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CPT code 64645: Muscle chemodenervation, additional extremity, five-plus muscles2026 Medicare rate & RVUs in Hawaii, Guam, HI

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 Hawaii, Guam, HI, Medicare pays $134.79 for 64645 in the office and $67.57 when it’s performed in a hospital or facility.

$134.79Office (non-facility)
$67.57Hospital or facility
+4.0%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 Hawaii, Guam, HI
  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 Hawaii, Guam, HI 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. Hawaii, Guam, HI pays $134.79. The RVUs are the same everywhere; the geographic indexes change the dollars.

64645 in Hawaii, Guam, HI vs other payment areas
  1. Hawaii, Guam, HI · this page$134.79
  2. Los Angeles, CA · California$140.97+$6.18
  3. Washington, DC area · District of Columbia$146.29+$11.50
  4. Miami, FL · Florida$149.94+$15.15
  5. Chicago, IL · Illinois$144.98+$10.19
  6. Manhattan, NY · New York$150.95+$16.16
  7. Alaska · Alaska$151.94+$17.15

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

Every other payment area

64645 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$115.57$63.84
ArkansasArkansas$113.82$63.04
ArizonaArizona$125.70$68.42
Bakersfield, CACalifornia$133.01$68.21
Chico, CACalifornia$132.09$67.29
El Centro, CACalifornia$132.15$67.35
Fresno, CACalifornia$132.09$67.29
Hanford, CACalifornia$132.09$67.29

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 Hawaii, Guam, HI 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

46

Locality
Hawaii, Guam, HI
Physician work
1.000
Practice expense
1.137
Malpractice
0.579
Office calculation for 64645 in Hawaii, Guam, HI
ComponentRVULocality factorAdjusted
Physician work1.36× 1.0001.3600
Practice expense2.18× 1.1372.4787
Malpractice0.34× 0.5790.1969
Total RVUs4.0355
Conversion factor× 33.4009

Office rate, Hawaii, Guam, HI$134.79

Office: (1.36 × 1 + 2.18 × 1.137 + 0.34 × 0.579) × $33.4009 = $134.79

Facility: (1.36 × 1 + 0.41 × 1.137 + 0.34 × 0.579) × $33.4009 = $67.57

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, Hawaii, Guam, HI
Primary code
64644Muscle chemodenervation, one extremity, five or more musclesPrimary extremity chemodenervation service for five or more muscles.$201.29
Same family
64643Chemodenervation, additional extremity, 1-4 musclesAdditional-extremity service when one to four muscles are treated.$103.82
64642Chemodenervation, one extremity, 1–4 musclesInitial-extremity service when one to four muscles are treated.$171.07
Used instead
64646Muscle chemodenervation, trunk, one to five musclesChemodenervation applies to trunk muscles rather than an additional extremity.$176.68
64647Trunk chemodenervation, six or more musclesChemodenervation applies to six or more trunk muscles rather than an additional extremity.$196.58

How 64645 has changed in Hawaii, Guam, HI

64645 · Office / nonfacility

$134.79

Effective 2026-10-01

The base rate is $12.85 higher than on 2025-10-01, moving from $121.94 to $134.79 (10.5%).

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

    $121.94changed to$134.79

    • 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
    • Practice expense GPCI 1.149 changed to 1.137
    • Malpractice GPCI 0.561 changed to 0.579

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $125.48changed to$121.94

    • Conversion factor 33.2875 changed to 32.3465

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $123.44changed to$125.48

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $126.99changed to$123.44

    • 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 1.003 changed to 1.000
    • Practice expense GPCI 1.146 changed to 1.149
    • Malpractice GPCI 0.618 changed to 0.561

  5. January 1, 2023

    RVU23A

    $131.21changed to$126.99

    • 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 1.010 changed to 1.003
    • Practice expense GPCI 1.143 changed to 1.146
    • Malpractice GPCI 0.675 changed to 0.618

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $129.67changed to$131.21

    • 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

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $126.33changed to$129.67

    • 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 1.006 changed to 1.010
    • Practice expense GPCI 1.144 changed to 1.143
    • Malpractice GPCI 0.644 changed to 0.675

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $124.13changed to$126.33

    • 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 1.001 changed to 1.006
    • Practice expense GPCI 1.146 changed to 1.144
    • Malpractice GPCI 0.614 changed to 0.644

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $121.71changed to$124.13

    • 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

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $121.89changed to$121.71

    • 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 1.002 changed to 1.001
    • Practice expense GPCI 1.154 changed to 1.146
    • Malpractice GPCI 0.616 changed to 0.614

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $121.90changed to$121.89

    • Conversion factor 35.8043 changed to 35.8887
    • Malpractice RVU 0.32 changed to 0.33
    • Work GPCI 1.003 changed to 1.002
    • Practice expense GPCI 1.162 changed to 1.154
    • Malpractice GPCI 0.618 changed to 0.616

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $121.73changed to$121.90

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 1.54 changed to 1.56
    • Malpractice RVU 0.33 changed to 0.32

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $121.12changed to$121.73

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $119.50changed to$121.12

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 1.53 changed to 1.54
    • Malpractice RVU 0.26 changed to 0.33
    • Work GPCI 1.002 changed to 1.003
    • Practice expense GPCI 1.158 changed to 1.162
    • Malpractice GPCI 0.659 changed to 0.618

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    No ratechanged to$119.50

    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$134.79$67.57RVU26D
2026-07-01$134.79$67.57RVU26C
2026-04-01$134.79$67.57RVU26B
2026-01-01$134.79$67.57RVU26A
2025-10-01$121.94$77.71RVU25D
2025-07-01$121.94$77.71RVU25C
2025-04-01$121.94$77.71RVU25B
2025-01-01$121.94$77.71RVU25A
2024-10-01$125.48$79.59RVU24D
2024-07-01$125.48$79.59RVU24C
2024-04-01$125.48$79.59RVU24B
2024-03-09$125.48$79.59RVU24AR
2024-01-01$123.44$78.29RVU24A
2023-10-01$126.99$81.55RVU23D
2023-07-01$126.99$81.55RVU23C
2023-04-01$126.99$81.55RVU23B
2023-01-01$126.99$81.55RVU23A
2022-10-01$131.21$84.54RVU22D
2022-07-01$131.21$84.54RVU22C
2022-04-01$131.21$84.54RVU22B
2022-01-01$131.21$84.54RVU22A
2021-10-01$129.67$84.60RVU21D
2021-07-01$129.67$84.60RVU21C
2021-04-01$129.67$84.60RVU21B
2021-01-01$129.67$84.60RVU21A
2020-10-01$126.33$85.87RVU20D
2020-07-01$126.33$85.87RVU20C
2020-04-01$126.33$85.87RVU20B
2020-01-01$126.33$85.87RVU20A
2019-10-01$124.13$85.72RVU19D
2019-07-01$124.13$85.72RVU19C
2019-04-01$124.13$85.72RVU19B
2019-01-01$124.13$85.72RVU19A
2018-10-01$121.71$85.82RVU18D
2018-07-01$121.71$85.82RVU18C
2018-04-01$121.71$85.82RVU18B
2018-01-01$121.71$85.82RVU18AR1
2017-10-01$121.89$86.27RVU17D
2017-07-01$121.89$86.27RVU17C
2017-04-01$121.89$86.27RVU17B
2017-01-01$121.89$86.27RVU17A
2016-10-01$121.90$86.12RVU16D
2016-07-01$121.90$86.12RVU16C
2016-04-01$121.90$86.12RVU16B
2016-01-01$121.90$86.12RVU16A
2015-10-01$121.73$86.24RVU15D
2015-07-01$121.73$86.24RVU15C
2015-04-01$121.12$85.81RVU15B
2015-01-01$121.12$85.81RVU15A
2014-10-01$119.50$85.07RVU14D
2014-07-01$119.50$85.07RVU14C
2014-04-01$119.50$85.07RVU14B
2014-01-01$119.50$85.07RVU14A
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 Hawaii, Guam, HI rate applies

Hawaii, Guam, HI is a Medicare payment area, not a city. Our Census mapping connects it to 163 cities and communities in Hawaii. Some span more than one payment area; confirm with the service ZIP.

  • Ahuimanu
  • Aiea
  • Ainaloa
  • Anahola
  • Black Sands
  • Captain Cook
  • Discovery Harbour
  • East Honolulu

Browse all communities in Hawaii

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 Hawaii, Guam, HIGPCI2026.csv, line 46 (RVU26D)

Open CMS sourceHow we calculate rates

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