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

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 Dakota, Medicare pays $144.68 for 64615 in the office and $96.92 when it’s performed in a hospital or facility.

$144.68Office (non-facility)
$96.92Hospital or facility
−7.8%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 Dakota
  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 Dakota 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 Dakota pays $144.68. The RVUs are the same everywhere; the geographic indexes change the dollars.

64615 in North Dakota vs other payment areas
  1. North Dakota · this page$144.68
  2. Los Angeles, CA · California$166.43+$21.75
  3. Washington, DC area · District of Columbia$176.13+$31.45
  4. Miami, FL · Florida$191.77+$47.09
  5. Chicago, IL · Illinois$184.60+$39.92
  6. Manhattan, NY · New York$185.30+$40.62
  7. Alaska · Alaska$182.70+$38.02

Other areas in North Dakota 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.

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 Dakota 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

84

Locality
North Dakota
Physician work
1.000
Practice expense
1.000
Malpractice
0.406
Office calculation for 64615 in North Dakota
ComponentRVULocality factorAdjusted
Physician work1.80× 1.0001.8000
Practice expense2.28× 1.0002.2800
Malpractice0.62× 0.4060.2517
Total RVUs4.3317
Conversion factor× 33.4009

Office rate, North Dakota$144.68

Office: (1.8 × 1 + 2.28 × 1 + 0.62 × 0.406) × $33.4009 = $144.68

Facility: (1.8 × 1 + 0.85 × 1 + 0.62 × 0.406) × $33.4009 = $96.92

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

How 64615 has changed in North Dakota

64615 · Office / nonfacility

$144.68

Effective 2026-10-01

The base rate is $5.73 higher than on 2025-10-01, moving from $138.95 to $144.68 (4.1%).

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

    $138.95changed to$144.68

    • 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
    • Malpractice GPCI 0.517 changed to 0.406

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $144.32changed to$138.95

    • 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

    $141.97changed to$144.32

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $145.31changed to$141.97

    • 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
    • Malpractice GPCI 0.474 changed to 0.517
  5. January 1, 2023

    RVU23A

    $147.03changed to$145.31

    • 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
    • Malpractice GPCI 0.431 changed to 0.474

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $146.00changed to$147.03

    • 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

    $145.13changed to$146.00

    • 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
    • Malpractice GPCI 0.485 changed to 0.431

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $143.77changed to$145.13

    • 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
    • Malpractice GPCI 0.540 changed to 0.485

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $141.29changed to$143.77

    • 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

    $138.89changed to$141.29

    • 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 0.547 changed to 0.540

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $138.33changed to$138.89

    • Conversion factor 35.8043 changed to 35.8887
    • Malpractice RVU 0.62 changed to 0.64
    • Malpractice GPCI 0.554 changed to 0.547

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $140.38changed to$138.33

    • 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

    $139.68changed to$140.38

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $136.32changed to$139.68

    • 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
    • Malpractice GPCI 0.536 changed to 0.554

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $134.06changed to$136.32

    • 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
    • Malpractice GPCI 0.517 changed to 0.536

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $134.06

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$144.68$96.92RVU26D
2026-07-01$144.68$96.92RVU26C
2026-04-01$144.68$96.92RVU26B
2026-01-01$144.68$96.92RVU26A
2025-10-01$138.95$110.16RVU25D
2025-07-01$138.95$110.16RVU25C
2025-04-01$138.95$110.16RVU25B
2025-01-01$138.95$110.16RVU25A
2024-10-01$144.32$113.03RVU24D
2024-07-01$144.32$113.03RVU24C
2024-04-01$144.32$113.03RVU24B
2024-03-09$144.32$113.03RVU24AR
2024-01-01$141.97$111.19RVU24A
2023-10-01$145.31$113.12RVU23D
2023-07-01$145.31$113.12RVU23C
2023-04-01$145.31$113.12RVU23B
2023-01-01$145.31$113.12RVU23A
2022-10-01$147.03$114.15RVU22D
2022-07-01$147.03$114.15RVU22C
2022-04-01$147.03$114.15RVU22B
2022-01-01$147.03$114.15RVU22A
2021-10-01$146.00$114.60RVU21D
2021-07-01$146.00$114.60RVU21C
2021-04-01$146.00$114.60RVU21B
2021-01-01$146.00$114.60RVU21A
2020-10-01$145.13$117.34RVU20D
2020-07-01$145.13$117.34RVU20C
2020-04-01$145.13$117.34RVU20B
2020-01-01$145.13$117.34RVU20A
2019-10-01$143.77$118.91RVU19D
2019-07-01$143.77$118.91RVU19C
2019-04-01$143.77$118.91RVU19B
2019-01-01$143.77$118.91RVU19A
2018-10-01$141.29$119.33RVU18D
2018-07-01$141.29$119.33RVU18C
2018-04-01$141.29$119.33RVU18B
2018-01-01$141.29$119.33RVU18AR1
2017-10-01$138.89$119.51RVU17D
2017-07-01$138.89$119.51RVU17C
2017-04-01$138.89$119.51RVU17B
2017-01-01$138.89$119.51RVU17A
2016-10-01$138.33$118.99RVU16D
2016-07-01$138.33$118.99RVU16C
2016-04-01$138.33$118.99RVU16B
2016-01-01$138.33$118.99RVU16A
2015-10-01$140.38$120.26RVU15D
2015-07-01$140.38$120.26RVU15C
2015-04-01$139.68$119.66RVU15B
2015-01-01$139.68$119.66RVU15A
2014-10-01$136.32$120.20RVU14D
2014-07-01$136.32$120.20RVU14C
2014-04-01$136.32$120.20RVU14B
2014-01-01$136.32$120.20RVU14A
2013-10-01$134.06$119.77RVU13D
2013-07-01$134.06$119.77RVU13C
2013-04-01$134.06$119.77RVU13B
2013-01-01$134.06$119.77RVU13AR

Price 64615 for an earlier date of service

Where the North Dakota rate applies

North Dakota is a Medicare payment area, not a city. Our Census mapping connects it to 406 cities and communities in North Dakota. Some span more than one payment area; confirm with the service ZIP.

  • Abercrombie
  • Adams
  • Alamo
  • Alexander
  • Alice
  • Almont
  • Alsen
  • Ambrose

Browse all communities in North Dakota

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 DakotaGPCI2026.csv, line 84 (RVU26D)

Open CMS sourceHow we calculate rates

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