CPT code 64644: Muscle chemodenervation, one extremity, five or more muscles2026 Medicare rate & RVUs in California
Reports chemodenervation injections into five or more muscles in one arm or leg, commonly to reduce focal spasticity or other involuntary muscle activity.
Medicare pays $196.88–$243.28 for 64644 in the office in California, from Chico, CA to San Benito County, CA. Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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On this page 9 sections
What 64644 covers
This service covers injection of a chemodenervating agent into five or more muscles in a single extremity to reduce unwanted muscle activity. Neurologists, physiatrists, and other clinicians who manage movement disorders or spasticity commonly perform it in outpatient clinics and hospital settings. Treatment may address focal upper- or lower-extremity muscle overactivity, including patterns that interfere with positioning, movement, or daily function.
Select the code by counting the muscles treated in that extremity, not the number of injection sites or the drug units. Documentation should identify the treated extremity and muscles, the treatment plan, and the administered product and dose. A separately treated additional extremity may support an additional-extremity code. The 0-day global period includes same-day preoperative and postoperative care. When multiple procedures are performed in one session, the highest-valued procedure is paid in full and others are subject to the standard 50% reduction. Modifier 50 is inappropriate. Assistant-at-surgery payment is restricted, and co-surgeons and team surgery 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 64644 pays more and less in California
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
29 payment localities
$196.88 to $243.28
29 of 29 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Bakersfield, CA | $197.97 | $102.42 |
| Chico, CA | $196.88 | $101.33 |
| El Centro, CA | $196.94 | $101.40 |
| Fresno, CA | $196.88 | $101.33 |
| Hanford, CA | $196.88 | $101.33 |
| Los Angeles, CA | $210.29 | $107.16 |
| Madera, CA | $196.88 | $101.33 |
| Marin County, CA | $237.59 | $114.67 |
| Merced, CA | $196.88 | $101.33 |
| Modesto, CA | $196.88 | $101.33 |
| Napa, CA | $225.47 | $110.57 |
| Oxnard, CA | $208.86 | $105.81 |
| Redding, CA | $196.88 | $101.33 |
| Rest of California | $196.88 | $101.33 |
| Riverside, CA | $201.17 | $105.63 |
| Sacramento, CA | $205.92 | $104.54 |
| Salinas, CA | $205.15 | $104.12 |
| San Benito County, CA | $243.28 | $117.58 |
| San Diego, CA | $209.55 | $105.29 |
| San Francisco, CA | $237.13 | $114.21 |
| San Luis Obispo, CA | $201.96 | $102.67 |
| Santa Clara County, CA | $241.43 | $115.72 |
| Santa Cruz, CA | $211.18 | $105.26 |
| Santa Maria, CA | $205.80 | $104.16 |
| Santa Rosa, CA | $213.25 | $106.20 |
| Stockton, CA | $196.88 | $101.33 |
| Vallejo, CA | $224.82 | $109.92 |
| Visalia, CA | $196.88 | $101.33 |
| Yuba City, CA | $196.88 | $101.33 |
How the 64644 rate is calculated
Each of 64644’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 · 64644
RVUs × geographic indexes × conversion factor
Work1.77
1.77 RVUs× 1.000 GPCI
Practice expense3.54
3.54 RVUs× 1.000 GPCI
Malpractice0.40
0.40 RVUs× 1.000 GPCI
Adjusted RVUs
5.7100
Conversion factor
$33.4009
Medicare rate
$190.72
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 64644
The CMS indicators that decide how 64644 is paid alongside other services.
CMS payment indicators · 64644
Muscle chemodenervation, one extremity, five or more muscles
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 000 | Same-day global: pre- and post-op care on the day of the procedure is included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| 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. |
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
64644 without 51 · national office
$190.72
Muscle chemodenervation, one extremity, five or more muscles
64644-51 · Second procedure: 50%
$95.36
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%).
64644 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 64642ChemodenervationOne extremity, 1–4 muscles
- Both apply to one extremity; 64642 is selected for one to four treated muscles, while 64644 is for five or more.
- 64645Muscle chemodenervationAdditional extremity, five-plus muscles
- 64645 describes treatment of five or more muscles in an additional extremity. This code describes the first extremity treated.
- 64646Muscle chemodenervationTrunk, one to five muscles
- 64646 applies to chemodenervation of trunk muscles. Use 64644 for five or more muscles in one extremity.
64644 billing questions
How is this distinguished from 64642?
Both describe treatment in one extremity. Use 64644 when five or more muscles in that extremity are treated; 64642 is for one to four.
Does the muscle count refer to injections or muscles?
Count the muscles treated, not injection sites, needle passes, or units of medication. The record should identify the muscles injected.
Can another extremity be reported separately?
Yes, when treatment is performed in an additional extremity, the applicable additional-extremity code may be reported. Match that code to the number of muscles treated in the additional extremity.
Should modifier 50 be used for both sides?
No. The CMS bilateral adjustment does not apply, and modifier 50 is inappropriate for this service. Report qualifying treatment by extremity using the applicable code structure.
Is the chemodenervating drug included?
This code represents the injection service. When the practice supplies the drug, the drug may be reported separately under the applicable drug code, supported by documentation of the product and dose.
What happens when other procedures are performed in the same session?
The highest-valued procedure is paid in full, and other procedures subject to the standard multiple-procedure rule are paid at 50% when performed in the same session.
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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