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CPT code 64643: Chemodenervation, additional extremity, 1-4 muscles2026 Medicare rate & RVUs in Fort Worth, TX

Reports chemodenervation of an additional extremity when treatment targets one to four muscles there, alongside the primary extremity procedure.

CMS RVU26DEffective Oct 1, 2026One payment locality38.6K Medicare services in 2024

In Fort Worth, TX, Medicare pays $98.50 for 64643 in the office and $58.98 when it’s performed in a hospital or facility.

$98.50Office (non-facility)
$58.98Hospital or facility
−1.4%vs the national office rate ($99.87)

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.

We’ll open 64643 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Fort Worth, TX
  2. What 64643 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 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 Fort Worth, TX 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. Fort Worth, TX pays $98.50. The RVUs are the same everywhere; the geographic indexes change the dollars.

64643 in Fort Worth, TX vs other payment areas
  1. Fort Worth, TX · this page$98.50
  2. Austin, TX · Texas$102.11+$3.61
  3. Beaumont, TX · Texas$94.60−$3.90
  4. Brazoria, TX · Texas$98.02−$0.48
  5. Dallas, TX · Texas$98.93+$0.43
  6. Galveston, TX · Texas$98.50
  7. Houston, TX · Texas$102.71+$4.21

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

Every other payment area

64643 in every other Medicare payment locality
Payment localityOfficeFacility
Rest of TexasTexas$96.45$58.41
Los Angeles, CACalifornia$108.51$61.10
Washington, DC areaDistrict of Columbia$112.22$65.00
Miami, FLFlorida$113.76$72.04
Chicago, ILIllinois$110.36$70.08
Manhattan, NYNew York$115.41$68.84
AlaskaAlaska$119.70$77.02
AlabamaAlabama$89.98$54.91

64643 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.

$88.75

$119.70

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

View every state and territory as a table
64643 office rate range by state
State / territoryOffice rate rangeLocalities
AK$119.701
AL$89.981
AR$88.751
AZ$97.141
CA$102.01–$123.8529
CO$102.021
CT$106.311
DC$112.221
DE$98.661
FL$101.43–$113.763
GA$95.68–$102.372
GU$103.821
HI$103.821
IA$90.781
ID$91.631
IL$99.63–$110.364
IN$92.091
KS$91.021
KY$93.391
LA$93.52–$97.822
MA$101.72–$110.832
MD$100.27–$112.223
ME$92.77–$96.562
MI$96.30–$103.302
MN$95.981
MO$92.43–$97.373
MS$90.571
MT$99.851
NC$93.581
ND$95.311
NE$91.051
NH$101.061
NJ$107.03–$111.292
NM$97.061
NV$98.641
NY$94.97–$118.915
OH$95.371
OK$92.541
OR$97.38–$104.362
PA$95.15–$104.222
PR$100.331
RI$101.521
SC$94.731
SD$94.771
TN$91.541
TX$94.60–$102.718
UT$95.941
VA$96.72–$112.222
VI$100.331
VT$95.551
WA$101.33–$112.352
WI$92.351
WV$96.311
WY$97.871

See 64643 in every payment locality

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

Office or facility?

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 Fort Worth, TX 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

100

Locality
Fort Worth, TX
Physician work
1.009
Practice expense
0.986
Malpractice
0.871
Office calculation for 64643 in Fort Worth, TX
ComponentRVULocality factorAdjusted
Physician work1.19× 1.0091.2007
Practice expense1.57× 0.9861.5480
Malpractice0.23× 0.8710.2003
Total RVUs2.9491
Conversion factor× 33.4009

Office rate, Fort Worth, TX$98.50

Office: (1.19 × 1.009 + 1.57 × 0.986 + 0.23 × 0.871) × $33.4009 = $98.50

Facility: (1.19 × 1.009 + 0.37 × 0.986 + 0.23 × 0.871) × $33.4009 = $58.98

Open 64643 in the RVU calculator

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

RuleCMS valueWhat it means
Global periodZZZAdd-on code: falls within the primary procedure’s global period.
Multiple procedures0No multiple-procedure reduction.
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.

Codes related to 64643

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

Codes related to 64643
CodeHow it relatesOffice range, Fort Worth, TX
Add-on codes
64642Chemodenervation, one extremity, 1–4 musclesPrimary extremity chemodenervation for one to four muscles; commonly paired with 64643.$160.78
Same family
64644Muscle chemodenervation, one extremity, five or more musclesPrimary extremity service when five or more muscles are treated.$187.87
64645Muscle chemodenervation, additional extremity, five-plus musclesAdditional-extremity service when five or more muscles are treated.$127.52
Used instead
64646Muscle chemodenervation, trunk, one to five musclesChemodenervation for trunk muscles rather than an extremity.$167.47

How 64643 has changed in Fort Worth, TX

64643 · Office / nonfacility

$98.50

Effective 2026-10-01

The base rate is $7.99 higher than on 2025-10-01, moving from $90.51 to $98.50 (8.8%).

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

    $90.51changed to$98.50

    • 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
    • Work GPCI 1.011 changed to 1.009
    • Practice expense GPCI 0.998 changed to 0.986
    • Malpractice GPCI 0.902 changed to 0.871

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $93.11changed to$90.51

    • 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.

  3. March 9, 2024

    RVU24AR

    $91.59changed to$93.11

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $91.87changed to$91.59

    • 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
    • Work GPCI 1.013 changed to 1.011
    • Practice expense GPCI 0.996 changed to 0.998
    • Malpractice GPCI 0.721 changed to 0.902

  5. January 1, 2023

    RVU23A

    $92.82changed to$91.87

    • 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
    • Work GPCI 1.016 changed to 1.013
    • Practice expense GPCI 0.995 changed to 0.996
    • Malpractice GPCI 0.539 changed to 0.721

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $92.36changed to$92.82

    • 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.

  7. January 1, 2021

    RVU21A

    $92.89changed to$92.36

    • 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
    • Work GPCI 1.011 changed to 1.016
    • Practice expense GPCI 0.991 changed to 0.995
    • Malpractice GPCI 0.643 changed to 0.539

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $93.02changed to$92.89

    • 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
    • Work GPCI 1.007 changed to 1.011
    • Practice expense GPCI 0.986 changed to 0.991
    • Malpractice GPCI 0.747 changed to 0.643

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $92.92changed to$93.02

    • Conversion factor 35.9996 changed to 36.0391

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $92.83changed to$92.92

    • 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
    • Work GPCI 1.006 changed to 1.007
    • Practice expense GPCI 0.991 changed to 0.986
    • Malpractice GPCI 0.760 changed to 0.747

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $93.12changed to$92.83

    • Conversion factor 35.8043 changed to 35.8887
    • Malpractice RVU 0.26 changed to 0.25
    • Work GPCI 1.005 changed to 1.006
    • Practice expense GPCI 0.995 changed to 0.991
    • Malpractice GPCI 0.772 changed to 0.760

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $93.85changed to$93.12

    • 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.

  13. July 1, 2015

    RVU15C

    $93.39changed to$93.85

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $91.10changed to$93.39

    • Conversion factor 35.8228 changed to 35.7547
    • Malpractice RVU 0.22 changed to 0.30
    • Work GPCI 1.002 changed to 1.005
    • Practice expense GPCI 0.987 changed to 0.995
    • Malpractice GPCI 0.799 changed to 0.772

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    No ratechanged to$91.10

    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$98.50$58.98RVU26D
2026-07-01$98.50$58.98RVU26C
2026-04-01$98.50$58.98RVU26B
2026-01-01$98.50$58.98RVU26A
2025-10-01$90.51$66.94RVU25D
2025-07-01$90.51$66.94RVU25C
2025-04-01$90.51$66.94RVU25B
2025-01-01$90.51$66.94RVU25A
2024-10-01$93.11$69.19RVU24D
2024-07-01$93.11$69.19RVU24C
2024-04-01$93.11$69.19RVU24B
2024-03-09$93.11$69.19RVU24AR
2024-01-01$91.59$68.06RVU24A
2023-10-01$91.87$68.91RVU23D
2023-07-01$91.87$68.91RVU23C
2023-04-01$91.87$68.91RVU23B
2023-01-01$91.87$68.91RVU23A
2022-10-01$92.82$69.06RVU22D
2022-07-01$92.82$69.06RVU22C
2022-04-01$92.82$69.06RVU22B
2022-01-01$92.82$69.06RVU22A
2021-10-01$92.36$69.45RVU21D
2021-07-01$92.36$69.45RVU21C
2021-04-01$92.36$69.45RVU21B
2021-01-01$92.36$69.45RVU21A
2020-10-01$92.89$71.79RVU20D
2020-07-01$92.89$71.79RVU20C
2020-04-01$92.89$71.79RVU20B
2020-01-01$92.89$71.79RVU20A
2019-10-01$93.02$72.77RVU19D
2019-07-01$93.02$72.77RVU19C
2019-04-01$93.02$72.77RVU19B
2019-01-01$93.02$72.77RVU19A
2018-10-01$92.92$72.69RVU18D
2018-07-01$92.92$72.69RVU18C
2018-04-01$92.92$72.69RVU18B
2018-01-01$92.92$72.69RVU18AR1
2017-10-01$92.83$72.92RVU17D
2017-07-01$92.83$72.92RVU17C
2017-04-01$92.83$72.92RVU17B
2017-01-01$92.83$72.92RVU17A
2016-10-01$93.12$73.17RVU16D
2016-07-01$93.12$73.17RVU16C
2016-04-01$93.12$73.17RVU16B
2016-01-01$93.12$73.17RVU16A
2015-10-01$93.85$74.19RVU15D
2015-07-01$93.85$74.19RVU15C
2015-04-01$93.39$73.82RVU15B
2015-01-01$93.39$73.82RVU15A
2014-10-01$91.10$71.66RVU14D
2014-07-01$91.10$71.66RVU14C
2014-04-01$91.10$71.66RVU14B
2014-01-01$91.10$71.66RVU14A
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 64643 for an earlier date of service

Where the Fort Worth, TX rate applies

Fort Worth, TX is a Medicare payment area, not a city. Our Census mapping connects it to 45 cities and communities in Texas. Some span more than one payment area; confirm with the service ZIP.

Browse all communities in Texas

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
RVUs for 64643PPRRVU2026_Oct_nonQPP.csv, line 7,186 (RVU26D)
Geographic factors for Fort Worth, TXGPCI2026.csv, line 100 (RVU26D)

Open CMS sourceHow we calculate rates

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