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CPT code 64616: Neck chemodenervation, neck muscles, excluding larynx2026 Medicare rate & RVUs in Virginia

Reports medication-induced weakening of neck muscles, commonly for cervical dystonia, when treatment targets neck muscles rather than laryngeal or other muscle groups.

CMS RVU26DEffective Oct 1, 2026One payment locality80.7K Medicare services in 2024

In Virginia, Medicare pays $137.40 for 64616 in the office and $94.06 when it’s performed in a hospital or facility.

$137.40Office (non-facility)
$94.06Hospital or facility
−4.3%vs the national office rate ($143.62)

Check a contract rate as a % of Medicare · 64616 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 64616 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Virginia
  2. What 64616 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 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.

How Virginia compares for 64616

Across 109 of 109 payment localities, the office rate for 64616 runs from $124.65 in Arkansas to $175.70 in NYC suburbs and Long Island, NY. Virginia pays $137.40. The RVUs are the same everywhere; the geographic indexes change the dollars.

64616 in Virginia vs other payment areas
  1. Virginia · this page$137.40
  2. Los Angeles, CA · California$154.17+$16.77
  3. Washington, DC area · District of Columbia$161.93+$24.53
  4. Miami, FL · Florida$172.32+$34.92
  5. Chicago, IL · Illinois$165.99+$28.59
  6. Manhattan, NY · New York$169.09+$31.69
  7. Alaska · Alaska$166.02+$28.62

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

Every other payment area

64616 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$126.73$88.15
ArkansasArkansas$124.65$86.77
ArizonaArizona$138.83$96.10
Bakersfield, CACalifornia$145.45$97.12
Chico, CACalifornia$144.13$95.81
El Centro, CACalifornia$144.21$95.89
Fresno, CACalifornia$144.13$95.81
Hanford, CACalifornia$144.13$95.81

64616 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.

$124.65

$166.02

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

View every state and territory as a table
64616 office rate range by state
State / territoryOffice rate rangeLocalities
AK$166.021
AL$126.731
AR$124.651
AZ$138.831
CA$144.13–$175.4529
CO$145.501
CT$154.071
DC$161.931
DE$141.261
FL$148.63–$172.323
GA$138.50–$148.362
GU$147.161
HI$147.161
IA$127.001
ID$128.651
IL$146.31–$165.994
IN$129.411
KS$127.931
KY$133.641
LA$134.05–$141.342
MA$145.12–$158.802
MD$143.68–$161.933
ME$131.14–$136.772
MI$139.07–$152.382
MN$134.101
MO$132.54–$139.953
MS$128.541
MT$143.591
NC$132.431
ND$133.701
NE$127.301
NH$144.701
NJ$154.33–$160.242
NM$140.581
NV$140.911
NY$134.81–$175.705
OH$137.041
OK$131.641
OR$138.36–$148.712
PA$136.38–$150.912
PR$144.221
RI$145.311
SC$135.251
SD$132.531
TN$128.871
TX$135.49–$149.768
UT$137.291
VA$137.40–$161.932
VI$144.221
VT$134.601
WA$144.37–$160.572
WI$128.831
WV$140.711
WY$139.281

See 64616 in every payment locality

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

Office or facility?

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.

The exact Virginia inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

7,171

Code
64616
Physician work
1.49
Practice expense
2.31
Malpractice
0.50

GPCI2026.csv

106

Locality
Virginia
Physician work
1.000
Practice expense
0.983
Malpractice
0.706
Office calculation for 64616 in Virginia
ComponentRVULocality factorAdjusted
Physician work1.49× 1.0001.4900
Practice expense2.31× 0.9832.2707
Malpractice0.50× 0.7060.3530
Total RVUs4.1137
Conversion factor× 33.4009

Office rate, Virginia$137.40

Office: (1.49 × 1 + 2.31 × 0.983 + 0.5 × 0.706) × $33.4009 = $137.40

Facility: (1.49 × 1 + 0.99 × 0.983 + 0.5 × 0.706) × $33.4009 = $94.06

Open 64616 in the RVU calculator

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

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)1Bilateral with modifier 50 pays 150% of the fee schedule amount.
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 · 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.

SurgeryVisit
Sep 28, 2026Oct 14, 2026

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).

When to use modifier 50

Codes related to 64616

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

Codes related to 64616
CodeHow it relatesOffice range, Virginia
Used instead
64615Migraine chemodenervation, bilateral head and neckUsed for chemodenervation directed at muscles for chronic migraine treatment.$149.60
64617Laryngeal chemodenervation, unilateral, EMG guidance when performedUsed for laryngeal muscle chemodenervation with EMG guidance.$154.93
64612Facial chemodenervation, facial nerve muscles, unilateralUsed when chemodenervation targets facial muscles.$137.31
64642Chemodenervation, one extremity, 1–4 musclesUsed for chemodenervation of one extremity involving 1–4 muscles.$157.86
64644Muscle chemodenervation, one extremity, five or more musclesUsed for chemodenervation of one extremity involving 5 or more muscles.$184.78

How 64616 has changed in Virginia

64616 · Office / nonfacility

$137.40

Effective 2026-10-01

The base rate is $7.00 higher than on 2025-10-01, moving from $130.40 to $137.40 (5.4%).

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

    $130.40changed to$137.40

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 1.53 changed to 1.49
    • Practice expense RVU 2.14 changed to 2.31
    • Malpractice RVU 0.52 changed to 0.50
    • Work GPCI 1.002 changed to 1.000
    • Practice expense GPCI 0.984 changed to 0.983
    • Malpractice GPCI 0.755 changed to 0.706

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $134.20changed to$130.40

    • Conversion factor 33.2875 changed to 32.3465

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $132.01changed to$134.20

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $135.57changed to$132.01

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 2.07 changed to 2.14
    • Malpractice RVU 0.51 changed to 0.52
    • Work GPCI 1.000 changed to 1.002
    • Practice expense GPCI 0.990 changed to 0.984
    • Malpractice GPCI 0.826 changed to 0.755

  5. January 1, 2023

    RVU23A

    $139.75changed to$135.57

    • Conversion factor 34.6062 changed to 33.8872
    • Malpractice RVU 0.50 changed to 0.51
    • Practice expense GPCI 0.995 changed to 0.990
    • Malpractice GPCI 0.897 changed to 0.826

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $137.53changed to$139.75

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 2.00 changed to 2.07
    • Malpractice RVU 0.47 changed to 0.50

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $135.59changed to$137.53

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 1.81 changed to 2.00
    • Malpractice RVU 0.48 changed to 0.47
    • Practice expense GPCI 0.991 changed to 0.995
    • Malpractice GPCI 0.903 changed to 0.897

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $134.34changed to$135.59

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 1.75 changed to 1.81
    • Malpractice RVU 0.52 changed to 0.48
    • Practice expense GPCI 0.986 changed to 0.991
    • Malpractice GPCI 0.908 changed to 0.903

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $132.06changed to$134.34

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 1.69 changed to 1.75

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $127.63changed to$132.06

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 1.60 changed to 1.69
    • Practice expense GPCI 0.985 changed to 0.986
    • Malpractice GPCI 0.866 changed to 0.908

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $125.44changed to$127.63

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 1.58 changed to 1.60
    • Malpractice RVU 0.51 changed to 0.52
    • Practice expense GPCI 0.983 changed to 0.985
    • Malpractice GPCI 0.824 changed to 0.866

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $124.18changed to$125.44

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 1.54 changed to 1.58
    • Malpractice RVU 0.50 changed to 0.51

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $123.56changed to$124.18

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $120.15changed to$123.56

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 1.52 changed to 1.54
    • Malpractice RVU 0.43 changed to 0.50
    • Practice expense GPCI 0.980 changed to 0.983
    • Malpractice GPCI 0.778 changed to 0.824

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    No ratechanged to$120.15

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: No rate

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$137.40$94.06RVU26D
2026-07-01$137.40$94.06RVU26C
2026-04-01$137.40$94.06RVU26B
2026-01-01$137.40$94.06RVU26A
2025-10-01$130.40$103.03RVU25D
2025-07-01$130.40$103.03RVU25C
2025-04-01$130.40$103.03RVU25B
2025-01-01$130.40$103.03RVU25A
2024-10-01$134.20$105.37RVU24D
2024-07-01$134.20$105.37RVU24C
2024-04-01$134.20$105.37RVU24B
2024-03-09$134.20$105.37RVU24AR
2024-01-01$132.01$103.65RVU24A
2023-10-01$135.57$106.72RVU23D
2023-07-01$135.57$106.72RVU23C
2023-04-01$135.57$106.72RVU23B
2023-01-01$135.57$106.72RVU23A
2022-10-01$139.75$109.79RVU22D
2022-07-01$139.75$109.79RVU22C
2022-04-01$139.75$109.79RVU22B
2022-01-01$139.75$109.79RVU22A
2021-10-01$137.53$109.41RVU21D
2021-07-01$137.53$109.41RVU21C
2021-04-01$137.53$109.41RVU21B
2021-01-01$137.53$109.41RVU21A
2020-10-01$135.59$111.27RVU20D
2020-07-01$135.59$111.27RVU20C
2020-04-01$135.59$111.27RVU20B
2020-01-01$135.59$111.27RVU20A
2019-10-01$134.34$112.31RVU19D
2019-07-01$134.34$112.31RVU19C
2019-04-01$134.34$112.31RVU19B
2019-01-01$134.34$112.31RVU19A
2018-10-01$132.06$112.54RVU18D
2018-07-01$132.06$112.54RVU18C
2018-04-01$132.06$112.54RVU18B
2018-01-01$132.06$112.54RVU18AR1
2017-10-01$127.63$111.02RVU17D
2017-07-01$127.63$111.02RVU17C
2017-04-01$127.63$111.02RVU17B
2017-01-01$127.63$111.02RVU17A
2016-10-01$125.44$108.89RVU16D
2016-07-01$125.44$108.89RVU16C
2016-04-01$125.44$108.89RVU16B
2016-01-01$125.44$108.89RVU16A
2015-10-01$124.18$108.28RVU15D
2015-07-01$124.18$108.28RVU15C
2015-04-01$123.56$107.75RVU15B
2015-01-01$123.56$107.75RVU15A
2014-10-01$120.15$105.76RVU14D
2014-07-01$120.15$105.76RVU14C
2014-04-01$120.15$105.76RVU14B
2014-01-01$120.15$105.76RVU14A
2013-10-01Not in this releaseNot in this releaseRVU13D
2013-07-01Not in this releaseNot in this releaseRVU13C
2013-04-01Not in this releaseNot in this releaseRVU13B
2013-01-01Not in this releaseNot in this releaseRVU13AR

Price 64616 for an earlier date of service

Where the Virginia rate applies

Virginia is a Medicare payment area, not a city. Our Census mapping connects it to 628 cities and communities in Virginia. Some span more than one payment area; confirm with the service ZIP.

  • Abbs Valley
  • Abingdon
  • Accomac
  • Adwolf
  • Afton
  • Alberta
  • Aldie
  • Allison Gap

Browse all communities in Virginia

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

Show the CMS file lines behind this rate
RVUs for 64616PPRRVU2026_Oct_nonQPP.csv, line 7,171 (RVU26D)
Geographic factors for VirginiaGPCI2026.csv, line 106 (RVU26D)

Open CMS sourceHow we calculate rates

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