2025 CPT code 64866

Surgical connection (anastomosis) between the facial and spinal accessory nerves to restore facial motor function.

Refer to CPT coding guidelines for proper reporting of this and related procedures. Modifier -51 (Multiple Procedures) may apply if significant additional procedures are performed at the same surgical session.

Modifiers may be applicable. Common modifiers include -22 (Increased Procedural Services), -51 (Multiple Procedures) and others depending on the circumstances.

Medical necessity for this procedure must be established by demonstrating significant facial nerve dysfunction that impacts the patient's quality of life and for which conservative treatments have failed or are not suitable.

In simple words: A surgical procedure to connect the facial nerve with a nerve in the neck to help restore movement in the face after paralysis.

Anastomosis; facial-spinal accessory nerve.This procedure involves surgically connecting the facial nerve to the spinal accessory nerve to restore facial motor function lost due to injury or tumor. The procedure typically involves an incision in the neck to access the nerves, careful dissection and preparation of the nerve endings, and suturing the nerves together under magnification.

Example 1: A patient with facial paralysis due to a tumor removal undergoes a facial-spinal accessory nerve anastomosis to restore facial movement., Following a traumatic injury severing the facial nerve, a patient receives a facial-spinal accessory nerve anastomosis to regain facial function., A patient with Bell's Palsy that has not resolved with conservative treatment undergoes a facial-spinal accessory nerve anastomosis to improve facial symmetry and function.

Documentation should include the cause of facial nerve dysfunction, the surgical approach, details of the anastomosis, and any intraoperative complications.

** As of December 1st, 2024, this code is designated as an inpatient-only procedure by CMS. This information may change, it is advised to always verify the most current information with the relevant payers.

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