supported by the comparison code
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 2 cited references ↓
01How is 64999 paid?
02What should be sent with a 64999 claim?
03Is SI joint RFA still billed with 64999?
Sources & references
Editorial content was developed using the following public sources.
- 01CMS Physician Fee Schedule 2026
- 02cms.govhttps://www.cms.gov/medicare/payment/fee-schedules/physician
Mira Scribe
Mira Scribe procedure notes describe what was done and why in clear language, which is the core of any unlisted-code submission.
See how Mira captures CPT 64999 documentation