CPT code 64644: Muscle chemodenervation, one extremity, five or more muscles2026 Medicare rate & RVUs in North Carolina

Reports chemodenervation injections into five or more muscles in one arm or leg, commonly to reduce focal spasticity or other involuntary muscle activity.

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

In North Carolina, Medicare pays $177.97 for 64644 in the office and $96.64 when it’s performed in a hospital or facility.

$177.97Office (non-facility)
$96.64Hospital or facility
−6.7%vs the national office rate ($190.72)

Check a contract rate as a % of Medicare · 64644 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 64644 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in North Carolina
  2. What 64644 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 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.

How North Carolina compares for 64644

Across 109 of 109 payment localities, the office rate for 64644 runs from $167.57 in Arkansas to $243.28 in San Benito County, CA. North Carolina pays $177.97. The RVUs are the same everywhere; the geographic indexes change the dollars.

64644 in North Carolina vs other payment areas
  1. North Carolina · this page$177.97
  2. Los Angeles, CA · California$210.29+$32.32
  3. Washington, DC area · District of Columbia$216.47+$38.50
  4. Miami, FL · Florida$215.99+$38.02
  5. Chicago, IL · Illinois$209.03+$31.06
  6. Manhattan, NY · New York$221.49+$43.52
  7. Alaska · Alaska$221.97+$44.00

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

Every other payment area

64644 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$170.14$93.86
ArkansasArkansas$167.57$92.68
ArizonaArizona$185.13$100.66
Bakersfield, CACalifornia$197.97$102.42
Chico, CACalifornia$196.88$101.33
El Centro, CACalifornia$196.94$101.40
Fresno, CACalifornia$196.88$101.33
Hanford, CACalifornia$196.88$101.33

64644 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.

$167.57

$221.97

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

View every state and territory as a table
64644 office rate range by state
State / territoryOffice rate rangeLocalities
AK$221.971
AL$170.141
AR$167.571
AZ$185.131
CA$196.88–$243.2829
CO$196.071
CT$203.811
DC$216.471
DE$188.251
FL$192.24–$215.993
GA$180.51–$195.472
GU$201.291
HI$201.291
IA$172.611
ID$174.221
IL$187.95–$209.034
IN$175.221
KS$172.741
KY$176.461
LA$176.56–$185.562
MA$195.22–$214.612
MD$191.63–$216.473
ME$176.21–$184.732
MI$182.16–$195.752
MN$184.741
MO$174.05–$185.073
MS$170.801
MT$190.691
NC$177.971
ND$182.781
NE$173.301
NH$193.901
NJ$205.26–$214.272
NM$183.591
NV$188.611
NY$180.84–$228.305
OH$180.541
OK$175.091
OR$186.28–$201.372
PA$180.29–$199.212
PR$191.821
RI$194.301
SC$179.731
SD$181.851
TN$173.771
TX$179.13–$196.178
UT$182.261
VA$184.78–$216.472
VI$191.821
VT$182.941
WA$194.56–$218.072
WI$176.511
WV$180.991
WY$187.251

See 64644 in every payment locality

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

Office or facility?

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.

The exact North Carolina inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

7,187

Code
64644
Physician work
1.77
Practice expense
3.54
Malpractice
0.40

GPCI2026.csv

83

Locality
North Carolina
Physician work
1.000
Practice expense
0.933
Malpractice
0.639
Office calculation for 64644 in North Carolina
ComponentRVULocality factorAdjusted
Physician work1.77× 1.0001.7700
Practice expense3.54× 0.9333.3028
Malpractice0.40× 0.6390.2556
Total RVUs5.3284
Conversion factor× 33.4009

Office rate, North Carolina$177.97

Office: (1.77 × 1 + 3.54 × 0.933 + 0.4 × 0.639) × $33.4009 = $177.97

Facility: (1.77 × 1 + 0.93 × 0.933 + 0.4 × 0.639) × $33.4009 = $96.64

Open 64644 in the RVU calculator

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

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

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%).

When to use modifier 51

How 64644 has changed in North Carolina

64644 · Office / nonfacility

$177.97

Effective 2026-10-01

The base rate is $16.14 higher than on 2025-10-01, moving from $161.83 to $177.97 (10.0%).

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

    $161.83changed to$177.97

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 1.82 changed to 1.77
    • Practice expense RVU 3.15 changed to 3.54
    • 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

    $166.23changed to$161.83

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 3.14 changed to 3.15

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $163.51changed to$166.23

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $167.79changed to$163.51

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 3.05 changed to 3.14
    • Malpractice RVU 0.41 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

    $173.55changed to$167.79

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 3.09 changed to 3.05
    • Malpractice RVU 0.40 changed to 0.41
    • 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

    $170.82changed to$173.55

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 2.97 changed to 3.09
    • Malpractice RVU 0.39 changed to 0.40

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $166.41changed to$170.82

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 2.70 changed to 2.97
    • Malpractice RVU 0.37 changed to 0.39
    • 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

    $162.76changed to$166.41

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 2.59 changed to 2.70
    • Malpractice RVU 0.41 changed to 0.37
    • 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

    $158.98changed to$162.76

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 2.49 changed to 2.59
    • Malpractice RVU 0.40 changed to 0.41

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $157.54changed to$158.98

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 2.43 changed to 2.49
    • Malpractice RVU 0.42 changed to 0.40
    • Malpractice GPCI 0.732 changed to 0.695

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $157.02changed to$157.54

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 2.42 changed to 2.43
    • Malpractice RVU 0.41 changed to 0.42
    • 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

    $157.41changed to$157.02

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 2.39 changed to 2.42
    • Malpractice RVU 0.44 changed to 0.41

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $156.63changed to$157.41

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $152.39changed to$156.63

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 2.36 changed to 2.39
    • Malpractice RVU 0.33 changed to 0.44
    • 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$152.39

    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$177.97$96.64RVU26D
2026-07-01$177.97$96.64RVU26C
2026-04-01$177.97$96.64RVU26B
2026-01-01$177.97$96.64RVU26A
2025-10-01$161.83$105.81RVU25D
2025-07-01$161.83$105.81RVU25C
2025-04-01$161.83$105.81RVU25B
2025-01-01$161.83$105.81RVU25A
2024-10-01$166.23$108.28RVU24D
2024-07-01$166.23$108.28RVU24C
2024-04-01$166.23$108.28RVU24B
2024-03-09$166.23$108.28RVU24AR
2024-01-01$163.51$106.51RVU24A
2023-10-01$167.79$110.31RVU23D
2023-07-01$167.79$110.31RVU23C
2023-04-01$167.79$110.31RVU23B
2023-01-01$167.79$110.31RVU23A
2022-10-01$173.55$114.14RVU22D
2022-07-01$173.55$114.14RVU22C
2022-04-01$173.55$114.14RVU22B
2022-01-01$173.55$114.14RVU22A
2021-10-01$170.82$114.48RVU21D
2021-07-01$170.82$114.48RVU21C
2021-04-01$170.82$114.48RVU21B
2021-01-01$170.82$114.48RVU21A
2020-10-01$166.41$115.40RVU20D
2020-07-01$166.41$115.40RVU20C
2020-04-01$166.41$115.40RVU20B
2020-01-01$166.41$115.40RVU20A
2019-10-01$162.76$115.79RVU19D
2019-07-01$162.76$115.79RVU19C
2019-04-01$162.76$115.79RVU19B
2019-01-01$162.76$115.79RVU19A
2018-10-01$158.98$115.75RVU18D
2018-07-01$158.98$115.75RVU18C
2018-04-01$158.98$115.75RVU18B
2018-01-01$158.98$115.75RVU18AR1
2017-10-01$157.54$116.45RVU17D
2017-07-01$157.54$116.45RVU17C
2017-04-01$157.54$116.45RVU17B
2017-01-01$157.54$116.45RVU17A
2016-10-01$157.02$116.40RVU16D
2016-07-01$157.02$116.40RVU16C
2016-04-01$157.02$116.40RVU16B
2016-01-01$157.02$116.40RVU16A
2015-10-01$157.41$116.98RVU15D
2015-07-01$157.41$116.98RVU15C
2015-04-01$156.63$116.39RVU15B
2015-01-01$156.63$116.39RVU15A
2014-10-01$152.39$113.45RVU14D
2014-07-01$152.39$113.45RVU14C
2014-04-01$152.39$113.45RVU14B
2014-01-01$152.39$113.45RVU14A
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 64644 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

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
RVUs for 64644PPRRVU2026_Oct_nonQPP.csv, line 7,187 (RVU26D)
Geographic factors for North CarolinaGPCI2026.csv, line 83 (RVU26D)

Open CMS sourceHow we calculate rates

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