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

Reports botulinum toxin chemodenervation of one extremity when treatment targets one to four muscles, commonly for focal spasticity or dystonia.

CMS RVU26DEffective Oct 1, 2026One payment locality44.8K Medicare services in 2024

In North Carolina, Medicare pays $152.16 for 64642 in the office and $89.52 when it’s performed in a hospital or facility.

$152.16Office (non-facility)
$89.52Hospital or facility
−6.8%vs the national office rate ($163.33)

Check a contract rate as a % of Medicare · 64642 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 64642 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in North Carolina
  2. What 64642 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 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.

How North Carolina compares for 64642

Across 109 of 109 payment localities, the office rate for 64642 runs from $143.40 in Arkansas to $205.87 in San Benito County, CA. North Carolina pays $152.16. The RVUs are the same everywhere; the geographic indexes change the dollars.

64642 in North Carolina vs other payment areas
  1. North Carolina · this page$152.16
  2. Los Angeles, CA · California$178.82+$26.66
  3. Washington, DC area · District of Columbia$184.89+$32.73
  4. Miami, FL · Florida$187.21+$35.05
  5. Chicago, IL · Illinois$181.06+$28.90
  6. Manhattan, NY · New York$190.04+$37.88
  7. Alaska · Alaska$190.64+$38.48

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

Every other payment area

64642 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$145.61$86.87
ArkansasArkansas$143.40$85.73
ArizonaArizona$158.46$93.41
Bakersfield, CACalifornia$168.53$94.94
Chico, CACalifornia$167.47$93.89
El Centro, CACalifornia$167.53$93.95
Fresno, CACalifornia$167.47$93.89
Hanford, CACalifornia$167.47$93.89

64642 rates by state

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

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Local rates. Clear comparisons.

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

$143.40

$190.64

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

View every state and territory as a table
64642 office rate range by state
State / territoryOffice rate rangeLocalities
AK$190.641
AL$145.611
AR$143.401
AZ$158.461
CA$167.47–$205.8729
CO$167.301
CT$174.571
DC$184.891
DE$161.131
FL$165.64–$187.213
GA$155.41–$167.652
GU$171.071
HI$171.071
IA$147.271
ID$148.741
IL$162.27–$181.064
IN$149.591
KS$147.601
KY$151.511
LA$151.68–$159.412
MA$166.66–$182.832
MD$163.96–$184.893
ME$150.68–$157.652
MI$156.61–$168.892
MN$156.961
MO$149.67–$158.723
MS$146.511
MT$163.301
NC$152.161
ND$155.591
NE$147.801
NH$165.661
NJ$175.63–$183.052
NM$157.941
NV$161.251
NY$154.64–$196.185
OH$155.041
OK$150.101
OR$159.08–$171.572
PA$154.70–$170.772
PR$164.201
RI$166.131
SC$154.041
SD$154.681
TN$148.521
TX$153.72–$167.988
UT$156.211
VA$157.86–$184.892
VI$164.201
VT$155.931
WA$166.03–$185.552
WI$150.261
WV$156.301
WY$159.941

See 64642 in every payment locality

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.

How the rate is built · 64642

RVUs × geographic indexes × conversion factor

Office or facility?

Work1.61

1.61 RVUs× 1.000 GPCI

Practice expense2.89

2.89 RVUs× 1.000 GPCI

Malpractice0.39

0.39 RVUs× 1.000 GPCI

Adjusted RVUs

4.8900

Conversion factor

$33.4009

Medicare rate

$163.33

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

7,185

Code
64642
Physician work
1.61
Practice expense
2.89
Malpractice
0.39

GPCI2026.csv

83

Locality
North Carolina
Physician work
1.000
Practice expense
0.933
Malpractice
0.639
Office calculation for 64642 in North Carolina
ComponentRVULocality factorAdjusted
Physician work1.61× 1.0001.6100
Practice expense2.89× 0.9332.6964
Malpractice0.39× 0.6390.2492
Total RVUs4.5556
Conversion factor× 33.4009

Office rate, North Carolina$152.16

Office: (1.61 × 1 + 2.89 × 0.933 + 0.39 × 0.639) × $33.4009 = $152.16

Facility: (1.61 × 1 + 0.88 × 0.933 + 0.39 × 0.639) × $33.4009 = $89.52

Open 64642 in the RVU calculator

Payment rules and modifiers for 64642

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

CMS payment indicators · 64642

Chemodenervation, one extremity, 1–4 muscles

RuleCMS valueWhat it means
Global period000Same-day global: pre- and post-op care on the day of the procedure is included.
Multiple procedures2Standard reduction: highest-valued procedure at 100%, others at 50%.
Bilateral (modifier 50)0The 150% bilateral adjustment doesn’t apply.
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.

What modifiers do to the payment

Modifier 51 · payment effect

With and without the modifier

64642 without 51 · national office

$163.33

Chemodenervation, one extremity, 1–4 muscles

64642-51 · Second procedure: 50%

$81.67

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 64642 has changed in North Carolina

64642 · Office / nonfacility

$152.16

Effective 2026-10-01

The base rate is $12.82 higher than on 2025-10-01, moving from $139.34 to $152.16 (9.2%).

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

    $139.34changed to$152.16

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 1.65 changed to 1.61
    • Practice expense RVU 2.59 changed to 2.89
    • 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

    $143.00changed to$139.34

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 2.57 changed to 2.59
    • Malpractice RVU 0.40 changed to 0.39

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $140.66changed to$143.00

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $143.37changed to$140.66

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 2.48 changed to 2.57
    • Malpractice RVU 0.38 changed to 0.40
    • Practice expense GPCI 0.927 changed to 0.926
    • Malpractice GPCI 0.742 changed to 0.665
  5. January 1, 2023

    RVU23A

    $147.80changed to$143.37

    • Conversion factor 34.6062 changed to 33.8872
    • Malpractice RVU 0.39 changed to 0.38
    • 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

    $144.93changed to$147.80

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 2.38 changed to 2.48
    • Malpractice RVU 0.36 changed to 0.39

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $142.61changed to$144.93

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 2.19 changed to 2.38
    • Malpractice RVU 0.35 changed to 0.36
    • 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

    $140.11changed to$142.61

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 2.12 changed to 2.19
    • Malpractice RVU 0.38 changed to 0.35
    • 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

    $138.95changed to$140.11

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 2.09 changed to 2.12

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $136.95changed to$138.95

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 2.02 changed to 2.09
    • Malpractice RVU 0.39 changed to 0.38
    • Malpractice GPCI 0.732 changed to 0.695

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $136.79changed to$136.95

    • Conversion factor 35.8043 changed to 35.8887
    • Malpractice RVU 0.38 changed to 0.39
    • 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

    $136.95changed to$136.79

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 2.01 changed to 2.02

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $136.27changed to$136.95

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $133.46changed to$136.27

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 1.99 changed to 2.01
    • Malpractice RVU 0.31 changed to 0.38
    • 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

    No ratechanged to$133.46

    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$152.16$89.52RVU26D
2026-07-01$152.16$89.52RVU26C
2026-04-01$152.16$89.52RVU26B
2026-01-01$152.16$89.52RVU26A
2025-10-01$139.34$97.40RVU25D
2025-07-01$139.34$97.40RVU25C
2025-04-01$139.34$97.40RVU25B
2025-01-01$139.34$97.40RVU25A
2024-10-01$143.00$99.84RVU24D
2024-07-01$143.00$99.84RVU24C
2024-04-01$143.00$99.84RVU24B
2024-03-09$143.00$99.84RVU24AR
2024-01-01$140.66$98.21RVU24A
2023-10-01$143.37$100.97RVU23D
2023-07-01$143.37$100.97RVU23C
2023-04-01$143.37$100.97RVU23B
2023-01-01$143.37$100.97RVU23A
2022-10-01$147.80$104.76RVU22D
2022-07-01$147.80$104.76RVU22C
2022-04-01$147.80$104.76RVU22B
2022-01-01$147.80$104.76RVU22A
2021-10-01$144.93$104.45RVU21D
2021-07-01$144.93$104.45RVU21C
2021-04-01$144.93$104.45RVU21B
2021-01-01$144.93$104.45RVU21A
2020-10-01$142.61$105.69RVU20D
2020-07-01$142.61$105.69RVU20C
2020-04-01$142.61$105.69RVU20B
2020-01-01$142.61$105.69RVU20A
2019-10-01$140.11$105.55RVU19D
2019-07-01$140.11$105.55RVU19C
2019-04-01$140.11$105.55RVU19B
2019-01-01$140.11$105.55RVU19A
2018-10-01$138.95$106.11RVU18D
2018-07-01$138.95$106.11RVU18C
2018-04-01$138.95$106.11RVU18B
2018-01-01$138.95$106.11RVU18AR1
2017-10-01$136.95$106.55RVU17D
2017-07-01$136.95$106.55RVU17C
2017-04-01$136.95$106.55RVU17B
2017-01-01$136.95$106.55RVU17A
2016-10-01$136.79$106.15RVU16D
2016-07-01$136.79$106.15RVU16C
2016-04-01$136.79$106.15RVU16B
2016-01-01$136.79$106.15RVU16A
2015-10-01$136.95$106.54RVU15D
2015-07-01$136.95$106.54RVU15C
2015-04-01$136.27$106.01RVU15B
2015-01-01$136.27$106.01RVU15A
2014-10-01$133.46$103.84RVU14D
2014-07-01$133.46$103.84RVU14C
2014-04-01$133.46$103.84RVU14B
2014-01-01$133.46$103.84RVU14A
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 64642 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

64642 billing questions

Is 64642 reported per muscle or per extremity?

It represents one extremity treated in the one-to-four-muscle range. Document the individual muscles treated; do not count each muscle or injection site as a separate unit of 64642.

How should treatment of both arms or both legs be reported?

Report 64642 for one extremity and, when the additional extremity is treated in the same one-to-four-muscle range, report 64643 for that additional extremity. Do not use modifier 50.

When should 64644 be used instead?

Use 64644 when five or more muscles are treated in one extremity. The distinction is the number of muscles treated in that extremity, not the number of injection sites.

Are toxin units or injection sites counted as units of 64642?

No. The code is selected by the number of muscles treated in the extremity. Drug quantity and injection sites are not the basis for counting this procedure code.

What same-day care is included in 64642?

Medicare assigns a 0-day global period, which includes same-day preoperative and postoperative care. Other procedures performed in the same session are subject to the standard 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 64642PPRRVU2026_Oct_nonQPP.csv, line 7,185 (RVU26D)
Geographic factors for North CarolinaGPCI2026.csv, line 83 (RVU26D)

Open CMS sourceHow we calculate rates

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