CPT 64553
Status A Medicare calculates a national payment amount for this code and pays it separately when the service is covered. Full definition → Nationally priced under PFS, using the RVU formula.
Where the non-facility amount comes from
- Physician relative value file (PPRRVU) CMS download page PPRRVU24_JAN.csv in rvu24ar-posted-04-01-2024.zip · row 12,560 hcpcs = 64553 (col 1) · status_code = A (col 4) · work_rvu = 6.13 (col 6) · pe_rvu_nonfacility = 107.37 (col 7) · pe_rvu_facility = 5.06 (col 9) · mp_rvu = 2.55 (col 11)
- Physician relative value file (PPRRVU) CMS download page PPRRVU24_JAN.csv in rvu24ar-posted-04-01-2024.zip · row 11 conversion_factor = 33.2875 (col 25)
(work_rvu × work_gpci + pe_rvu × pe_gpci + mp_rvu × mp_gpci) × conversion_factor
= (6.13 × 1.000 + 107.37 × 1.000 + 2.55 × 1.000) × $33.2875 = $3,863.01
Where the facility amount comes from
- Physician relative value file (PPRRVU) CMS download page PPRRVU24_JAN.csv in rvu24ar-posted-04-01-2024.zip · row 12,560 hcpcs = 64553 (col 1) · status_code = A (col 4) · work_rvu = 6.13 (col 6) · pe_rvu_nonfacility = 107.37 (col 7) · pe_rvu_facility = 5.06 (col 9) · mp_rvu = 2.55 (col 11)
- Physician relative value file (PPRRVU) CMS download page PPRRVU24_JAN.csv in rvu24ar-posted-04-01-2024.zip · row 11 conversion_factor = 33.2875 (col 25)
(work_rvu × work_gpci + pe_rvu × pe_gpci + mp_rvu × mp_gpci) × conversion_factor
= (6.13 × 1.000 + 5.06 × 1.000 + 2.55 × 1.000) × $33.2875 = $457.37
How much did Medicare pay for CPT 64553 in Q1 2024? Copy link
Medicare paid $3,863.01 for CPT 64553 in the office (non-facility) setting and $457.37 in a facility under the Q1 2024 Physician Fee Schedule, effective January 2024. These are the national allowed amounts before the ~2% sequestration cut and before locality (GPCI) adjustment. Across payment localities, the office amount is $3,314.36–$5,400.80 and the facility amount is $384.31–$589.24. This is a 50.1% increase from the previous quarter.
Source: Physician relative value file (Q1 2024) · effective January 2024 · materially updated Aug 4, 2026 · compact facts
Why this amount?
- Status A (Active): Medicare calculates a national payment amount for this code and pays it separately when the service is covered.
- Q1 2024 conversion factor: $33.2875.
- National baseline uses GPCI 1.000 — enter a ZIP for your locality's payable amount.
CMS evidence · 2 sources
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Rates by locality Copy link
The amounts above use GPCI 1.000, a national baseline no locality actually bills at. Medicare rescales every code by the local Geographic Practice Cost Indices before paying it, so what 64553 pays depends on where the service is furnished. Tap a state for its localities.
64553 non-facility rate by metro area
Highest-paying metro first. Each figure is that payment locality's own GPCI-adjusted amount.
San Jose, CA
$5,388.91
San Francisco, CA
$5,331.40
Long Island, NY
$4,668.42
Seattle, WA
$4,645.61
Queens, NY
$4,612.44
Washington, DC
$4,575.13
Boston, MA
$4,566.68
Los Angeles, CA
$4,538.64
New York City, NY
$4,525.26
San Diego, CA
$4,515.05
Northern New Jersey, NJ
$4,493.53
Sacramento, CA
$4,390.16
Portland, OR
$4,207.31
Riverside, CA
$4,189.09
Baltimore, MD
$4,172.10
Miami, FL
$4,086.84
Suburban Chicago, IL
$4,083.19
Philadelphia, PA
$4,072.36
Chicago, IL
$4,033.06
Austin, TX
$4,020.12
Fort Lauderdale, FL
$3,921.23
Houston, TX
$3,911.31
Dallas, TX
$3,879.84
Detroit, MI
$3,874.54
Atlanta, GA
$3,863.16
Fort Worth, TX
$3,849.79
St. Louis, MO
$3,690.95
Kansas City, MO
$3,676.48
New Orleans, LA
$3,643.94
64553 facility rate by metro area
Highest-paying metro first. Each figure is that payment locality's own GPCI-adjusted amount.
Miami, FL
$589.24
Long Island, NY
$581.65
New York City, NY
$554.28
Chicago, IL
$549.08
Queens, NY
$542.69
Fort Lauderdale, FL
$522.39
Detroit, MI
$516.57
Washington, DC
$515.60
Suburban Chicago, IL
$514.08
Northern New Jersey, NJ
$502.12
San Jose, CA
$501.81
Baltimore, MD
$500.82
San Francisco, CA
$498.79
Houston, TX
$495.45
Seattle, WA
$490.72
Boston, MA
$490.12
Philadelphia, PA
$486.22
Los Angeles, CA
$472.30
Atlanta, GA
$467.73
Riverside, CA
$466.72
New Orleans, LA
$459.66
San Diego, CA
$458.92
Austin, TX
$457.82
Sacramento, CA
$453.24
Fort Worth, TX
$450.96
Portland, OR
$450.89
Dallas, TX
$450.35
St. Louis, MO
$448.78
Kansas City, MO
$447.93
Q1 2024 amounts, computed with each locality's own GPCIs, before the ~2% sequestration cut. A state with more than one payment locality shows a range — its tile is colored by the mean across those localities, which is a shading choice, not an amount anyone is paid.
How this amount is computed Copy link
CPT 64553 has a work RVU of 6.13, a non-facility practice expense RVU of 107.37, a facility practice expense RVU of 5.06 and a malpractice RVU of 2.55 — for total non-facility RVUs of 116.05 and total facility RVUs of 13.74 in the Q1 2024 release.
amount = (work RVU × work GPCI + PE RVU × PE GPCI + MP RVU × MP GPCI) × conversion factor. National amounts use GPCI = 1.000. To price an RVU figure of your own, use the RVU-to-dollars converter.
| Component | RVU |
|---|---|
| Work RVU | 6.13 |
| Practice expense RVU (non-facility) | 107.37 |
| Practice expense RVU (facility) | 5.06 |
| Malpractice RVU | 2.55 |
Every rate combines three parts: work (the clinician’s time, skill and effort), practice expense (office overhead — higher when the service is done in a doctor’s own office), and malpractice (the share of liability-insurance cost). A blank means CMS publishes no national number for that part. Read it as unknown, and never as zero.
What does 64553 cost? Copy link
Four numbers get called the cost of a code. Each answers a different question.
Computed from the Q1 2024 CMS release
- Medicare allowed amount
- $3,863.01
- Medicare's share
- $3,090.41
- Patient coinsurance
- $772.60
- Limiting charge
- $4,220.34
What Medicare recognizes as the full price for 64553 in the office (non-facility) setting. Every figure below derives from it.
80% of the allowed amount, before the ~2% sequestration cut.
The remaining 20%, once the annual Part B deductible is met. Medigap or Medicaid often covers it.
The ceiling a non-participating provider can bill a patient on an unassigned claim — 109.25% of the allowed amount.
National Q1 2024 figures at GPCI 1.000. Adjust for your locality and sequestration, or see the questions below for each figure in full.
Common questions Copy link
Is $3,863.01 what a practice actually receives?
It's the national allowed amount — the starting point. Medicare pays 80% of it ($3,090.41) and the patient owes 20% coinsurance ($772.60). Sequestration trims Medicare's share by about 2%, your locality's GPCIs scale the total up or down, and the expected-payment calculator applies all three. What lands is practice revenue: staff, space, equipment and billing, not clinician take-home pay. The practice-expense RVU above is CMS's estimate of that overhead share.
Sources: Budget Control Act sequestration provisions; CMS Medicare Fee-for-Service payment guidance; CMS Geographic Practice Cost Index (GPCI) files; CMS Physician Fee Schedule overview (cms.gov).
Why are the facility and non-facility amounts different?
Only the practice-expense RVU changes with the setting. For 64553 it's 107.37 RVUs in the office versus 5.06 in a facility — the whole $3,405.64 gap between $3,863.01 and $457.37. In an office the practice bears the overhead, so Medicare pays more; in a hospital or ASC the facility bills its own fee, so the professional payment is lower. See facility vs non-facility.
Sources: CMS Medicare Physician Fee Schedule Relative Value Files; CMS Practice Expense methodology (cms.gov).
What's the non-participating amount for 64553?
$3,669.86 in the office (non-facility) setting — 95% of the $3,863.01 participating fee schedule amount above. A participating provider takes the fee schedule amount as payment in full on every claim. A non-participating provider is paid this reduced amount, but chooses claim by claim whether to accept assignment. See participating vs non-participating.
Sources: CMS Physician Fee Schedule overview (cms.gov); CMS Medicare Fee-for-Service payment guidance.
What's the limiting charge for 64553?
$4,220.34 in the office (non-facility) setting — the ceiling on what a non-participating provider can bill the patient on an unassigned claim. That's 109.25% of the $3,863.01 amount above. The non-participating amount is 95% of the fee schedule rate ($3,669.86), and the statutory cap is 115% of that. See limiting charge.
Sources: CMS Physician Fee Schedule overview (cms.gov); CMS Medicare Fee-for-Service payment guidance.
Why would a Medicare claim for 64553 be denied or paid less?
These come from CMS indicators on this page, not general billing advice.
- 64553 carries a 10-day global period — routine post-operative care within that window is included in the surgical payment rather than paid on its own claim. See how it's computed
- Bilateral surgery: no bilateral adjustment. See billing policy
- Assistant at surgery: restricted without documentation. See billing policy
- Co-surgeons: not permitted. See billing policy
- Team surgery: not permitted. See billing policy
- Multiple procedures: standard reduction applies. See billing policy
Payer-specific coverage and documentation rules live outside these files, so a claim that clears every check here can still be denied on other grounds.
When does this rate change?
CMS publishes a fee schedule release every quarter (January, April, July, October), and each is versioned here. The 64553 rate last moved in Q1 2026 (+34.0% non-facility) — see its rate history or what changed each release, or get an email when a new release moves rates.
Sources: CMS Medicare Physician Fee Schedule Relative Value Files.
Applicable payment rules Copy link
Only the rules that can matter for 64553, each linking to its detail on this page.
Global period: what 64553's fee already covers Copy link
The fee covers pre-operative work on the day of the procedure plus related follow-up care for the next 10 days. Related visits inside that window are not billed separately.
Billing a related follow-up visit inside the 10-day window is the most common way this code gets denied — the payment for that care is already inside the 64553 fee.
| Modifier | Reports |
|---|---|
| -25 | A significant, separately identifiable E/M on the same day as the procedure, beyond its usual pre- and post-operative care. |
| -24 | An E/M during the follow-up window that is unrelated to this surgery, so it is paid separately. |
| -58 | A staged or more extensive follow-on procedure during the window. Starts a new follow-up period. |
| -78 | An unplanned return to the operating room for a related procedure during the window. Does not start a new follow-up period. |
| -79 | An unrelated procedure by the same physician during the window. Starts a new follow-up period. |
A modifier reports what happened; it does not by itself make a service payable. Documentation has to support it.
Billing policy Copy link
What 64553's billing-policy indicators mean. These show for every code, priced or not: a restriction like "bilateral not allowed" still matters on a carrier-priced code. See modifier amounts below for the dollar figures these support.
| Policy | Value | What it means |
|---|---|---|
| Bilateral surgery | 0 | No bilateral adjustment. The 150% bilateral payment adjustment does not apply to this procedure. |
| Assistant at surgery | 0 | Restricted without documentation. Payment for an assistant at surgery is restricted for this procedure unless supporting documentation establishes medical necessity. |
| Co-surgeons | 0 | Not permitted. Medicare does not recognize co-surgeons (modifier 62) for this procedure. |
| Team surgery | 0 | Not permitted. Medicare does not recognize a surgical team (modifier 66) for this procedure. |
| Multiple procedures | 2 | Standard reduction applies. The same standard ranking-and-reduction rule as indicator 1 applies to this procedure when billed with others on the same date. |
| Professional/technical split | 0 | No PC/TC split. This is a physician service code; the professional/technical split does not apply, and the code is billed as a single service. |
Modifier amounts: -26/TC, -50, -80/81/82, -AS, -62, -66 Copy link
National non-facility amounts for the modifiers this code's indicators support. Single-line modifiers only. -51 (multiple-procedure reduction) depends on the other codes on the same claim, so it's a claim-level number rather than a per-code one. Use the calculator for a locality-adjusted, sequestration-aware amount.
| Modifier | What it means | Amount |
|---|---|---|
| -26/TC | Professional/technical split | Not payable |
| -50 | Bilateral procedure | Not payable |
| -80/81/82 | Assistant surgeon (physician) | Not payable |
| -AS | Assistant at surgery (PA, NP, or CNS) | Not payable |
| -62 | Co-surgeons, each | Not payable |
| -66 | Team surgery | Not payable |
These apply standard MPFS percentages — assistant surgeon 16%, co-surgeon 62.5%, bilateral 150% — to the national non-facility amount above, so its source citation covers them too. They are derived here rather than read from a CMS column: check them against the current Medicare Claims Processing Manual before relying on them for payment.
Can you bill it with another code? Copy link
Enter a second CPT or HCPCS code billed on the same date of service. We'll check the current NCCI procedure-to-procedure edit between it and 64553.
Rate history by release Copy link
National non-facility amount for 64553 across quarterly releases. +2,179.1% increase since Q2 2014 · high $4,841.46 in Q1 2026
| Release | Status | Non-facility | Facility |
|---|---|---|---|
| Q3 2026 Jul 1, 2026 – present | A | $4,841.46 (0.0% no change ) | $450.91 (0.0% no change ) |
| Q2 2026 Apr 1, 2026 – Jun 30, 2026 | A | $4,841.46 (0.0% no change ) | $450.91 (0.0% no change ) |
| Q1 2026 Jan 1, 2026 – Mar 31, 2026 | A | $4,841.46 (+34.0% increase ) | $450.91 (+1.1% increase ) |
| Q4 2025 Oct 1, 2025 – Dec 31, 2025 | A | $3,614.07 (0.0% no change ) | $446.06 (0.0% no change ) |
| Q3 2025 Jul 1, 2025 – Sep 30, 2025 | A | $3,614.07 (0.0% no change ) | $446.06 (0.0% no change ) |
| Q2 2025 Apr 1, 2025 – Jun 30, 2025 | A | $3,614.07 (0.0% no change ) | $446.06 (0.0% no change ) |
| Q1 2025 Jan 1, 2025 – Mar 31, 2025 | A | $3,614.07 (-6.4% decrease ) | $446.06 (-2.5% decrease ) |
| Q4 2024 Oct 1, 2024 – Dec 31, 2024 | A | $3,863.01 (0.0% no change ) | $457.37 (0.0% no change ) |
| Q3 2024 Jul 1, 2024 – Sep 30, 2024 | A | $3,863.01 (0.0% no change ) | $457.37 (0.0% no change ) |
| Q2 2024 Apr 1, 2024 – Jun 30, 2024 | A | $3,863.01 (0.0% no change ) | $457.37 (0.0% no change ) |
| Q1 2024 Jan 1, 2024 – Mar 31, 2024 | A | $3,863.01 (+50.1% increase ) | $457.37 (+15.6% increase ) |
| Q4 2023 Oct 1, 2023 – Dec 31, 2023 | A | $2,574.07 (0.0% no change ) | $395.80 (0.0% no change ) |
| Q3 2023 Jul 1, 2023 – Sep 30, 2023 | A | $2,574.07 (0.0% no change ) | $395.80 (0.0% no change ) |
| Q2 2023 Apr 1, 2023 – Jun 30, 2023 | A | $2,574.07 (0.0% no change ) | $395.80 (0.0% no change ) |
| Q1 2023 Jan 1, 2023 – Mar 31, 2023 | A | $2,574.07 (-3.0% decrease ) | $395.80 (+2.6% increase ) |
| Q4 2022 Oct 1, 2022 – Dec 31, 2022 | A | $2,653.60 (0.0% no change ) | $385.86 (0.0% no change ) |
| Q3 2022 Jul 1, 2022 – Sep 30, 2022 | A | $2,653.60 (0.0% no change ) | $385.86 (0.0% no change ) |
| Q2 2022 Apr 1, 2022 – Jun 30, 2022 | A | $2,653.60 (0.0% no change ) | $385.86 (0.0% no change ) |
| Q1 2022 Jan 1, 2022 – Mar 31, 2022 | A | $2,653.60 (+6.2% increase ) | $385.86 (+4.2% increase ) |
| Q4 2021 Oct 1, 2021 – Dec 31, 2021 | A | $2,498.00 (0.0% no change ) | $370.22 (0.0% no change ) |
| Q3 2021 Jul 1, 2021 – Sep 30, 2021 | A | $2,498.00 (0.0% no change ) | $370.22 (0.0% no change ) |
| Q2 2021 Apr 1, 2021 – Jun 30, 2021 | A | $2,498.00 (0.0% no change ) | $370.22 (0.0% no change ) |
| Q1 2021 Jan 1, 2021 – Mar 31, 2021 | A | $2,498.00 (+20.4% increase ) | $370.22 (-0.3% decrease ) |
| Q4 2020 Oct 1, 2020 – Dec 31, 2020 | A | $2,075.15 (0.0% no change ) | $371.36 (0.0% no change ) |
| Q3 2020 Jul 1, 2020 – Sep 30, 2020 | A | $2,075.15 (0.0% no change ) | $371.36 (0.0% no change ) |
| Q2 2020 Apr 1, 2020 – Jun 30, 2020 | A | $2,075.15 (0.0% no change ) | $371.36 (0.0% no change ) |
| Q1 2020 Jan 1, 2020 – Mar 31, 2020 | A | $2,075.15 (+18.0% increase ) | $371.36 (+1.2% increase ) |
| Q4 2019 Oct 1, 2019 – Dec 31, 2019 | A | $1,759.07 (0.0% no change ) | $366.88 (0.0% no change ) |
| Q3 2019 Jul 1, 2019 – Sep 30, 2019 | A | $1,759.07 (0.0% no change ) | $366.88 (0.0% no change ) |
| Q2 2019 Apr 1, 2019 – Jun 30, 2019 | A | $1,759.07 (0.0% no change ) | $366.88 (0.0% no change ) |
| Q1 2019 Jan 1, 2019 – Mar 31, 2019 | A | $1,759.07 (+52.0% increase ) | $366.88 (-6.8% decrease ) |
| Q4 2018 Oct 1, 2018 – Dec 31, 2018 | A | $1,157.03 (0.0% no change ) | $393.48 (0.0% no change ) |
| Q3 2018 Jul 1, 2018 – Sep 30, 2018 | A | $1,157.03 (0.0% no change ) | $393.48 (0.0% no change ) |
| Q2 2018 Apr 1, 2018 – Jun 30, 2018 | A | $1,157.03 (0.0% no change ) | $393.48 (0.0% no change ) |
| Q1 2018 Jan 1, 2018 – Mar 31, 2018 | A | $1,157.03 (+458.7% increase ) | $393.48 (+152.0% increase ) |
| Q4 2017 Oct 1, 2017 – Dec 31, 2017 | A | $207.08 (0.0% no change ) | $156.12 (0.0% no change ) |
| Q3 2017 Jul 1, 2017 – Sep 30, 2017 | A | $207.08 (0.0% no change ) | $156.12 (0.0% no change ) |
| Q2 2017 Apr 1, 2017 – Jun 30, 2017 | A | $207.08 (0.0% no change ) | $156.12 (0.0% no change ) |
| Q1 2017 Jan 1, 2017 – Mar 31, 2017 | A | $207.08 (-2.8% decrease ) | $156.12 (-2.7% decrease ) |
| Q4 2016 Oct 1, 2016 – Dec 31, 2016 | A | $213.04 (0.0% no change ) | $160.40 (0.0% no change ) |
| Q3 2016 Jul 1, 2016 – Sep 30, 2016 | A | $213.04 (0.0% no change ) | $160.40 (0.0% no change ) |
| Q2 2016 Apr 1, 2016 – Jun 30, 2016 | A | $213.04 (0.0% no change ) | $160.40 (0.0% no change ) |
| Q1 2016 Jan 1, 2016 – Mar 31, 2016 | A | $213.04 (-2.7% decrease ) | $160.40 (-3.0% decrease ) |
| Q4 2015 Oct 1, 2015 – Dec 31, 2015 | A | $218.84 (+0.5% increase ) | $165.29 (+0.5% increase ) |
| Q3 2015 Jul 1, 2015 – Sep 30, 2015 | A | $217.75 (0.0% no change ) | $164.47 (0.0% no change ) |
| Q2 2015 Apr 1, 2015 – Jun 30, 2015 | A | $217.75 (0.0% no change ) | $164.47 (0.0% no change ) |
| Q1 2015 Jan 1, 2015 – Mar 31, 2015 | A | $217.75 (+2.5% increase ) | $164.47 (+3.2% increase ) |
| Q4 2014 Oct 1, 2014 – Dec 31, 2014 | A | $212.43 (0.0% no change ) | $159.41 (0.0% no change ) |
| Q3 2014 Jul 1, 2014 – Sep 30, 2014 | A | $212.43 (0.0% no change ) | $159.41 (0.0% no change ) |
| Q2 2014 Apr 1, 2014 – Jun 30, 2014 | A | $212.43 | $159.41 |
Contracted rate: % of Medicare Copy link
Commercial payer contracts usually price off the Medicare amount above ("BCBS pays 115% of Medicare"). Enter your contract's percentage below to see what 64553 pays at that rate — $3,863.01 is 100%.
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How often 64553 is billed Copy link
Across Original Medicare in CY2024, 64553 ranked #4,333 of the 7,879 CPT codes billed to Medicare that year, by patients served or total allowed dollars.
2024 Medicare fee-for-service national totals. They exclude Medicare Advantage, Medicaid and commercial volume, so real-world use runs higher. This is a calendar-year snapshot from the CMS Physician & Other Practitioners dataset, on a different cycle from the Q1 2024 fee schedule above.
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Source & method
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This is computed from CMS's Medicare Physician Fee Schedule Q1 2024 release (schedule pfs, effective January 2024). National amounts apply a GPCI of 1.000 and leave sequestration off. The status indicator decides payability, never the RVU values, so a blank RVU stays blank. Releases are immutable: a rate retrieved for a past quarter always reflects that release. Modifier amounts apply standard MPFS percentages to this code's billing indicators. We derive them here rather than read them from CMS, so confirm them against the current Claims Processing Manual before relying on them for payment. Our methodology covers the depth: sourcing, parsing, versioning, and how we cross-check claims before they ship.
Conversion factor $33.2875 read from the same file, row 11, column 25.
Use the (i) buttons next to each amount above for the exact row, columns, and math.
Cite this rate
This link keeps pointing at the Q1 2024 figures, even after a newer release lands.
CPT 64553 Medicare Physician Fee Schedule rate: $3,863.01 (Q1 2024). Localis. https://localishealth.com/cpt/64553/2024/A