2025 CPT code 64999
(Active) Effective Date: N/A Revision Date: N/A Deletion Date: N/A Surgery - Surgical Procedures on the Nervous System Surgery Feed
Unlisted procedure, nervous system.
Modifiers may be applicable depending on the circumstances of the service. Consult the CPT guidelines for modifier usage.
The medical necessity for using code 64999 must be clearly documented and justified in the medical record. The documentation should demonstrate that the performed procedure was medically necessary and appropriate based on the patient's clinical condition.
The physician or other qualified healthcare professional performs a complex procedure on the nervous system not otherwise specified by a current CPT code.
In simple words: This code is for procedures on the nervous system that don't have their own specific code.Doctors use it when no other code fits what they did.They have to explain exactly what they did in detail.
This CPT code is used to report procedures on the nervous system that are not listed in the CPT codebook.It should only be used when no other specific code adequately describes the procedure performed.Detailed documentation, including a comparison to similar coded procedures, is crucial for proper reimbursement.
Example 1: A neurosurgeon performs a novel microsurgical technique to repair a complex nerve injury not previously encountered.The surgeon uses 64999 to bill for this unique procedure, submitting detailed operative notes and a comparison to similar nerve repair codes. , A neurologist performs an experimental neuromodulation procedure to treat chronic pain. Since no other code exists, the physician utilizes 64999,providing a comprehensive report documenting the procedure's steps, rationale, and comparison to existing techniques., During a craniotomy for a brain tumor, an unexpected vascular anomaly requires a specialized repair. The neurosurgeon employs 64999 and includes detailed operative notes describing the anomaly repair, comparing this situation to existing procedures such as aneurysm repair or vascular bypasses.
* Comprehensive operative notes describing the procedure in detail.* Preoperative and postoperative imaging studies (if applicable).* Justification for using the unlisted code, including comparison to similar existing codes.* Detailed explanation of the medical necessity for the procedure.* Patient's medical history and examination findings.
** When using 64999, thorough documentation is critical to avoid claim denials. The supporting documentation should provide enough detail for the payer to understand the nature, extent and medical necessity of the procedure.
- Revenue Code: P1G (MAJOR PROCEDURE - OTHER)
- RVU: This is dependent on local payer rules and the specific procedure performed.RVUs will need to be determined based on the documentation provided.
- Global Days: The global period will vary depending on the specific procedure performed. Refer to your local payer guidelines.
- Payment Status: Active
- Modifier TC rule: The applicability of a TC modifier depends on the specifics of the procedure.Additional information regarding the technical component versus professional component is necessary to determine modifier usage.
- Fee Schedule: Fee schedules for unlisted codes vary widely depending on the payer and the specific procedure. Documentation supporting the charge is crucial for reimbursement.
- Specialties:Neurosurgery, Neurology, Neurosurgery
- Place of Service:Inpatient Hospital, Outpatient Hospital, Ambulatory Surgical Center