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CPT code 64645: Muscle chemodenervation, additional extremity, five-plus muscles2026 Medicare rate & RVUs in Santa Rosa, CA

Reports chemodenervation of each additional extremity when five or more muscles are treated there, alongside the primary extremity service.

CMS RVU26DEffective Oct 1, 2026One payment locality8.8K Medicare services in 2024

In Santa Rosa, CA, Medicare pays $142.29 for 64645 in the office and $69.69 when it’s performed in a hospital or facility.

$142.29Office (non-facility)
$69.69Hospital or facility
+9.8%vs the national office rate ($129.60)

Check a contract rate as a % of Medicare · 64645 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 64645 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Santa Rosa, CA
  2. What 64645 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 64645 covers

This code represents chemodenervation in an additional arm or leg when treatment involves five or more muscles in that extremity. It commonly accompanies botulinum toxin treatment for spasticity after stroke or in neurologic conditions such as cerebral palsy, and may be performed by a neurologist, physiatrist, or another qualified clinician in an office or outpatient facility. The service is counted by extremity, not by injection or toxin dose.

Report it only with the primary code for treatment of one extremity involving five or more muscles, 64644. Use one unit for each additional extremity that meets the five-muscle threshold. Documentation should identify each treated extremity, the muscles injected, and the clinical reason for treatment. CMS classifies this as an add-on service; payment is made within the primary 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 Santa Rosa, CA compares for 64645

Across 109 of 109 payment localities, the office rate for 64645 runs from $113.82 in Arkansas to $161.51 in San Benito County, CA. Santa Rosa, CA pays $142.29. The RVUs are the same everywhere; the geographic indexes change the dollars.

64645 in Santa Rosa, CA vs other payment areas
  1. Santa Rosa, CA · this page$142.29
  2. Bakersfield, CA · California$133.01−$9.28
  3. Chico, CA · California$132.09−$10.20
  4. El Centro, CA · California$132.15−$10.14
  5. Fresno, CA · California$132.09−$10.20
  6. Hanford, CA · California$132.09−$10.20
  7. Los Angeles, CA · California$140.97−$1.32

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

Every other payment area

64645 in every other Medicare payment locality
Payment localityOfficeFacility
Madera, CACalifornia$132.09$67.29
Merced, CACalifornia$132.09$67.29
Modesto, CACalifornia$132.09$67.29
Napa, CACalifornia$150.02$72.11
Oxnard, CACalifornia$139.84$69.96
Redding, CACalifornia$132.09$67.29
Rest of CaliforniaCalifornia$132.09$67.29
Riverside, CACalifornia$135.73$70.94

64645 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.

$113.82

$151.94

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

View every state and territory as a table
64645 office rate range by state
State / territoryOffice rate rangeLocalities
AK$151.941
AL$115.571
AR$113.821
AZ$125.701
CA$132.09–$161.5129
CO$132.311
CT$138.501
DC$146.291
DE$127.801
FL$132.10–$149.943
GA$123.91–$133.182
GU$134.791
HI$134.791
IA$116.561
ID$117.791
IL$129.65–$144.984
IN$118.441
KS$116.971
KY$120.551
LA$120.74–$126.842
MA$131.88–$144.332
MD$129.99–$146.293
ME$119.48–$124.752
MI$124.73–$134.842
MN$123.711
MO$119.25–$126.123
MS$116.511
MT$129.571
NC$120.621
ND$122.851
NE$116.931
NH$131.161
NJ$139.21–$144.882
NM$125.831
NV$127.771
NY$122.58–$156.005
OH$123.351
OK$119.271
OR$125.93–$135.502
PA$123.00–$135.592
PR$130.231
RI$131.631
SC$122.361
SD$122.051
TN$117.711
TX$122.24–$133.728
UT$124.071
VA$125.02–$146.292
VI$130.231
VT$123.261
WA$131.33–$146.322
WI$118.681
WV$124.951
WY$126.641

See 64645 in every payment locality

How the 64645 rate is calculated

Each of 64645’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 · 64645

RVUs × geographic indexes × conversion factor

Office or facility?

Work1.36

1.36 RVUs× 1.000 GPCI

Practice expense2.18

2.18 RVUs× 1.000 GPCI

Malpractice0.34

0.34 RVUs× 1.000 GPCI

Adjusted RVUs

3.8800

Conversion factor

$33.4009

Medicare rate

$129.60

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

The exact Santa Rosa, CA inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

7,188

Code
64645
Physician work
1.36
Practice expense
2.18
Malpractice
0.34

GPCI2026.csv

31

Locality
Santa Rosa, CA
Physician work
1.030
Practice expense
1.228
Malpractice
0.536
Office calculation for 64645 in Santa Rosa, CA
ComponentRVULocality factorAdjusted
Physician work1.36× 1.0301.4008
Practice expense2.18× 1.2282.6770
Malpractice0.34× 0.5360.1822
Total RVUs4.2601
Conversion factor× 33.4009

Office rate, Santa Rosa, CA$142.29

Office: (1.36 × 1.03 + 2.18 × 1.228 + 0.34 × 0.536) × $33.4009 = $142.29

Facility: (1.36 × 1.03 + 0.41 × 1.228 + 0.34 × 0.536) × $33.4009 = $69.69

Open 64645 in the RVU calculator

Payment rules and modifiers for 64645

The CMS indicators that decide how 64645 is paid alongside other services.

CMS payment indicators · 64645

Muscle chemodenervation, additional extremity, five-plus 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 64645

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

Codes related to 64645
CodeHow it relatesOffice range, Santa Rosa, CA
Primary code
64644Muscle chemodenervation, one extremity, five or more musclesPrimary extremity chemodenervation service for five or more muscles.$213.25
Same family
64643Chemodenervation, additional extremity, 1-4 musclesAdditional-extremity service when one to four muscles are treated.$109.45
64642Chemodenervation, one extremity, 1–4 musclesInitial-extremity service when one to four muscles are treated.$180.91
Used instead
64646Muscle chemodenervation, trunk, one to five musclesChemodenervation applies to trunk muscles rather than an additional extremity.$186.45
64647Trunk chemodenervation, six or more musclesChemodenervation applies to six or more trunk muscles rather than an additional extremity.$207.38

How 64645 has changed in Santa Rosa, CA

64645 · Office / nonfacility

$142.29

Effective 2026-10-01

The base rate is $14.02 higher than on 2025-10-01, moving from $128.27 to $142.29 (10.9%).

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

    $128.27changed to$142.29

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 1.39 changed to 1.36
    • Practice expense RVU 1.91 changed to 2.18
    • Malpractice RVU 0.33 changed to 0.34
    • Work GPCI 1.027 changed to 1.030
    • Practice expense GPCI 1.232 changed to 1.228
    • Malpractice GPCI 0.560 changed to 0.536

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $132.00changed to$128.27

    • Conversion factor 33.2875 changed to 32.3465

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $129.85changed to$132.00

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $131.83changed to$129.85

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 1.87 changed to 1.91
    • Malpractice RVU 0.34 changed to 0.33
    • Work GPCI 1.036 changed to 1.027
    • Practice expense GPCI 1.205 changed to 1.232
    • Malpractice GPCI 0.579 changed to 0.560

  5. January 1, 2023

    RVU23A

    $134.27changed to$131.83

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 1.90 changed to 1.87
    • Malpractice RVU 0.32 changed to 0.34
    • Work GPCI 1.045 changed to 1.036
    • Practice expense GPCI 1.177 changed to 1.205
    • Malpractice GPCI 0.597 changed to 0.579

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $131.41changed to$134.27

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 1.84 changed to 1.90
    • Malpractice RVU 0.31 changed to 0.32
    • Work GPCI 1.042 changed to 1.045
    • Practice expense GPCI 1.159 changed to 1.177

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $127.17changed to$131.41

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 1.68 changed to 1.84
    • Malpractice RVU 0.28 changed to 0.31
    • Work GPCI 1.038 changed to 1.042
    • Practice expense GPCI 1.142 changed to 1.159
    • Malpractice GPCI 0.580 changed to 0.597

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $123.75changed to$127.17

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 1.62 changed to 1.68
    • Malpractice RVU 0.32 changed to 0.28
    • Work GPCI 1.024 changed to 1.038
    • Practice expense GPCI 1.130 changed to 1.142
    • Malpractice GPCI 0.562 changed to 0.580

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $120.26changed to$123.75

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 1.57 changed to 1.62
    • Malpractice RVU 0.31 changed to 0.32
    • Work GPCI 1.023 changed to 1.024
    • Practice expense GPCI 1.111 changed to 1.130

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $119.50changed to$120.26

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 1.56 changed to 1.57
    • Malpractice RVU 0.33 changed to 0.31
    • Work GPCI 1.024 changed to 1.023
    • Practice expense GPCI 1.093 changed to 1.111
    • Malpractice GPCI 0.610 changed to 0.562

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    No ratechanged to$119.50

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2014

    RVU14A

    No ratechanged toNo rate

    Held through RVU14B, RVU14C, RVU14D, RVU15A, RVU15B, RVU15C, RVU15D, RVU16A, RVU16B, RVU16C, RVU16D.

  13. 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$142.29$69.69RVU26D
2026-07-01$142.29$69.69RVU26C
2026-04-01$142.29$69.69RVU26B
2026-01-01$142.29$69.69RVU26A
2025-10-01$128.27$80.85RVU25D
2025-07-01$128.27$80.85RVU25C
2025-04-01$128.27$80.85RVU25B
2025-01-01$128.27$80.85RVU25A
2024-10-01$132.00$82.79RVU24D
2024-07-01$132.00$82.79RVU24C
2024-04-01$132.00$82.79RVU24B
2024-03-09$132.00$82.79RVU24AR
2024-01-01$129.85$81.44RVU24A
2023-10-01$131.83$84.05RVU23D
2023-07-01$131.83$84.05RVU23C
2023-04-01$131.83$84.05RVU23B
2023-01-01$131.83$84.05RVU23A
2022-10-01$134.27$86.21RVU22D
2022-07-01$134.27$86.21RVU22C
2022-04-01$134.27$86.21RVU22B
2022-01-01$134.27$86.21RVU22A
2021-10-01$131.41$85.71RVU21D
2021-07-01$131.41$85.71RVU21C
2021-04-01$131.41$85.71RVU21B
2021-01-01$131.41$85.71RVU21A
2020-10-01$127.17$86.78RVU20D
2020-07-01$127.17$86.78RVU20C
2020-04-01$127.17$86.78RVU20B
2020-01-01$127.17$86.78RVU20A
2019-10-01$123.75$85.88RVU19D
2019-07-01$123.75$85.88RVU19C
2019-04-01$123.75$85.88RVU19B
2019-01-01$123.75$85.88RVU19A
2018-10-01$120.26$85.46RVU18D
2018-07-01$120.26$85.46RVU18C
2018-04-01$120.26$85.46RVU18B
2018-01-01$120.26$85.46RVU18AR1
2017-10-01$119.50$85.77RVU17D
2017-07-01$119.50$85.77RVU17C
2017-04-01$119.50$85.77RVU17B
2017-01-01$119.50$85.77RVU17A
2016-10-01Rate data unavailableRate data unavailableRVU16D
2016-07-01Rate data unavailableRate data unavailableRVU16C
2016-04-01Rate data unavailableRate data unavailableRVU16B
2016-01-01Rate data unavailableRate data unavailableRVU16A
2015-10-01Rate data unavailableRate data unavailableRVU15D
2015-07-01Rate data unavailableRate data unavailableRVU15C
2015-04-01Rate data unavailableRate data unavailableRVU15B
2015-01-01Rate data unavailableRate data unavailableRVU15A
2014-10-01Rate data unavailableRate data unavailableRVU14D
2014-07-01Rate data unavailableRate data unavailableRVU14C
2014-04-01Rate data unavailableRate data unavailableRVU14B
2014-01-01Rate data unavailableRate data unavailableRVU14A
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 64645 for an earlier date of service

Where the Santa Rosa, CA rate applies

Santa Rosa, CA is a Medicare payment area, not a city. Our Census mapping connects it to 38 cities and communities in California. Some span more than one payment area; confirm with the service ZIP.

  • Petaluma
  • Santa Rosa
  • Bloomfield
  • Bodega
  • Bodega Bay
  • Boyes Hot Springs
  • Carmet
  • Cazadero

Browse all communities in California

64645 billing questions

When is 64645 used instead of 64644?

Use 64644 for the initial extremity when five or more muscles are treated. Use 64645 for each additional extremity treated at that same muscle-count level.

Can 64645 be billed by itself?

No. It is an add-on code and must be reported with 64644 for the primary extremity service.

How are units counted?

Count one unit for each additional extremity in which five or more muscles are treated. The unit count is not based on the number of injections or toxin dose.

What documentation supports a unit of 64645?

Document the additional extremity, the muscles injected there, and the treatment indication. The record should support that at least five muscles were treated in that extremity.

How does the add-on status affect payment?

CMS pays 64645 within the global period of its primary procedure. It must accompany 64644 rather than stand alone.

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 64645PPRRVU2026_Oct_nonQPP.csv, line 7,188 (RVU26D)
Geographic factors for Santa Rosa, CAGPCI2026.csv, line 31 (RVU26D)

Open CMS sourceHow we calculate rates

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