CPT code 64643: Chemodenervation, additional extremity, 1-4 muscles2026 Medicare rate & RVUs in Iowa
Reports chemodenervation of an additional extremity when treatment targets one to four muscles there, alongside the primary extremity procedure.
In Iowa, Medicare pays $90.78 for 64643 in the office and $54.10 when it’s performed in a hospital or facility.
Check a contract rate as a % of Medicare · 64643 nationwide
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 11 sections
What 64643 covers
This add-on code represents chemodenervation of an additional limb, treating one to four muscles in that extremity. It is commonly used when a clinician injects botulinum toxin to manage focal spasticity, such as after stroke, traumatic brain injury, or in cerebral palsy. Physicians and other qualified practitioners typically perform the injections in an office or facility setting, selecting target muscles based on the patient’s functional goals and examination findings.
Report 64643 with the primary extremity chemodenervation service, generally 64642, when another extremity is treated at the same session. The muscle count is assessed separately for each extremity; this code represents an additional extremity with one to four treated muscles, not each individual muscle or injection site. Documentation should identify the treated extremity, muscles, indication, and administered treatment. CMS classifies this as an add-on code: it is billed only with a primary procedure, and its payment falls within that procedure’s global period.
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 Iowa compares for 64643
Across 109 of 109 payment localities, the office rate for 64643 runs from $88.75 in Arkansas to $123.85 in San Benito County, CA. Iowa pays $90.78. The RVUs are the same everywhere; the geographic indexes change the dollars.
- Iowa · this page$90.78
- Los Angeles, CA · California$108.51+$17.73
- Washington, DC area · District of Columbia$112.22+$21.44
- Miami, FL · Florida$113.76+$22.98
- Chicago, IL · Illinois$110.36+$19.58
- Manhattan, NY · New York$115.41+$24.63
- Alaska · Alaska$119.70+$28.92
Other areas in Iowa first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| AlabamaAlabama | $89.98 | $54.91 |
| ArkansasArkansas | $88.75 | $54.32 |
| ArizonaArizona | $97.14 | $58.30 |
| Bakersfield, CACalifornia | $102.65 | $58.73 |
| Chico, CACalifornia | $102.01 | $58.09 |
| El Centro, CACalifornia | $102.05 | $58.12 |
| Fresno, CACalifornia | $102.01 | $58.09 |
| Hanford, CACalifornia | $102.01 | $58.09 |
| Madera, CACalifornia | $102.01 | $58.09 |
| Merced, CACalifornia | $102.01 | $58.09 |
| Modesto, CACalifornia | $102.01 | $58.09 |
| Napa, CACalifornia | $115.27 | $62.44 |
| Oxnard, CACalifornia | $107.63 | $60.25 |
| Redding, CACalifornia | $102.01 | $58.09 |
| Rest of CaliforniaCalifornia | $102.01 | $58.09 |
| Riverside, CACalifornia | $104.49 | $60.56 |
| Sacramento, CACalifornia | $106.28 | $59.67 |
| Salinas, CACalifornia | $105.87 | $59.42 |
| San Diego, CACalifornia | $107.82 | $59.88 |
| Marin County, CACalifornia | $120.99 | $64.47 |
| San Francisco, CACalifornia | $120.73 | $64.21 |
| San Benito County, CACalifornia | $123.85 | $66.06 |
| Santa Clara County, CACalifornia | $122.79 | $64.99 |
| San Luis Obispo, CACalifornia | $104.27 | $58.62 |
| Santa Cruz, CACalifornia | $108.41 | $59.71 |
| Santa Maria, CACalifornia | $106.12 | $59.39 |
| Santa Rosa, CACalifornia | $109.45 | $60.23 |
| Stockton, CACalifornia | $102.01 | $58.09 |
| Vallejo, CACalifornia | $114.89 | $62.07 |
| Visalia, CACalifornia | $102.01 | $58.09 |
| Yuba City, CACalifornia | $102.01 | $58.09 |
| ColoradoColorado | $102.02 | $59.37 |
| ConnecticutConnecticut | $106.31 | $63.15 |
| DelawareDelaware | $98.66 | $59.06 |
| Fort Lauderdale, FLFlorida | $106.76 | $66.16 |
| Rest of FloridaFlorida | $101.43 | $63.11 |
| Atlanta, GAGeorgia | $102.37 | $61.65 |
| Rest of GeorgiaGeorgia | $95.68 | $59.93 |
| Hawaii, Guam, HIHawaii | $103.82 | $58.25 |
| IdahoIdaho | $91.63 | $54.75 |
| East St. Louis, ILIllinois | $103.46 | $66.59 |
| Rest of IllinoisIllinois | $99.63 | $63.04 |
| Suburban Chicago, ILIllinois | $107.49 | $66.33 |
| IndianaIndiana | $92.09 | $54.94 |
| KansasKansas | $91.02 | $54.79 |
| KentuckyKentucky | $93.39 | $57.76 |
| New Orleans, LALouisiana | $97.82 | $60.10 |
| Rest of LouisianaLouisiana | $93.52 | $58.04 |
| Metropolitan Boston, MAMassachusetts | $110.83 | $62.97 |
| Rest of MassachusettsMassachusetts | $101.72 | $59.52 |
| Baltimore area, MDMaryland | $106.15 | $63.15 |
| Rest of MarylandMaryland | $100.27 | $59.70 |
| Rest of MaineMaine | $92.77 | $55.90 |
| Southern Maine, MEMaine | $96.56 | $56.84 |
| Detroit, MIMichigan | $103.30 | $64.63 |
| Rest of MichiganMichigan | $96.30 | $59.70 |
| MinnesotaMinnesota | $95.98 | $54.74 |
| Metropolitan Kansas City, MOMissouri | $96.49 | $58.86 |
| Metropolitan St. Louis, MOMissouri | $97.37 | $59.21 |
| Rest of MissouriMissouri | $92.43 | $57.88 |
| MississippiMississippi | $90.57 | $56.06 |
| MontanaMontana | $99.85 | $59.77 |
| North CarolinaNorth Carolina | $93.58 | $56.19 |
| North DakotaNorth Dakota | $95.31 | $55.22 |
| NebraskaNebraska | $91.05 | $54.06 |
| New HampshireNew Hampshire | $101.06 | $59.33 |
| Northern New JerseyNew Jersey | $111.29 | $64.79 |
| Rest of New JerseyNew Jersey | $107.03 | $63.26 |
| New MexicoNew Mexico | $97.06 | $60.31 |
| NevadaNevada | $98.64 | $58.52 |
| NYC suburbs and Long Island, NYNew York | $118.91 | $71.25 |
| Poughkeepsie and northern NYC suburbs, NYNew York | $108.25 | $64.36 |
| Queens, NYNew York | $115.35 | $67.98 |
| Rest of New YorkNew York | $94.97 | $56.89 |
| OhioOhio | $95.37 | $58.77 |
| OklahomaOklahoma | $92.54 | $56.75 |
| Portland, OROregon | $104.36 | $59.83 |
| Rest of OregonOregon | $97.38 | $57.46 |
| Metropolitan Philadelphia, PAPennsylvania | $104.22 | $62.49 |
| Rest of PennsylvaniaPennsylvania | $95.15 | $58.35 |
| Puerto RicoPuerto Rico | $100.33 | $59.81 |
| Rhode IslandRhode Island | $101.52 | $60.12 |
| South CarolinaSouth Carolina | $94.73 | $57.70 |
| South DakotaSouth Dakota | $94.77 | $54.69 |
| TennesseeTennessee | $91.54 | $55.11 |
| Austin, TXTexas | $102.11 | $59.71 |
| Beaumont, TXTexas | $94.60 | $58.13 |
| Brazoria, TXTexas | $98.02 | $58.30 |
| Dallas, TXTexas | $98.93 | $59.01 |
| Fort Worth, TXTexas | $98.50 | $58.98 |
| Galveston, TXTexas | $98.50 | $58.70 |
| Houston, TXTexas | $102.71 | $62.91 |
| Rest of TexasTexas | $96.45 | $58.41 |
| UtahUtah | $95.94 | $58.26 |
| VirginiaVirginia | $96.72 | $57.32 |
| Virgin Islands, VIUnited States Virgin Islands | $100.33 | $59.81 |
| VermontVermont | $95.55 | $55.87 |
| Rest of WashingtonWashington | $101.33 | $59.12 |
| King County, WAWashington | $112.35 | $63.17 |
| WisconsinWisconsin | $92.35 | $53.95 |
| West VirginiaWest Virginia | $96.31 | $61.48 |
| WyomingWyoming | $97.87 | $57.79 |
64643 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.
$88.75
$119.70
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 | $119.70 | 1 |
| AL | $89.98 | 1 |
| AR | $88.75 | 1 |
| AZ | $97.14 | 1 |
| CA | $102.01–$123.85 | 29 |
| CO | $102.02 | 1 |
| CT | $106.31 | 1 |
| DC | $112.22 | 1 |
| DE | $98.66 | 1 |
| FL | $101.43–$113.76 | 3 |
| GA | $95.68–$102.37 | 2 |
| GU | $103.82 | 1 |
| HI | $103.82 | 1 |
| IA | $90.78 | 1 |
| ID | $91.63 | 1 |
| IL | $99.63–$110.36 | 4 |
| IN | $92.09 | 1 |
| KS | $91.02 | 1 |
| KY | $93.39 | 1 |
| LA | $93.52–$97.82 | 2 |
| MA | $101.72–$110.83 | 2 |
| MD | $100.27–$112.22 | 3 |
| ME | $92.77–$96.56 | 2 |
| MI | $96.30–$103.30 | 2 |
| MN | $95.98 | 1 |
| MO | $92.43–$97.37 | 3 |
| MS | $90.57 | 1 |
| MT | $99.85 | 1 |
| NC | $93.58 | 1 |
| ND | $95.31 | 1 |
| NE | $91.05 | 1 |
| NH | $101.06 | 1 |
| NJ | $107.03–$111.29 | 2 |
| NM | $97.06 | 1 |
| NV | $98.64 | 1 |
| NY | $94.97–$118.91 | 5 |
| OH | $95.37 | 1 |
| OK | $92.54 | 1 |
| OR | $97.38–$104.36 | 2 |
| PA | $95.15–$104.22 | 2 |
| PR | $100.33 | 1 |
| RI | $101.52 | 1 |
| SC | $94.73 | 1 |
| SD | $94.77 | 1 |
| TN | $91.54 | 1 |
| TX | $94.60–$102.71 | 8 |
| UT | $95.94 | 1 |
| VA | $96.72–$112.22 | 2 |
| VI | $100.33 | 1 |
| VT | $95.55 | 1 |
| WA | $101.33–$112.35 | 2 |
| WI | $92.35 | 1 |
| WV | $96.31 | 1 |
| WY | $97.87 | 1 |
How the 64643 rate is calculated
Each of 64643’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 · 64643
RVUs × geographic indexes × conversion factor
Work1.19
1.19 RVUs× 1.000 GPCI
Practice expense1.57
1.57 RVUs× 1.000 GPCI
Malpractice0.23
0.23 RVUs× 1.000 GPCI
Adjusted RVUs
2.9900
Conversion factor
$33.4009
Medicare rate
$99.87
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
The exact Iowa inputs and CMS source lines
PPRRVU2026_Oct_nonQPP.csv
7,186
- Code
- 64643
- Physician work
- 1.19
- Practice expense
- 1.57
- Malpractice
- 0.23
GPCI2026.csv
53
- Locality
- Iowa
- Physician work
- 1.000
- Practice expense
- 0.915
- Malpractice
- 0.397
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 1.19 | × 1.000 | 1.1900 |
| Practice expense | 1.57 | × 0.915 | 1.4366 |
| Malpractice | 0.23 | × 0.397 | 0.0913 |
| Total RVUs | 2.7179 | ||
| Conversion factor | × 33.4009 | ||
Office rate, Iowa$90.78
Office: (1.19 × 1 + 1.57 × 0.915 + 0.23 × 0.397) × $33.4009 = $90.78
Facility: (1.19 × 1 + 0.37 × 0.915 + 0.23 × 0.397) × $33.4009 = $54.10
Payment rules and modifiers for 64643
The CMS indicators that decide how 64643 is paid alongside other services.
CMS payment indicators · 64643
Chemodenervation, additional extremity, 1-4 muscles
| Rule | CMS value | What it means |
|---|---|---|
| Global period | ZZZ | Add-on code: falls within the primary procedure’s global period. |
| Multiple procedures | 0 | No multiple-procedure reduction. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| 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. |
How 64643 has changed in Iowa
64643 · Office / nonfacility
$90.78
Effective 2026-10-01
The base rate is $7.75 higher than on 2025-10-01, moving from $83.03 to $90.78 (9.3%).
It is unchanged from the immediately preceding available release, effective 2026-07-01.
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
January 1, 2026
RVU26A
$83.03changed to$90.78
- Conversion factor 32.3465 changed to 33.4009
- Work RVU 1.22 changed to 1.19
- Practice expense RVU 1.36 changed to 1.57
- Practice expense GPCI 0.913 changed to 0.915
- Malpractice GPCI 0.457 changed to 0.397
Held through RVU26B, RVU26C, RVU26D.
January 1, 2025
RVU25A
$85.29changed to$83.03
- Conversion factor 33.2875 changed to 32.3465
- Practice expense RVU 1.35 changed to 1.36
- Malpractice RVU 0.24 changed to 0.23
Held through RVU25B, RVU25C, RVU25D.
March 9, 2024
RVU24AR
$83.90changed to$85.29
- Conversion factor 32.7442 changed to 33.2875
Held through RVU24B, RVU24C, RVU24D.
January 1, 2024
RVU24A
$85.17changed to$83.90
- Conversion factor 33.8872 changed to 32.7442
- Practice expense RVU 1.30 changed to 1.35
- Malpractice RVU 0.25 changed to 0.24
- Practice expense GPCI 0.910 changed to 0.913
- Malpractice GPCI 0.441 changed to 0.457
January 1, 2023
RVU23A
$87.18changed to$85.17
- Conversion factor 34.6062 changed to 33.8872
- Practice expense RVU 1.32 changed to 1.30
- Malpractice RVU 0.24 changed to 0.25
- Practice expense GPCI 0.907 changed to 0.910
- Malpractice GPCI 0.425 changed to 0.441
Held through RVU23B, RVU23C, RVU23D.
January 1, 2022
RVU22A
$86.81changed to$87.18
- Conversion factor 34.8931 changed to 34.6062
- Practice expense RVU 1.29 changed to 1.32
- Malpractice RVU 0.23 changed to 0.24
Held through RVU22B, RVU22C, RVU22D.
January 1, 2021
RVU21A
$87.00changed to$86.81
- Conversion factor 36.0896 changed to 34.8931
- Practice expense RVU 1.21 changed to 1.29
- Malpractice RVU 0.22 changed to 0.23
- Malpractice GPCI 0.424 changed to 0.425
Held through RVU21B, RVU21C, RVU21D.
January 1, 2020
RVU20A
$86.52changed to$87.00
- Conversion factor 36.0391 changed to 36.0896
- Practice expense RVU 1.19 changed to 1.21
- Malpractice RVU 0.24 changed to 0.22
- Malpractice GPCI 0.423 changed to 0.424
Held through RVU20B, RVU20C, RVU20D.
January 1, 2019
RVU19A
$86.43changed to$86.52
- Conversion factor 35.9996 changed to 36.0391
Held through RVU19B, RVU19C, RVU19D.
January 1, 2018
RVU18AR1
$86.09changed to$86.43
- Conversion factor 35.8887 changed to 35.9996
- Practice expense RVU 1.18 changed to 1.19
- Malpractice RVU 0.25 changed to 0.24
- Practice expense GPCI 0.902 changed to 0.907
- Malpractice GPCI 0.458 changed to 0.423
Held through RVU18B, RVU18C, RVU18D.
January 1, 2017
RVU17A
$86.13changed to$86.09
- Conversion factor 35.8043 changed to 35.8887
- Malpractice RVU 0.26 changed to 0.25
- Practice expense GPCI 0.896 changed to 0.902
- Malpractice GPCI 0.493 changed to 0.458
Held through RVU17B, RVU17C, RVU17D.
January 1, 2016
RVU16A
$86.50changed to$86.13
- Conversion factor 35.9335 changed to 35.8043
- Practice expense RVU 1.16 changed to 1.18
- Malpractice RVU 0.30 changed to 0.26
Held through RVU16B, RVU16C, RVU16D.
July 1, 2015
RVU15C
$86.07changed to$86.50
- Conversion factor 35.7547 changed to 35.9335
Held through RVU15D.
January 1, 2015
RVU15A
$84.51changed to$86.07
- Conversion factor 35.8228 changed to 35.7547
- Malpractice RVU 0.22 changed to 0.30
- Practice expense GPCI 0.892 changed to 0.896
- Malpractice GPCI 0.475 changed to 0.493
Held through RVU15B.
January 1, 2014
RVU14A
No ratechanged to$84.51
Held through RVU14B, RVU14C, RVU14D.
January 1, 2013
RVU13AR
Earliest loaded release: No rate
Held through RVU13B, RVU13C, RVU13D.
| Effective from | Office | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | $90.78 | $54.10 | RVU26D |
| 2026-07-01 | $90.78 | $54.10 | RVU26C |
| 2026-04-01 | $90.78 | $54.10 | RVU26B |
| 2026-01-01 | $90.78 | $54.10 | RVU26A |
| 2025-10-01 | $83.03 | $61.47 | RVU25D |
| 2025-07-01 | $83.03 | $61.47 | RVU25C |
| 2025-04-01 | $83.03 | $61.47 | RVU25B |
| 2025-01-01 | $83.03 | $61.47 | RVU25A |
| 2024-10-01 | $85.29 | $63.41 | RVU24D |
| 2024-07-01 | $85.29 | $63.41 | RVU24C |
| 2024-04-01 | $85.29 | $63.41 | RVU24B |
| 2024-03-09 | $85.29 | $63.41 | RVU24AR |
| 2024-01-01 | $83.90 | $62.37 | RVU24A |
| 2023-10-01 | $85.17 | $64.20 | RVU23D |
| 2023-07-01 | $85.17 | $64.20 | RVU23C |
| 2023-04-01 | $85.17 | $64.20 | RVU23B |
| 2023-01-01 | $85.17 | $64.20 | RVU23A |
| 2022-10-01 | $87.18 | $65.52 | RVU22D |
| 2022-07-01 | $87.18 | $65.52 | RVU22C |
| 2022-04-01 | $87.18 | $65.52 | RVU22B |
| 2022-01-01 | $87.18 | $65.52 | RVU22A |
| 2021-10-01 | $86.81 | $65.92 | RVU21D |
| 2021-07-01 | $86.81 | $65.92 | RVU21C |
| 2021-04-01 | $86.81 | $65.92 | RVU21B |
| 2021-01-01 | $86.81 | $65.92 | RVU21A |
| 2020-10-01 | $87.00 | $67.69 | RVU20D |
| 2020-07-01 | $87.00 | $67.69 | RVU20C |
| 2020-04-01 | $87.00 | $67.69 | RVU20B |
| 2020-01-01 | $87.00 | $67.69 | RVU20A |
| 2019-10-01 | $86.52 | $67.89 | RVU19D |
| 2019-07-01 | $86.52 | $67.89 | RVU19C |
| 2019-04-01 | $86.52 | $67.89 | RVU19B |
| 2019-01-01 | $86.52 | $67.89 | RVU19A |
| 2018-10-01 | $86.43 | $67.82 | RVU18D |
| 2018-07-01 | $86.43 | $67.82 | RVU18C |
| 2018-04-01 | $86.43 | $67.82 | RVU18B |
| 2018-01-01 | $86.43 | $67.82 | RVU18AR1 |
| 2017-10-01 | $86.09 | $67.96 | RVU17D |
| 2017-07-01 | $86.09 | $67.96 | RVU17C |
| 2017-04-01 | $86.09 | $67.96 | RVU17B |
| 2017-01-01 | $86.09 | $67.96 | RVU17A |
| 2016-10-01 | $86.13 | $68.16 | RVU16D |
| 2016-07-01 | $86.13 | $68.16 | RVU16C |
| 2016-04-01 | $86.13 | $68.16 | RVU16B |
| 2016-01-01 | $86.13 | $68.16 | RVU16A |
| 2015-10-01 | $86.50 | $68.79 | RVU15D |
| 2015-07-01 | $86.50 | $68.79 | RVU15C |
| 2015-04-01 | $86.07 | $68.45 | RVU15B |
| 2015-01-01 | $86.07 | $68.45 | RVU15A |
| 2014-10-01 | $84.51 | $66.94 | RVU14D |
| 2014-07-01 | $84.51 | $66.94 | RVU14C |
| 2014-04-01 | $84.51 | $66.94 | RVU14B |
| 2014-01-01 | $84.51 | $66.94 | RVU14A |
| 2013-10-01 | Not in this release | Not in this release | RVU13D |
| 2013-07-01 | Not in this release | Not in this release | RVU13C |
| 2013-04-01 | Not in this release | Not in this release | RVU13B |
| 2013-01-01 | Not in this release | Not in this release | RVU13AR |
Where the Iowa rate applies
Iowa is a Medicare payment area, not a city. Our Census mapping connects it to 1026 cities and communities in Iowa. Some span more than one payment area; confirm with the service ZIP.
- Ackley
- Ackworth
- Adair
- Adel
- Afton
- Agency
- Ainsworth
- Akron
64643 billing questions
When is 64643 used instead of 64642?
64642 reports the primary extremity treated with one to four muscles. Use 64643 for each additional extremity treated with one to four muscles during the service.
Can 64643 be billed by itself?
No. It is an add-on code and must be reported with a primary procedure, generally 64642 for the first extremity.
Is the code counted per muscle or per extremity?
It is counted per additional extremity. The extremity must have one to four muscles treated; the code is not reported once for each muscle or injection site.
When should 64645 be used instead?
Use 64645 for an additional extremity when five or more muscles are treated there. The one-to-four muscle threshold is evaluated separately for each extremity.
What documentation supports 64643?
Document the additional extremity, the muscles treated in that limb, the indication for chemodenervation, and the treatment performed.
How does the global-period rule affect 64643?
CMS treats 64643 as an add-on service paid within the primary procedure’s global period. It must accompany a primary procedure.
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
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