Summary & Overview
CPT 64864: Repair of Facial Nerve or Nerve in External Cranium
CPT code 64864 represents surgical repair of a facial nerve or a nerve in the external cranium, performed to address functional deficits from trauma, lesions, infection, or other insults. This code captures a specialized microsurgical procedure with implications for motor and sensory restoration in the head and face. Nationally, procedures coded with 64864 are clinically significant because they affect facial movement, expression, and oral competence, and they can require multidisciplinary care including neurosurgery, otolaryngology, and plastic/reconstructive surgery.
Key payers included in the analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of what the code denotes, typical sites of service, and which major payers are relevant for coverage and billing discussions. The publication outlines clinical context for use of 64864, common billing considerations, and where readers can expect to find benchmarking and policy updates related to nerve repair procedures. Where specific input data are missing, the text notes "Data not available in the input." The goal is to provide clinicians, coders, and policy professionals with a clear national-level summary of clinical scope and payer relevance for CPT code 64864.
Billing Code Overview
CPT code 64864 describes repair of facial nerve or nerve in the external cranium, addressing damage caused by trauma, lesions, infection, or other conditions. The procedure involves microsurgical or surgical repair techniques to restore continuity or function of the affected cranial or facial nerve.
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Service type: Nerve repair / neurosurgical or reconstructive microsurgery
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Typical site of service: Operating room or ambulatory surgical center, often in hospital-based surgical settings
Clinical & Coding Specifications
Clinical Context
A 36-year-old male presents to the emergency department after a motor vehicle collision with a laceration and crush injury to the right preauricular region and signs of facial paralysis on the ipsilateral side. Facial nerve function is assessed with House-Brackmann grading and imaging (CT temporal bone) demonstrates disruption of the facial nerve in the extratemporal segment. The patient is taken to the operating room for exploration and repair of the facial nerve under general anesthesia. Intraoperative neural monitoring is used to identify functional nerve fascicles; damaged segments are debrided and primary end-to-end microsurgical repair with epineurial suture is performed. When direct repair is not feasible due to a gap, an interposition nerve graft (sural nerve) may be harvested and coapted. Postoperative care includes facial function monitoring, wound care, analgesia, and referral to physical therapy for facial retraining. Typical site of service is an inpatient or ambulatory surgical center depending on acuity and comorbidities. Service type is surgical — microsurgical nerve repair of the facial nerve or external cranial nerves for traumatic or pathologic injury.
Coding Specifications
- Modifier table
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when work, time, or technical difficulty substantially exceeds the typical service for . |