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

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 Houston, TX, Medicare pays $167.98 for 64642 in the office and $101.32 when it’s performed in a hospital or facility.

$167.98Office (non-facility)
$101.32Hospital or facility
+2.8%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 Houston, TX
  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 Houston, TX 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. Houston, TX pays $167.98. The RVUs are the same everywhere; the geographic indexes change the dollars.

64642 in Houston, TX vs other payment areas
  1. Houston, TX · this page$167.98
  2. Austin, TX · Texas$167.55−$0.43
  3. Beaumont, TX · Texas$153.72−$14.26
  4. Brazoria, TX · Texas$160.03−$7.95
  5. Dallas, TX · Texas$161.58−$6.40
  6. Fort Worth, TX · Texas$160.78−$7.20
  7. Galveston, TX · Texas$160.84−$7.14

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

Every other payment area

64642 in every other Medicare payment locality
Payment localityOfficeFacility
Rest of TexasTexas$157.14$93.43
Los Angeles, CACalifornia$178.82$99.40
Washington, DC areaDistrict of Columbia$184.89$105.80
Miami, FLFlorida$187.21$117.32
Chicago, ILIllinois$181.06$113.59
Manhattan, NYNew York$190.04$112.03
AlaskaAlaska$190.64$119.14
AlabamaAlabama$145.61$86.87

64642 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.

$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 Houston, TX 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

102

Locality
Houston, TX
Physician work
1.008
Practice expense
0.993
Malpractice
1.376
Office calculation for 64642 in Houston, TX
ComponentRVULocality factorAdjusted
Physician work1.61× 1.0081.6229
Practice expense2.89× 0.9932.8698
Malpractice0.39× 1.3760.5366
Total RVUs5.0293
Conversion factor× 33.4009

Office rate, Houston, TX$167.98

Office: (1.61 × 1.008 + 2.89 × 0.993 + 0.39 × 1.376) × $33.4009 = $167.98

Facility: (1.61 × 1.008 + 0.88 × 0.993 + 0.39 × 1.376) × $33.4009 = $101.32

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

Codes related to 64642

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

Codes related to 64642
CodeHow it relatesOffice range, Houston, TX
Add-on codes
64643Chemodenervation, additional extremity, 1-4 musclesAdd-on for each additional extremity treated in the one-to-four-muscle range.$102.71
Same family
64644Muscle chemodenervation, one extremity, five or more musclesCovers one extremity when five or more muscles are treated.$195.39
64645Muscle chemodenervation, additional extremity, five-plus musclesCovers each additional extremity in the five-or-more-muscle range.$133.72
Used instead
64646Muscle chemodenervation, trunk, one to five musclesFor chemodenervation of trunk muscles rather than muscles of an extremity.$176.17

How 64642 has changed in Houston, TX

64642 · Office / nonfacility

$167.98

Effective 2026-10-01

The base rate is $12.06 higher than on 2025-10-01, moving from $155.92 to $167.98 (7.7%).

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

    $155.92changed to$167.98

    • 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
    • Work GPCI 1.014 changed to 1.008
    • Practice expense GPCI 1.003 changed to 0.993
    • Malpractice GPCI 1.409 changed to 1.376

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $160.26changed to$155.92

    • 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

    $157.64changed to$160.26

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $157.45changed to$157.64

    • 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
    • Work GPCI 1.023 changed to 1.014
    • Practice expense GPCI 1.016 changed to 1.003
    • Malpractice GPCI 1.154 changed to 1.409

  5. January 1, 2023

    RVU23A

    $159.39changed to$157.45

    • Conversion factor 34.6062 changed to 33.8872
    • Malpractice RVU 0.39 changed to 0.38
    • Work GPCI 1.032 changed to 1.023
    • Practice expense GPCI 1.029 changed to 1.016
    • Malpractice GPCI 0.900 changed to 1.154

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $156.18changed to$159.39

    • 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

    $153.31changed to$156.18

    • 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
    • Work GPCI 1.026 changed to 1.032
    • Practice expense GPCI 1.020 changed to 1.029
    • Malpractice GPCI 0.918 changed to 0.900

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $150.79changed to$153.31

    • 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
    • Work GPCI 1.020 changed to 1.026
    • Practice expense GPCI 1.012 changed to 1.020
    • Malpractice GPCI 0.936 changed to 0.918

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $149.53changed to$150.79

    • 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

    $146.79changed to$149.53

    • 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
    • Practice expense GPCI 1.009 changed to 1.012
    • Malpractice GPCI 0.946 changed to 0.936

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $145.95changed to$146.79

    • Conversion factor 35.8043 changed to 35.8887
    • Malpractice RVU 0.38 changed to 0.39
    • Work GPCI 1.019 changed to 1.020
    • Practice expense GPCI 1.006 changed to 1.009
    • Malpractice GPCI 0.955 changed to 0.946

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $146.12changed to$145.95

    • 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

    $145.39changed to$146.12

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $141.94changed to$145.39

    • 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
    • Work GPCI 1.014 changed to 1.019
    • Practice expense GPCI 1.004 changed to 1.006
    • Malpractice GPCI 0.939 changed to 0.955

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    No ratechanged to$141.94

    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$167.98$101.32RVU26D
2026-07-01$167.98$101.32RVU26C
2026-04-01$167.98$101.32RVU26B
2026-01-01$167.98$101.32RVU26A
2025-10-01$155.92$110.50RVU25D
2025-07-01$155.92$110.50RVU25C
2025-04-01$155.92$110.50RVU25B
2025-01-01$155.92$110.50RVU25A
2024-10-01$160.26$113.52RVU24D
2024-07-01$160.26$113.52RVU24C
2024-04-01$160.26$113.52RVU24B
2024-03-09$160.26$113.52RVU24AR
2024-01-01$157.64$111.66RVU24A
2023-10-01$157.45$110.97RVU23D
2023-07-01$157.45$110.97RVU23C
2023-04-01$157.45$110.97RVU23B
2023-01-01$157.45$110.97RVU23A
2022-10-01$159.39$111.67RVU22D
2022-07-01$159.39$111.67RVU22C
2022-04-01$159.39$111.67RVU22B
2022-01-01$159.39$111.67RVU22A
2021-10-01$156.18$111.29RVU21D
2021-07-01$156.18$111.29RVU21C
2021-04-01$156.18$111.29RVU21B
2021-01-01$156.18$111.29RVU21A
2020-10-01$153.31$112.82RVU20D
2020-07-01$153.31$112.82RVU20C
2020-04-01$153.31$112.82RVU20B
2020-01-01$153.31$112.82RVU20A
2019-10-01$150.79$113.23RVU19D
2019-07-01$150.79$113.23RVU19C
2019-04-01$150.79$113.23RVU19B
2019-01-01$150.79$113.23RVU19A
2018-10-01$149.53$113.83RVU18D
2018-07-01$149.53$113.83RVU18C
2018-04-01$149.53$113.83RVU18B
2018-01-01$149.53$113.83RVU18AR1
2017-10-01$146.79$113.84RVU17D
2017-07-01$146.79$113.84RVU17C
2017-04-01$146.79$113.84RVU17B
2017-01-01$146.79$113.84RVU17A
2016-10-01$145.95$112.81RVU16D
2016-07-01$145.95$112.81RVU16C
2016-04-01$145.95$112.81RVU16B
2016-01-01$145.95$112.81RVU16A
2015-10-01$146.12$113.22RVU15D
2015-07-01$146.12$113.22RVU15C
2015-04-01$145.39$112.66RVU15B
2015-01-01$145.39$112.66RVU15A
2014-10-01$141.94$109.93RVU14D
2014-07-01$141.94$109.93RVU14C
2014-04-01$141.94$109.93RVU14B
2014-01-01$141.94$109.93RVU14A
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 Houston, TX rate applies

Houston, TX is a Medicare payment area, not a city. Our Census mapping connects it to 46 cities and communities in Texas. Some span more than one payment area; confirm with the service ZIP.

Browse all communities in Texas

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 Houston, TXGPCI2026.csv, line 102 (RVU26D)

Open CMS sourceHow we calculate rates

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