CPT code 64642: Chemodenervation, one extremity, 1–4 muscles2026 Medicare rate & RVUs

Medicare pays $163.33 for 64642 nationally in the office and $96.19 in a hospital or facility. Local office rates run $143.40–$205.87.

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

What 64642 covers

A clinician injects a chemodenervating agent, commonly botulinum toxin, into one to four muscles in a single arm or leg. Neurologists and physical medicine and rehabilitation physicians commonly perform this treatment for focal spasticity, such as after stroke or in cerebral palsy, and for focal dystonia. Services may occur in an office or outpatient hospital. The code represents the treated extremity and muscle-count range, not the number of injection sites or the amount of drug administered.

Document the treated extremity, each muscle injected, and the condition being treated. For another extremity in the same one-to-four-muscle range, report the additional-extremity code 64643 rather than modifier 50. Medicare assigns a 0-day global period, so same-day preoperative and postoperative care is included. When multiple procedures occur in one session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% multiple-procedure reduction. Medicare does not pay an assistant at surgery for this service; co-surgeon and team-surgery reporting 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 64642 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

64642 rates by state

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

How the 64642 rate is calculated

Each of 64642’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.

Payment rules and modifiers for 64642

The CMS indicators that decide how 64642 is paid alongside other services.

What modifiers do to the payment

When to use modifier 51

64642 compared with similar codes

How to choose

64643ChemodenervationAdditional extremity, 1-4 muscles

64643 is for each additional extremity treated in the one-to-four-muscle range; 64642 reports the first extremity in that range.

64644Muscle chemodenervationOne extremity, five or more muscles

Choose 64644 when five or more muscles are treated in one extremity. Choose 64642 for one to four muscles in that extremity.

64645Muscle chemodenervationAdditional extremity, five-plus muscles

64645 reports each additional extremity when five or more muscles are treated there; it is not the additional-extremity code for the one-to-four-muscle range.

64646Muscle chemodenervationTrunk, one to five muscles

64646 is for chemodenervation of trunk muscles. Code 64642 is for one extremity treated in the one-to-four-muscle range.

Codes related to 64642

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

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

Open CMS sourceHow we calculate rates