CPT 64790 Peripheral Nerve Sheath Tumor Reimbursement | OpenPayer

Summary & Overview

CPT 64790: Excision of Peripheral Nerve Sheath Tumor

CPT code 64790 represents surgical excision of a tumor located along or within the nerve sheath of a major peripheral nerve. This operative code captures a specialized neurosurgical or peripheral nerve surgery procedure performed in an operating room or ambulatory surgical center and is used in claims for removal of nerve sheath neoplasms such as schwannomas when they involve major peripheral nerves. Nationally, accurate coding for these procedures matters for clinical tracking, appropriate resource allocation, and consistent payment across commercial and public payers.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical context for CPT code 64790, typical sites of service, and the kinds of benchmarks and billing considerations commonly reviewed by payers and provider billing teams. The publication summarizes payment and utilization benchmarks where available, highlights policy and documentation elements that commonly affect claims processing, and provides clinical context to help coding specialists and surgical teams align operative reports with billing. Data not available in the input is noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 64790peripheral nerve surgerynerve sheath tumorsurgical excisionneurosurgeryambulatory surgical centeroperating roomprocedure codingbilling compliance

Billing Code Overview

CPT code 64790 describes surgical excision of a tumor arising from the nerve sheath of a major peripheral nerve. This procedure involves removal of a neoplasm located along or within the protective sheath of a large peripheral nerve.

Service type: Surgical excision of peripheral nerve sheath tumor
Typical site of service: Hospital operating room or ambulatory surgical center where major peripheral nerve surgeries are performed.

Clinical & Coding Specifications

Clinical Context

A 46-year-old outpatient presents with progressive numbness, paresthesia, and a palpable mass along the volar aspect of the forearm consistent with a peripheral nerve sheath tumor. Imaging with MRI demonstrates a well-circumscribed enhancing lesion contiguous with the median nerve. After preoperative evaluation and informed consent, the patient is scheduled for surgical excision of the nerve sheath tumor under general anesthesia. Intraoperative steps include exposure of the affected nerve, microsurgical dissection to separate tumor from viable nerve fascicles, tumor excision (enucleation or segmental resection if necessary), hemostasis, and layered wound closure. Postoperative workflow includes neuropathic pain management, wound checks, pathology evaluation of the excised lesion, and referral to physical therapy for range-of-motion and nerve gliding exercises. Typical site of service is an ambulatory surgical center or hospital operating room. The service type is operative peripheral nerve tumor excision performed by neurosurgery, orthopedic hand surgery, or peripheral nerve/plastic surgery specialists. Common postoperative considerations include neurologic monitoring, neuropraxia that may resolve over weeks to months, and surveillance imaging if malignancy or recurrence is suspected.

Coding Specifications

The following modifiers are most clinically relevant to 64790 and are described for appropriate reporting.

Modifier	Description	When to Use

CPT 64795: Nerve Biopsy, Excision of Nerve Sample

CPT-64774-NERVE-TUMOR-EXCISION-PERIPHERAL-NERVE

CPT 64774: Excision of Tumor from Mixed Peripheral Nerve

CPT-64782-PERIPHERAL-NERVE-TUMOR-EXCISION-HAND-FOOT

CPT 64782: Excision of Peripheral Nerve Tumor, Hand or Foot

CPT-64776-DIGITAL-NERVE-TUMOR-EXCISION-FINGER-TOE

CPT 64776: Excision of Tumor or Mass on Digital Nerve (Finger/Toe)

CPT-64792-NERVE-SHEATH-TUMOR-EXCISION-EXTENSIVE

CPT 64792: Excision of Extensive Nerve Sheath Tumor

CPT-64778-PERIPHERAL-NERVE-TUMOR-EXCISION-ADDITIONAL-DIGIT

CPT 64778: Excision of Additional Peripheral Nerve Tumor in Finger or Toe

CPT-64786-SCIATIC-NERVE-TUMOR-EXCISION

CPT 64786: Sciatic Nerve Tumor Excision

CPT-64783-PERIPHERAL-NERVE-NEUROMA-EXCISION-HAND-FOOT-ADDITIONAL

CPT 64783: Additional Peripheral Nerve Neuroma Excision of Hand or Foot

CPT-64788-EXCISION-SUBCUTANEOUS-TUMOR-CUTANEOUS-NERVE

CPT 64788: Excision of Subcutaneous Tumor Along Cutaneous Nerve

CPT-64784-PERIPHERAL-NERVE-TUMOR-EXCISION

CPT 64784: Peripheral Nerve Tumor Excision, Non-Sciatic

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Taxonomy Code	Specialty	Notes
2086S0001X	Neurosurgery	Peripheral nerve tumor excision commonly performed by neurosurgeons with peripheral nerve expertise.
206E00000X	Orthopedic Hand Surgery	Hand and upper-extremity orthopedic surgeons often perform nerve sheath tumor excisions in the extremities.
208800000X	Plastic Surgery	Reconstructive plastic surgeons perform excision with nerve repair or soft-tissue reconstruction when needed.
207P00000X	Neurology (Consulting)	Neurologists provide preoperative electrodiagnostic assessment but do not perform the procedure.
3336C0001X	Pain Medicine (Perioperative management)	Pain specialists may be involved in complex perioperative neuropathic pain management.

Related Diagnoses

No ICD-10 codes were provided in the input. The following are commonly associated diagnoses for peripheral nerve sheath tumor excision.

ICD-10 Code	Description	Clinical Relevance
`D36.1`	Benign neoplasm of peripheral nerves and autonomic nervous system	Primary diagnosis for benign nerve sheath tumors such as schwannoma or neurofibroma targeted by `64790`.
`C47.9`	Malignant neoplasm of peripheral nerves and autonomic nervous system, unspecified	Used when pathology demonstrates malignancy (e.g., malignant peripheral nerve sheath tumor) requiring excision and possible oncologic follow-up.
`M79.6`	Pain in limb	Symptom code used when neuropathic limb pain prompts evaluation and surgical intervention.
`G57.0`	Lesion of sciatic nerve	Relevant when tumor involves a named major peripheral nerve such as the sciatic nerve.
`G56.0`	Carpal tunnel syndrome	Included when tumor involvement causes median nerve compression at the wrist requiring excision and decompression.
`G56.2`	Lesion of ulnar nerve	Relevant for tumors involving the ulnar nerve at the elbow or forearm.
`R22.2`	Localized swelling, mass and lump, trunk	Symptom/physical finding code when a palpable mass prompts imaging and excision.

Related CPT Codes

The following CPT codes are commonly performed alongside or in the perioperative management of a peripheral nerve sheath tumor excision.

CPT Code	Description	Relationship to This Procedure
`64718`	Neuroplasty and/or transposition; median nerve at carpal tunnel	Performed when decompression or neurolysis of the median nerve is indicated either concurrently if tumor involves carpal tunnel or as a staged procedure.
`64831`	Repair of single peripheral nerve; end-to-end anastomosis, without nerve graft	Used when segmental nerve resection during tumor excision requires primary neurorrhaphy.
`64864`	Repair/transfer of median nerve with prosthesis, etc. (note: illustrative of nerve reconstruction; specific code selection depends on technique)	Selected when nerve reconstruction beyond simple repair is required; verify exact code per technique.
`64727`	Neuroplasty and/or transposition; ulnar nerve at elbow	Relevant when tumor involves or requires decompression/transposition of the ulnar nerve in the same setting.
`20610`	Arthrocentesis, aspiration and/or injection; major joint or bursa (e.g., for diagnostic or symptomatic management)	May be used for perioperative joint/bursa injections when pain management adjacent to operative site is necessary.

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