CPT code 64616: Neck chemodenervation, neck muscles, excluding larynx2026 Medicare rate & RVUs
Reports medication-induced weakening of neck muscles, commonly for cervical dystonia, when treatment targets neck muscles rather than laryngeal or other muscle groups.
Medicare pays $143.62 for 64616 nationally in the office and $99.53 in a hospital or facility. Local office rates run $124.65–$175.70.
Medicare rate · 64616
Neck chemodenervation, neck muscles, excluding larynx
- Work RVUs
- 1.49
- Total RVUs
- 4.30
- Global days
- 010
National rate · 2026
$143.62
Office setting, before claim adjustments.
See every locality for 64616 →Billed by an NP, PA or therapist? →
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 10 sections
What 64616 covers
This service involves injecting a medication such as botulinum toxin into neck muscles to reduce involuntary muscle activity. Neurologists, physiatrists, and other clinicians who treat movement disorders commonly perform it in an office or facility setting. Cervical dystonia, with involuntary neck contractions or abnormal head posture, is a typical indication. The code is for neck muscles and excludes laryngeal muscle treatment.
Select the code based on the treated anatomy and clinical service, not simply the injection location or number of injection sites. Document the indication, muscles treated, medication, and treatment details. Related postoperative visits during the 10-day global period are included. When multiple procedures are performed in one session, the highest-valued procedure is paid in full and others at 50%. For bilateral treatment, modifier 50 is paid at 150%. Assistant-at-surgery payment is restricted; 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 64616 pays more and less
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
109 payment localities
$124.65 to $175.70
109 of 109 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Alabama | $126.73 | $88.15 |
| Alaska | $166.02 | $119.07 |
| Arizona | $138.83 | $96.10 |
| Arkansas | $124.65 | $86.77 |
| Atlanta, GA | $148.36 | $103.57 |
| Austin, TX | $146.29 | $99.65 |
| Bakersfield, CA | $145.45 | $97.12 |
| Baltimore area, MD | $154.01 | $106.70 |
| Beaumont, TX | $135.49 | $95.37 |
| Brazoria, TX | $139.65 | $95.96 |
| Chicago, IL | $165.99 | $121.68 |
| Chico, CA | $144.13 | $95.81 |
| Colorado | $145.50 | $98.59 |
| Connecticut | $154.07 | $106.58 |
| Dallas, TX | $141.39 | $97.48 |
| Delaware | $141.26 | $97.70 |
| Detroit, MI | $152.38 | $109.83 |
| East St. Louis, IL | $154.39 | $113.82 |
| El Centro, CA | $144.21 | $95.89 |
| Fort Lauderdale, FL | $158.12 | $113.46 |
| Fort Worth, TX | $140.84 | $97.37 |
| Fresno, CA | $144.13 | $95.81 |
| Galveston, TX | $140.61 | $96.83 |
| Hanford, CA | $144.13 | $95.81 |
| Hawaii, Guam, HI | $147.16 | $97.03 |
| Houston, TX | $149.76 | $105.98 |
| Idaho | $128.65 | $88.09 |
| Indiana | $129.41 | $88.54 |
| Iowa | $127.00 | $86.65 |
| Kansas | $127.93 | $88.08 |
| Kentucky | $133.64 | $94.44 |
| King County, WA | $160.57 | $106.47 |
| Los Angeles, CA | $154.17 | $102.02 |
| Madera, CA | $144.13 | $95.81 |
| Manhattan, NY | $169.09 | $117.86 |
| Marin County, CA | $170.95 | $108.79 |
| Merced, CA | $144.13 | $95.81 |
| Metropolitan Boston, MA | $158.80 | $106.15 |
| Metropolitan Kansas City, MO | $138.53 | $97.13 |
| Metropolitan Philadelphia, PA | $150.91 | $105.01 |
| Metropolitan St. Louis, MO | $139.95 | $97.98 |
| Miami, FL | $172.32 | $126.43 |
| Minnesota | $134.10 | $88.74 |
| Mississippi | $128.54 | $90.58 |
| Modesto, CA | $144.13 | $95.81 |
| Montana | $143.59 | $99.50 |
| Napa, CA | $163.08 | $104.97 |
| Nebraska | $127.30 | $86.60 |
| Nevada | $140.91 | $96.78 |
| New Hampshire | $144.70 | $98.80 |
| New Mexico | $140.58 | $100.15 |
| New Orleans, LA | $141.34 | $99.85 |
| North Carolina | $132.43 | $91.29 |
| North Dakota | $133.70 | $89.61 |
| Northern New Jersey | $160.24 | $109.10 |
| NYC suburbs and Long Island, NY | $175.70 | $123.28 |
| Ohio | $137.04 | $96.79 |
| Oklahoma | $131.64 | $92.27 |
| Oxnard, CA | $152.76 | $100.65 |
| Portland, OR | $148.71 | $99.73 |
| Poughkeepsie and northern NYC suburbs, NY | $156.70 | $108.42 |
| Puerto Rico | $144.22 | $99.65 |
| Queens, NY | $168.23 | $116.12 |
| Redding, CA | $144.13 | $95.81 |
| Rest of California | $144.13 | $95.81 |
| Rest of Florida | $148.63 | $106.48 |
| Rest of Georgia | $138.50 | $99.17 |
| Rest of Illinois | $146.31 | $106.06 |
| Rest of Louisiana | $134.05 | $95.03 |
| Rest of Maine | $131.14 | $90.58 |
| Rest of Maryland | $143.68 | $99.06 |
| Rest of Massachusetts | $145.12 | $98.69 |
| Rest of Michigan | $139.07 | $98.81 |
| Rest of Missouri | $132.54 | $94.54 |
| Rest of New Jersey | $154.33 | $106.19 |
| Rest of New York | $134.81 | $92.92 |
| Rest of Oregon | $138.36 | $94.44 |
| Rest of Pennsylvania | $136.38 | $95.90 |
| Rest of Texas | $138.07 | $96.23 |
| Rest of Washington | $144.37 | $97.94 |
| Rhode Island | $145.31 | $99.77 |
| Riverside, CA | $149.47 | $101.15 |
| Sacramento, CA | $150.24 | $98.97 |
| Salinas, CA | $149.69 | $98.59 |
| San Benito County, CA | $175.45 | $111.88 |
| San Diego, CA | $152.59 | $99.86 |
| San Francisco, CA | $170.38 | $108.22 |
| San Luis Obispo, CA | $147.45 | $97.23 |
| Santa Clara County, CA | $173.13 | $109.55 |
| Santa Cruz, CA | $153.51 | $99.94 |
| Santa Maria, CA | $150.08 | $98.67 |
| Santa Rosa, CA | $154.96 | $100.82 |
| South Carolina | $135.25 | $94.52 |
| South Dakota | $132.53 | $88.45 |
| Southern Maine, ME | $136.77 | $93.07 |
| Stockton, CA | $144.13 | $95.81 |
| Suburban Chicago, IL | $158.95 | $113.67 |
| Tennessee | $128.87 | $88.79 |
| Utah | $137.29 | $95.85 |
| Vallejo, CA | $162.26 | $104.15 |
| Vermont | $134.60 | $90.95 |
| Virgin Islands, VI | $144.22 | $99.65 |
| Virginia | $137.40 | $94.06 |
| Visalia, CA | $144.13 | $95.81 |
| Washington, DC area | $161.93 | $110.00 |
| West Virginia | $140.71 | $102.40 |
| Wisconsin | $128.83 | $86.59 |
| Wyoming | $139.28 | $95.19 |
| Yuba City, CA | $144.13 | $95.81 |
64616 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.
$124.65
$166.02
Color shows the midpoint of each state’s locality range.
View every state and territory as a table
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | $166.02 | 1 |
| AL | $126.73 | 1 |
| AR | $124.65 | 1 |
| AZ | $138.83 | 1 |
| CA | $144.13–$175.45 | 29 |
| CO | $145.50 | 1 |
| CT | $154.07 | 1 |
| DC | $161.93 | 1 |
| DE | $141.26 | 1 |
| FL | $148.63–$172.32 | 3 |
| GA | $138.50–$148.36 | 2 |
| GU | $147.16 | 1 |
| HI | $147.16 | 1 |
| IA | $127.00 | 1 |
| ID | $128.65 | 1 |
| IL | $146.31–$165.99 | 4 |
| IN | $129.41 | 1 |
| KS | $127.93 | 1 |
| KY | $133.64 | 1 |
| LA | $134.05–$141.34 | 2 |
| MA | $145.12–$158.80 | 2 |
| MD | $143.68–$161.93 | 3 |
| ME | $131.14–$136.77 | 2 |
| MI | $139.07–$152.38 | 2 |
| MN | $134.10 | 1 |
| MO | $132.54–$139.95 | 3 |
| MS | $128.54 | 1 |
| MT | $143.59 | 1 |
| NC | $132.43 | 1 |
| ND | $133.70 | 1 |
| NE | $127.30 | 1 |
| NH | $144.70 | 1 |
| NJ | $154.33–$160.24 | 2 |
| NM | $140.58 | 1 |
| NV | $140.91 | 1 |
| NY | $134.81–$175.70 | 5 |
| OH | $137.04 | 1 |
| OK | $131.64 | 1 |
| OR | $138.36–$148.71 | 2 |
| PA | $136.38–$150.91 | 2 |
| PR | $144.22 | 1 |
| RI | $145.31 | 1 |
| SC | $135.25 | 1 |
| SD | $132.53 | 1 |
| TN | $128.87 | 1 |
| TX | $135.49–$149.76 | 8 |
| UT | $137.29 | 1 |
| VA | $137.40–$161.93 | 2 |
| VI | $144.22 | 1 |
| VT | $134.60 | 1 |
| WA | $144.37–$160.57 | 2 |
| WI | $128.83 | 1 |
| WV | $140.71 | 1 |
| WY | $139.28 | 1 |
How the 64616 rate is calculated
Each of 64616’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 · 64616
RVUs × geographic indexes × conversion factor
Work1.49
1.49 RVUs× 1.000 GPCI
Practice expense2.31
2.31 RVUs× 1.000 GPCI
Malpractice0.50
0.50 RVUs× 1.000 GPCI
Adjusted RVUs
4.3000
Conversion factor
$33.4009
Medicare rate
$143.62
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 64616
64616 has a 10-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 64616
Neck chemodenervation, neck muscles, excluding larynx
| 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) | 1 | Bilateral with modifier 50 pays 150% of the fee schedule amount. |
| Assistant at surgery (80/81/82/AS) | 1 | Not paid (statutory restriction). |
| 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 · 64616
Neck chemodenervation, neck muscles, excluding larynx
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 50 · payment effect
With and without the modifier
64616 without 50 · national office
$143.62
Neck chemodenervation, neck muscles, excluding larynx
64616-50 · Bilateral: 150%
$215.43
Both sides on one line with modifier 50 are paid at 150% of the fee schedule amount (subject to multiple-procedure rules with other procedures).
64616 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 64615Migraine chemodenervationBilateral head and neck
- Choose 64616 for treatment directed at neck muscles, such as for cervical dystonia. Choose 64615 when the chemodenervation is directed at muscles for chronic migraine treatment.
- 64617Laryngeal chemodenervationUnilateral, EMG guidance when performed
- 64617 is for laryngeal muscle treatment with EMG guidance. 64616 covers neck muscles outside the larynx.
- 64642ChemodenervationOne extremity, 1–4 muscles
- 64642 applies to chemodenervation of one extremity involving 1–4 muscles. Use 64616 when the treated muscles are in the neck.
64616 billing questions
When should this code be chosen instead of 64615?
Use 64616 for treatment directed at neck muscles, commonly for cervical dystonia. Code 64615 is for chemodenervation directed at muscles for chronic migraine treatment.
Can this code be used for injections into laryngeal muscles?
No. Laryngeal muscle treatment is reported with 64617, which identifies laryngeal chemodenervation with EMG guidance.
How is bilateral treatment reported?
Report modifier 50 for bilateral treatment. CMS pays the bilateral procedure at 150%.
Are follow-up visits included?
Related postoperative visits during the 10-day global period are included in the procedure.
What documentation supports reporting this code?
Document the clinical indication, the neck muscles treated, the medication administered, and the treatment performed. The record should distinguish neck treatment from laryngeal, facial, or extremity muscle treatment.
How does CMS handle this code when other procedures are performed in the same session?
Under the standard multiple procedure reduction, the highest-valued procedure is paid in full and other procedures are paid at 50%.
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
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