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CPT code 64615: Migraine chemodenervation, bilateral head and neck2026 Medicare rate & RVUs in North Carolina

Reports bilateral medication injections into head and neck muscles for chronic migraine treatment, commonly performed by a neurologist or headache specialist.

CMS RVU26DEffective Oct 1, 2026One payment locality191.4K Medicare services in 2024

In North Carolina, Medicare pays $144.41 for 64615 in the office and $99.84 when it’s performed in a hospital or facility.

$144.41Office (non-facility)
$99.84Hospital or facility
−8.0%vs the national office rate ($156.98)

Check a contract rate as a % of Medicare · 64615 nationwide

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

We’ll open 64615 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in North Carolina
  2. What 64615 covers
  3. Compared with other areas
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Related codes
  8. Rate history
  9. Where it applies
  10. Billing questions
  11. Sources

What 64615 covers

This service covers medication injections into muscles on both sides of the head and neck, commonly using onabotulinumtoxinA for chronic migraine. A neurologist or headache specialist may inject muscles such as the frontalis, temporalis, occipital, cervical paraspinal, and trapezius muscles in an office or outpatient facility. The service represents the overall bilateral treatment, rather than a separate charge for each injection site.

Select the code for bilateral chemodenervation of the covered head and neck muscles, and document the indication, treated sites, laterality, and dose. Report the bilateral code once for the session; modifier 50 does not increase its payment. When other procedures are performed in the same session, the highest-valued procedure is paid in full and the others are subject to the standard 50% multiple-procedure reduction. Related postoperative visits during the 10-day global period are included. Assistant-at-surgery payment is restricted, and co-surgeons and team surgery are not permitted. The toxin may be reported separately under its applicable drug code when supplied by the practice.

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.

How North Carolina compares for 64615

Across 109 of 109 payment localities, the office rate for 64615 runs from $136.20 in Arkansas to $192.97 in NYC suburbs and Long Island, NY. North Carolina pays $144.41. The RVUs are the same everywhere; the geographic indexes change the dollars.

64615 in North Carolina vs other payment areas
  1. North Carolina · this page$144.41
  2. Los Angeles, CA · California$166.43+$22.02
  3. Washington, DC area · District of Columbia$176.13+$31.72
  4. Miami, FL · Florida$191.77+$47.36
  5. Chicago, IL · Illinois$184.60+$40.19
  6. Manhattan, NY · New York$185.30+$40.89
  7. Alaska · Alaska$182.70+$38.29

Other areas in North Carolina first, then benchmark localities. Bars start at $0.

Every other payment area

64615 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$138.48$96.68
ArkansasArkansas$136.20$95.17
ArizonaArizona$151.64$105.36
Bakersfield, CACalifornia$157.34$104.99
Chico, CACalifornia$155.71$103.36
El Centro, CACalifornia$155.81$103.46
Fresno, CACalifornia$155.71$103.36
Hanford, CACalifornia$155.71$103.36

64615 rates by state

Office rate range in each state. Select a state to see its payment localities.

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

Explore a state

Local rates. Clear comparisons.

Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.

$136.20

$182.70

Color shows the midpoint of each state’s locality range.

View every state and territory as a table
64615 office rate range by state
State / territoryOffice rate rangeLocalities
AK$182.701
AL$138.481
AR$136.201
AZ$151.641
CA$155.71–$187.6529
CO$158.041
CT$168.401
DC$176.131
DE$154.281
FL$164.05–$191.773
GA$152.74–$162.552
GU$158.701
HI$158.701
IA$138.021
ID$139.981
IL$162.02–$184.604
IN$140.781
KS$139.401
KY$146.771
LA$147.36–$155.312
MA$157.78–$171.952
MD$156.80–$176.133
ME$143.06–$148.662
MI$153.03–$168.522
MN$144.611
MO$145.94–$153.373
MS$140.991
MT$156.941
NC$144.411
ND$144.681
NE$138.241
NH$157.521
NJ$168.40–$174.362
NM$154.831
NV$153.601
NY$147.03–$192.975
OH$150.521
OK$144.221
OR$150.53–$161.102
PA$149.60–$165.192
PR$157.511
RI$158.401
SC$148.091
SD$143.231
TN$140.471
TX$148.66–$164.728
UT$150.301
VA$149.60–$176.132
VI$157.511
VT$145.991
WA$156.85–$173.492
WI$139.461
WV$155.931
WY$151.601

See 64615 in every payment locality

How the 64615 rate is calculated

Each of 64615’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 · 64615

RVUs × geographic indexes × conversion factor

Office or facility?

Work1.80

1.80 RVUs× 1.000 GPCI

Practice expense2.28

2.28 RVUs× 1.000 GPCI

Malpractice0.62

0.62 RVUs× 1.000 GPCI

Adjusted RVUs

4.7000

Conversion factor

$33.4009

Medicare rate

$156.98

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

The exact North Carolina inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

7,170

Code
64615
Physician work
1.80
Practice expense
2.28
Malpractice
0.62

GPCI2026.csv

83

Locality
North Carolina
Physician work
1.000
Practice expense
0.933
Malpractice
0.639
Office calculation for 64615 in North Carolina
ComponentRVULocality factorAdjusted
Physician work1.80× 1.0001.8000
Practice expense2.28× 0.9332.1272
Malpractice0.62× 0.6390.3962
Total RVUs4.3234
Conversion factor× 33.4009

Office rate, North Carolina$144.41

Office: (1.8 × 1 + 2.28 × 0.933 + 0.62 × 0.639) × $33.4009 = $144.41

Facility: (1.8 × 1 + 0.85 × 0.933 + 0.62 × 0.639) × $33.4009 = $99.84

Open 64615 in the RVU calculator

Payment rules and modifiers for 64615

64615 has a 10-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 64615

Migraine chemodenervation, bilateral head and neck

RuleCMS valueWhat it means
Global period010Minor procedure: the day of the procedure plus 10 days after are included.
Multiple procedures2Standard reduction: highest-valued procedure at 100%, others at 50%.
Bilateral (modifier 50)2Already bilateral by definition: paid once at 100%.
Assistant at surgery (80/81/82/AS)1Not paid (statutory restriction).
Co-surgeons (62)0Not permitted.
Team surgery (66)0Not permitted.
Professional/technical0Physician service: no professional/technical split.
Split (54/55/56)0.10/0.80/0.10Share of the payment for pre-op, the procedure itself, and post-op care.

Global surgery period · 64615

Migraine chemodenervation, bilateral head and neck

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.

SurgeryVisit
Sep 28, 2026Oct 14, 2026

What modifiers do to the payment

Modifier 51 · payment effect

With and without the modifier

64615 without 51 · national office

$156.98

Migraine chemodenervation, bilateral head and neck

64615-51 · Second procedure: 50%

$78.49

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%).

When to use modifier 51

Codes related to 64615

Related codes aren’t interchangeable: bill the code that matches the service performed.

Codes related to 64615
CodeHow it relatesOffice range, North Carolina
Often billed with
J0585OnabotulinumtoxinA, per 1 unitOnabotulinumtoxinA drug code commonly reported when the practice supplies the medication.No office rate
Used instead
64612Facial chemodenervation, facial nerve muscles, unilateralFor facial-muscle chemodenervation in a different clinical situation, rather than bilateral migraine treatment.$132.35
64616Neck chemodenervation, neck muscles, excluding larynxFor neck-muscle chemodenervation for cervical dystonia, rather than the bilateral migraine service.$132.43
64642Chemodenervation, one extremity, 1–4 musclesFor chemodenervation of a limited number of muscles in one extremity.$152.16

How 64615 has changed in North Carolina

64615 · Office / nonfacility

$144.41

Effective 2026-10-01

The base rate is $7.52 higher than on 2025-10-01, moving from $136.89 to $144.41 (5.5%).

It is unchanged from the immediately preceding available release, effective 2026-07-01.

Base rate by release · bars start at $0 · select a bar to compare

One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.

What changed, release by release

  1. January 1, 2026

    RVU26A

    $136.89changed to$144.41

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 1.85 changed to 1.80
    • Practice expense RVU 2.12 changed to 2.28
    • Malpractice RVU 0.63 changed to 0.62
    • Practice expense GPCI 0.926 changed to 0.933
    • Malpractice GPCI 0.665 changed to 0.639

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $142.11changed to$136.89

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 2.16 changed to 2.12

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $139.79changed to$142.11

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $145.95changed to$139.79

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 2.13 changed to 2.16
    • Malpractice RVU 0.65 changed to 0.63
    • Practice expense GPCI 0.927 changed to 0.926
    • Malpractice GPCI 0.742 changed to 0.665

  5. January 1, 2023

    RVU23A

    $149.75changed to$145.95

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 2.14 changed to 2.13
    • Malpractice RVU 0.60 changed to 0.65
    • Practice expense GPCI 0.928 changed to 0.927
    • Malpractice GPCI 0.819 changed to 0.742

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $148.76changed to$149.75

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 2.08 changed to 2.14
    • Malpractice RVU 0.59 changed to 0.60

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $146.05changed to$148.76

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 1.89 changed to 2.08
    • Malpractice RVU 0.58 changed to 0.59
    • Practice expense GPCI 0.930 changed to 0.928
    • Malpractice GPCI 0.757 changed to 0.819

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $142.68changed to$146.05

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 1.81 changed to 1.89
    • Malpractice RVU 0.61 changed to 0.58
    • Practice expense GPCI 0.931 changed to 0.930
    • Malpractice GPCI 0.695 changed to 0.757

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $140.43changed to$142.68

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 1.74 changed to 1.81
    • Malpractice RVU 0.62 changed to 0.61

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $139.01changed to$140.43

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 1.67 changed to 1.74
    • Malpractice RVU 0.64 changed to 0.62
    • Malpractice GPCI 0.732 changed to 0.695

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $138.89changed to$139.01

    • Conversion factor 35.8043 changed to 35.8887
    • Malpractice RVU 0.62 changed to 0.64
    • Practice expense GPCI 0.930 changed to 0.931
    • Malpractice GPCI 0.768 changed to 0.732

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $141.39changed to$138.89

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 1.68 changed to 1.67
    • Malpractice RVU 0.68 changed to 0.62

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $140.68changed to$141.39

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $136.13changed to$140.68

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 1.65 changed to 1.68
    • Malpractice RVU 0.57 changed to 0.68
    • Practice expense GPCI 0.929 changed to 0.930
    • Malpractice GPCI 0.732 changed to 0.768

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $133.27changed to$136.13

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 1.78 changed to 1.65
    • Malpractice RVU 0.60 changed to 0.57
    • Practice expense GPCI 0.927 changed to 0.929
    • Malpractice GPCI 0.695 changed to 0.732

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $133.27

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$144.41$99.84RVU26D
2026-07-01$144.41$99.84RVU26C
2026-04-01$144.41$99.84RVU26B
2026-01-01$144.41$99.84RVU26A
2025-10-01$136.89$110.23RVU25D
2025-07-01$136.89$110.23RVU25C
2025-04-01$136.89$110.23RVU25B
2025-01-01$136.89$110.23RVU25A
2024-10-01$142.11$113.13RVU24D
2024-07-01$142.11$113.13RVU24C
2024-04-01$142.11$113.13RVU24B
2024-03-09$142.11$113.13RVU24AR
2024-01-01$139.79$111.29RVU24A
2023-10-01$145.95$116.10RVU23D
2023-07-01$145.95$116.10RVU23C
2023-04-01$145.95$116.10RVU23B
2023-01-01$145.95$116.10RVU23A
2022-10-01$149.75$119.24RVU22D
2022-07-01$149.75$119.24RVU22C
2022-04-01$149.75$119.24RVU22B
2022-01-01$149.75$119.24RVU22A
2021-10-01$148.76$119.62RVU21D
2021-07-01$148.76$119.62RVU21C
2021-04-01$148.76$119.62RVU21B
2021-01-01$148.76$119.62RVU21A
2020-10-01$146.05$120.20RVU20D
2020-07-01$146.05$120.20RVU20C
2020-04-01$146.05$120.20RVU20B
2020-01-01$146.05$120.20RVU20A
2019-10-01$142.68$119.53RVU19D
2019-07-01$142.68$119.53RVU19C
2019-04-01$142.68$119.53RVU19B
2019-01-01$142.68$119.53RVU19A
2018-10-01$140.43$119.98RVU18D
2018-07-01$140.43$119.98RVU18C
2018-04-01$140.43$119.98RVU18B
2018-01-01$140.43$119.98RVU18AR1
2017-10-01$139.01$120.96RVU17D
2017-07-01$139.01$120.96RVU17C
2017-04-01$139.01$120.96RVU17B
2017-01-01$139.01$120.96RVU17A
2016-10-01$138.89$120.91RVU16D
2016-07-01$138.89$120.91RVU16C
2016-04-01$138.89$120.91RVU16B
2016-01-01$138.89$120.91RVU16A
2015-10-01$141.39$122.67RVU15D
2015-07-01$141.39$122.67RVU15C
2015-04-01$140.68$122.06RVU15B
2015-01-01$140.68$122.06RVU15A
2014-10-01$136.13$121.15RVU14D
2014-07-01$136.13$121.15RVU14C
2014-04-01$136.13$121.15RVU14B
2014-01-01$136.13$121.15RVU14A
2013-10-01$133.27$120.02RVU13D
2013-07-01$133.27$120.02RVU13C
2013-04-01$133.27$120.02RVU13B
2013-01-01$133.27$120.02RVU13AR

Price 64615 for an earlier date of service

Where the North Carolina rate applies

North Carolina is a Medicare payment area, not a city. Our Census mapping connects it to 785 cities and communities in North Carolina. Some span more than one payment area; confirm with the service ZIP.

  • Aberdeen
  • Advance
  • Ahoskie
  • Alamance
  • Albemarle
  • Alexis
  • Alliance
  • Altamahaw

Browse all communities in North Carolina

64615 billing questions

Should modifier 50 be appended?

No. The code is already priced as bilateral, and modifier 50 does not increase payment.

Is the service reported per injection site or muscle?

Report the bilateral service once for the session, not once for each injection or treated muscle. Document the sites and dose.

Can the botulinum toxin drug be billed separately?

The practice may report the applicable drug code separately when it supplies the toxin. Keep documentation of the product and dose administered.

How does the 10-day global period affect follow-up visits?

Related postoperative visits during the 10 days after the procedure are included in the service.

What happens when another procedure is performed in the same session?

The highest-valued procedure is paid in full; other procedures in that session are subject to the standard 50% multiple-procedure reduction.

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
RVUs for 64615PPRRVU2026_Oct_nonQPP.csv, line 7,170 (RVU26D)
Geographic factors for North CarolinaGPCI2026.csv, line 83 (RVU26D)

Open CMS sourceHow we calculate rates

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