2025 CPT code 64864

Surgical repair of a damaged facial or extracranial nerve.

Adhere to the most recent CPT coding guidelines, especially those pertaining to surgical procedures on the nervous system.Proper documentation is crucial for accurate coding.

Modifiers may be applicable depending on the circumstances of the surgery.Examples include modifiers for multiple procedures (51), increased procedural services (22), or assistant surgeons (80, 81, 82). Consult the CPT codebook for specific guidance and payer guidelines.

Medical necessity is established when a patient has demonstrable nerve damage causing functional impairment (e.g., facial weakness, paralysis) that would benefit from surgical repair.Documentation must clearly demonstrate the extent of the deficit and the patient’s need for surgical intervention.

The clinical responsibility rests with a surgeon (neurosurgeon or plastic surgeon, depending on the location of the nerve injury). The surgeon prepares the patient, makes the incision, locates and repairs the nerve, and closes the incision.Anesthesiologist may also be involved.

IMPORTANT Related codes include 64865 (suture of facial nerve; infratemporal, with or without grafting), 64866 (anastomosis; facial-spinal accessory), 64868 (anastomosis; facial-hypoglossal), 64885 and 64886 (nerve graft, head or neck, with varying lengths), and others depending on the specific circumstances of the nerve injury and repair technique used.

In simple words: The doctor repairs a damaged facial nerve or a nerve outside the skull. This might be needed because of an injury, infection, or other problem. The doctor makes a cut (or uses an existing wound), fixes the nerve, and closes the area.

This CPT code encompasses the surgical repair of a damaged facial or extracranial nerve.The procedure involves locating the damaged nerve, preparing the nerve ends for repair by cleaning them, aligning the nerve endings, and suturing them together.Additional sutures may be required depending on the nerve's size.A nerve graft or nerve reconstruction may also be necessary.The surgical site is then closed with sutures.Graft harvesting, reconstruction, and closure are reported separately.

Example 1: A patient sustains a laceration to the face resulting in damage to the facial nerve branches.The surgeon performs a neurorrhaphy to repair the nerve, aiming to restore facial muscle function. , A patient undergoes parotidectomy (removal of the parotid gland) that results in accidental facial nerve damage.The surgeon performs an extracranial neurorrhaphy to restore the nerve’s continuity. , A patient with a history of Bell's palsy undergoes surgical exploration and repair of the extracranial portion of the facial nerve due to persistent nerve dysfunction. The surgeon performs a neurorrhaphy using microsurgical techniques.

Detailed operative notes describing the location and extent of the nerve injury, the technique used for repair (including suture type and number, use of nerve graft), and postoperative management. Preoperative imaging (e.g., MRI, CT) demonstrating the nerve damage, pathology reports (if applicable) and any other relevant diagnostic information.

** The specific surgical approach (e.g., open, endoscopic) and the use of adjunctive techniques (e.g., nerve grafts, microsurgical techniques) should be considered for accurate coding.Accurate documentation of the extent of the nerve repair and the type of surgical repair performed is essential for appropriate reimbursement.

  • Revenue Code: P1G (MAJOR PROCEDURE - OTHER)
  • RVU: This information requires access to a specific payer's fee schedule and is not consistently available across all payers. RVUs vary widely based on geographic location, facility type, and other factors.
  • Global Days : The global surgical period is not explicitly defined for this code.It varies based on the complexity of the surgery and the payer's specific guidelines.Clarification should be sought from the payer.
  • Payment Status: Active
  • Modifier TC rule: The application of a technical component (TC) modifier is not typically required for this code, as it usually represents the entire service performed by the surgeon.
  • Fee Schedule : Historical fee schedule data is not included here and is dependent upon specific payer contracts, location, and date of service.
  • Specialties:Neurosurgery, Plastic Surgery, Otolaryngology
  • Place of Service:Inpatient Hospital, Outpatient Hospital, Ambulatory Surgical Center
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