CPT 64865 Facial Nerve Repair Reimbursement | OpenPayer

Summary & Overview

CPT 64865: Facial Nerve Repair with Possible Graft, Temple Region

CPT code 64865 denotes surgical repair, with possible grafting, of the facial nerve in the temple to restore motor and/or sensory function after traumatic injury or tumor-related disruption. This code captures complex microsurgical reconstruction aimed at reestablishing facial nerve continuity and function, often requiring specialized neurosurgical or otolaryngology expertise and an operating-room setting. Nationally, accurate use of CPT code 64865 affects surgical case classification, resource allocation, and post-operative outcome tracking for facial nerve reconstruction.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for when CPT code 64865 applies, typical settings of care, and operational considerations relevant to billing and coding teams. The publication also outlines common modifiers and payer-specific considerations where available, benchmarking utilization patterns and reimbursement themes when data is present. Additionally, the report highlights relevant coding relationships and documentation points that support appropriate reporting of this complex surgical procedure.

Data not available in the input for associated taxonomies, ICD-10 diagnoses, and related codes.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 64865facial nerve repairnerve graftinghead and neck surgerysurgical codingambulatory surgeryoperating roomneurosurgeryotolaryngology

Billing Code Overview

CPT code 64865 describes surgical repair, with possible grafting, of the facial nerve in the temple region. The procedure is performed to restore sensory and/or motor function when the facial nerve is damaged or severed due to trauma or a facial nerve tumor.

Service type: Surgical nerve repair and reconstruction
Typical site of service: Hospital operating room or ambulatory surgical center

Clinical & Coding Specifications

Clinical Context

A typical patient is a 42-year-old adult who sustained a penetrating temporal scalp trauma after a motor vehicle collision with resultant facial weakness and sensory disturbance over the temple distribution. Preoperative evaluation includes cranial nerve assessment, high-resolution facial nerve imaging (MRI with nerve sequences or CT if fracture suspected), and electrodiagnostic studies when indicated. The surgical team, typically a facial plastic surgeon or neurosurgeon with peripheral nerve expertise, performs exploration of the temporal branch of the facial nerve under general anesthesia. Intraoperative nerve stimulation and microscopy guide repair; options include primary end-to-end neurorrhaphy when tension-free approximation is possible, or interposition nerve grafting (commonly sural nerve graft) when segmental loss prevents direct repair. Postoperative care involves facial function monitoring, wound care, short-term corticosteroids as indicated, and referral for facial neuromuscular rehabilitation. Typical site of service is an ambulatory surgical center or hospital operating room. The service type is an operative repair of the facial nerve (temporal branch) with possible grafting to restore motor and sensory function after traumatic injury or tumor resection.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when work required is substantially greater than typical for `64865` (extensive dissection, prolonged operative time).

CPT 64876: Nerve Repair with Bone Excision to Allow Tension-Free Repair

CPT-64858-SCIATIC-NERVE-REPAIR

CPT 64858: Repair of Sciatic Nerve

CPT-64861-BRACHIAL-PLEXUS-REPAIR-SURGERY

CPT 64861: Brachial Plexus Repair Surgery

CPT-64835-MEDIAN-NERVE-BRANCH-REPAIR-THUMB-MOTOR-SENSORY

CPT 64835: Repair of Median Nerve Branch for Thumb Function

CPT-64857-PERIPHERAL-NERVE-REPAIR-ARM-LEG

CPT 64857: Major Peripheral Nerve Repair of Arm or Leg

CPT-64831-FINGER-TOE-NERVE-REPAIR

CPT 64831: Repair of Nerve in Finger or Toe

CPT-64834-SENSORY-NERVE-REPAIR-HAND-FOOT

CPT 64834: Sensory Nerve Repair of Hand or Foot

CPT-64856-PERIPHERAL-NERVE-REPAIR-WITH-TRANSPOSITION

CPT 64856: Major Peripheral Nerve Repair with Transposition

CPT-64832-ADDITIONAL-DIGITAL-NERVE-REPAIR-FINGER-TOE

CPT 64832: Repair of Additional Digital Nerve in Finger or Toe

CPT-64874-NERVE-MOBILIZATION-AND-REPOSITIONING-REPAIR

CPT 64874: Peripheral Nerve Mobilization and Repositioning Repair

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Taxonomy Code	Specialty	Notes
207V00000X	Otolaryngology (ENT)	Frequently performs facial nerve repairs related to temporal bone trauma or tumor resection.
207P00000X	Facial Plastic Surgery	Commonly performs peripheral facial nerve repair and reconstructive grafting for functional and aesthetic restoration.
2084P0800X	Neurological Surgery	Involved when intracranial extension, skull base exposure, or complex nerve reconstruction is required.
2080P0202X	Plastic Surgery	Performs microsurgical nerve repair and grafting as part of head and neck reconstructive procedures.
208000000X	General Surgery (Head & Neck subspecialty)	May participate in trauma settings or combined head and neck oncologic resections.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`S04.02XA`	Injury of facial nerve, left initial encounter	Direct traumatic injury to the facial nerve requiring exploration and repair.
`S04.01XA`	Injury of facial nerve, right initial encounter	Right-sided facial nerve injury presenting with motor deficit indicating surgical repair like `64865`.
`C71.2`	Malignant neoplasm of temporal lobe	Tumor resection in the temporal region may require nerve repair if the facial nerve is involved or sacrificed.
`G51.0`	Bell's palsy	While typically managed nonoperatively, persistent or iatrogenic palsy after surgery may lead to consideration of surgical repair in select cases.
`T90.2`	Sequelae of injury of facial nerve	Chronic sequelae after acute facial nerve injury that may prompt reconstructive repair including grafting.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`20680`	Removal of deep (e.g., foreign body), soft tissue of face, requiring incision and drainage or excision	Performed when foreign bodies or devitalized tissue in the temporal region must be removed prior to or during facial nerve repair.
`15738`	Muscle, myocutaneous or fasciocutaneous flap; trunk, arms or legs (includes harvesting nerve graft when indicated)	Used when local flap or complex soft-tissue reconstruction is required in conjunction with nerve repair; nerve graft harvest may be billed separately.
`69990`	Operating microscope, surgical	Reported when operative microscope is used for microsurgical nerve repair and grafting.
`64505`	Percutaneous implantation of neurostimulator electrode array; cranial nerve	May be relevant in staged procedures for facial reanimation when neurotization or electrical stimulation is part of the broader treatment plan.
`64400`	Injection, anesthetic agent; trigeminal nerve, diagnostic block	Performed preoperatively for diagnostic nerve block or postoperative pain management in head and face procedures.

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