CPT code 64611: Salivary gland injection, bilateral parotid and submandibular glands2026 Medicare rate & RVUs in California
Reports bilateral botulinum toxin treatment of the parotid and submandibular glands for excessive saliva, including chronic drooling related to neurologic disease.
Medicare pays $141.99–$176.99 for 64611 in the office in California, from Chico, CA to San Benito County, CA. Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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On this page 9 sections
What 64611 covers
This service uses injected medication to reduce saliva production by treating the parotid and submandibular glands on both sides. It is commonly performed for persistent drooling, including in patients with neurologic conditions such as cerebral palsy, Parkinson disease, or stroke. Neurologists, otolaryngologists, and other clinicians who manage sialorrhea may provide the injections in office or facility settings.
Report the code for the bilateral gland treatment, not for injections into facial or other muscles. Document the indication, glands treated, laterality, medication and dose, and the procedure performed. The code is priced as bilateral; modifier 50 does not increase payment. Related postoperative visits are included in its 10-day global period. When other procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% multiple-procedure reduction. Assistant-at-surgery payment requires documented medical necessity; co-surgeons and team surgery are not permitted.
This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.
Where 64611 pays more and less in California
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
29 payment localities
$141.99 to $176.99
29 of 29 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Bakersfield, CA | $143.00 | $109.69 |
| Chico, CA | $141.99 | $108.67 |
| El Centro, CA | $142.05 | $108.74 |
| Fresno, CA | $141.99 | $108.67 |
| Hanford, CA | $141.99 | $108.67 |
| Los Angeles, CA | $152.48 | $116.52 |
| Madera, CA | $141.99 | $108.67 |
| Marin County, CA | $172.54 | $129.68 |
| Merced, CA | $141.99 | $108.67 |
| Modesto, CA | $141.99 | $108.67 |
| Napa, CA | $163.62 | $123.56 |
| Oxnard, CA | $151.42 | $115.49 |
| Redding, CA | $141.99 | $108.67 |
| Rest of California | $141.99 | $108.67 |
| Riverside, CA | $146.15 | $112.84 |
| Sacramento, CA | $148.80 | $113.45 |
| Salinas, CA | $148.26 | $113.03 |
| San Benito County, CA | $176.99 | $133.16 |
| San Diego, CA | $151.72 | $115.37 |
| San Francisco, CA | $172.09 | $129.24 |
| San Luis Obispo, CA | $145.95 | $111.33 |
| Santa Clara County, CA | $175.18 | $131.35 |
| Santa Cruz, CA | $153.09 | $116.16 |
| Santa Maria, CA | $148.81 | $113.37 |
| Santa Rosa, CA | $154.59 | $117.27 |
| Stockton, CA | $141.99 | $108.67 |
| Vallejo, CA | $162.99 | $122.93 |
| Visalia, CA | $141.99 | $108.67 |
| Yuba City, CA | $141.99 | $108.67 |
How the 64611 rate is calculated
Each of 64611’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 64611
RVUs × geographic indexes × conversion factor
Work1.00
1.00 RVUs× 1.000 GPCI
Practice expense2.76
2.76 RVUs× 1.000 GPCI
Malpractice0.39
0.39 RVUs× 1.000 GPCI
Adjusted RVUs
4.1500
Conversion factor
$33.4009
Medicare rate
$138.61
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 64611
64611 has a 10-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 64611
Salivary gland injection, bilateral parotid and submandibular glands
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 010 | Minor procedure: the day of the procedure plus 10 days after are included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 2 | Already bilateral by definition: paid once at 100%. |
| Assistant at surgery (80/81/82/AS) | 0 | Not paid without supporting documentation. |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.10/0.80/0.10 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 64611
Salivary gland injection, bilateral parotid and submandibular glands
10-day global period ends
Oct 11, 2026
Covers Oct 1, 2026 through Oct 11, 2026 (11 days).
Visit on Oct 31, 2026
After the global period ends: visits and procedures are billed normally.
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
64611 without 51 · national office
$138.61
Salivary gland injection, bilateral parotid and submandibular glands
64611-51 · Second procedure: 50%
$69.31
When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).
64611 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 64612Facial chemodenervationFacial nerve muscles, unilateral
- 64611 treats the bilateral parotid and submandibular glands to reduce saliva. 64612 is for chemodenervation of facial muscles, such as for facial spasm.
- 64615Migraine chemodenervationBilateral head and neck
- 64615 is used for chemodenervation associated with chronic migraine treatment; it does not describe salivary gland injections.
- 64616Neck chemodenervationNeck muscles, excluding larynx
- 64616 targets neck muscles, commonly for cervical dystonia. Choose 64611 when the treated structures are the bilateral salivary glands.
64611 billing questions
When should 64611 be chosen over 64612?
Use 64611 for bilateral parotid and submandibular gland chemodenervation to reduce saliva. Code 64612 describes chemodenervation of facial muscles, not salivary glands.
Is modifier 50 needed for the bilateral treatment?
The code is already priced as bilateral, and modifier 50 does not increase payment. Document that the bilateral gland treatment was performed.
How many units should be reported for treatment of both sides?
Report the bilateral service as one code rather than a separate unit for each gland or side. The code's bilateral pricing does not support an increased payment from modifier 50.
Is the medication included in the procedure code?
The code reports the gland chemodenervation procedure. Any separately reportable drug supply depends on how the medication was furnished and applicable drug-billing requirements.
What documentation supports 64611?
Record the clinical reason for treating excessive saliva, the parotid and submandibular glands treated on both sides, and the medication and dose administered.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file lines behind this rate
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