2025 CPT code 64865
(Active) Effective Date: N/A Revision Date: N/A Deletion Date: N/A Surgery - Neurorrhaphy Procedures Surgical Procedures on the Nervous System Feed
Surgical repair of the facial nerve in the infratemporal region, with or without grafting.
Modifiers may be applicable based on the specific circumstances of the procedure (e.g., 59 for distinct procedural service, 22 for increased procedural services, 51 for multiple procedures). Consult the CPT codebook and your payer's guidelines.
Surgical repair of a damaged or severed facial nerve is medically necessary to restore motor and sensory function and improve the patient's quality of life.The procedure is indicated when conservative management has failed or is not appropriate given the severity of the injury.
The neurosurgeon or otolaryngologist is typically responsible for this procedure.This includes patient preparation, surgical approach, nerve repair or grafting, and wound closure. Post-operative care may involve follow-up appointments to monitor recovery and address complications.
- Surgical Procedures on the Nervous System
- Surgical Procedures on the Extracranial Nerves, Peripheral Nerves, and Autonomic Nervous System; Neurorrhaphy Procedures
In simple words: The doctor repairs a damaged facial nerve near the temple, possibly using a nerve graft from another part of the body to bridge a gap. This helps restore facial movement and sensation.
This procedure involves the surgical repair of a damaged or severed facial nerve located in the infratemporal fossa (below the temple).The surgeon accesses the nerve, typically through an existing wound or a new incision in the temple region.The nerve ends are meticulously mobilized, trimmed to expose healthy tissue, and precisely sutured together under magnification.If the nerve gap is too large due to damage or tumor resection, a nerve graft (such as sural nerve or great auricular nerve) is harvested from a donor site, prepared, and meticulously sutured to bridge the defect.The donor site is then closed. The graft is carefully positioned to ensure proper innervation and protected from compression or trauma. The wound is closed.
Example 1: A patient presents after a motorcycle accident with a complete transection of the facial nerve in the temporal region.Code 64865 is used to document the repair of the facial nerve with a sural nerve graft., A patient undergoes a parotidectomy (removal of the parotid gland) for a benign tumor. During the procedure, the facial nerve is damaged.A neurorrhaphy with possible grafting (code 64865) is performed to restore nerve continuity., A patient with a history of facial nerve palsy undergoes an exploration of the infratemporal fossa to assess the facial nerve. The surgeon finds a section of the nerve to be severely damaged and performs a neurorrhaphy with a nerve graft.
* Preoperative imaging (e.g., MRI, CT scan) showing the extent of nerve damage.* Operative report detailing the surgical approach, nerve repair technique, graft used (if any), and assessment of nerve continuity.* Intraoperative photographs.* Postoperative imaging to confirm proper placement of the graft.* Documentation of patient's neurological status pre- and postoperatively.
** Accurate documentation is crucial for appropriate coding and reimbursement.The choice of nerve graft and surgical technique will vary depending on the individual case.Always refer to the most current CPT coding guidelines and payer-specific policies.
- Revenue Code: P1G (Major Procedure - Other)
- RVU: Information not available in provided source.Consult the AMA CPT codebook or your payer's fee schedule for RVU information.
- Global Days : Information not available in provided source. The global period will vary depending on payer and specific circumstances.
- Payment Status: Active
- Modifier TC rule: The TC (Technical Component) modifier is not usually applicable for 64865, as the entire procedure is typically considered the professional component.However, payer-specific rules may vary.
- Fee Schedule : Information not available in provided source. Consult historical CPT fee schedules or your payer's historical data for this information.
- Specialties:Neurosurgery, Otolaryngology
- Place of Service:Inpatient Hospital, Outpatient Hospital, Ambulatory Surgical Center