CPT code 64645: Muscle chemodenervation, additional extremity, five-plus muscles2026 Medicare rate & RVUs in Ohio
Reports chemodenervation of each additional extremity when five or more muscles are treated there, alongside the primary extremity service.
In Ohio, Medicare pays $123.35 for 64645 in the office and $69.38 when it’s performed in a hospital or facility.
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.
On this page 11 sections
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 Ohio 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. Ohio pays $123.35. The RVUs are the same everywhere; the geographic indexes change the dollars.
- Ohio · this page$123.35
- Los Angeles, CA · California$140.97+$17.62
- Washington, DC area · District of Columbia$146.29+$22.94
- Miami, FL · Florida$149.94+$26.59
- Chicago, IL · Illinois$144.98+$21.63
- Manhattan, NY · New York$150.95+$27.60
- Alaska · Alaska$151.94+$28.59
Other areas in Ohio first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| 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 |
| 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 |
| Sacramento, CACalifornia | $137.83 | $69.07 |
| Salinas, CACalifornia | $137.31 | $68.79 |
| San Diego, CACalifornia | $140.03 | $69.32 |
| Marin County, CACalifornia | $157.62 | $74.26 |
| San Francisco, CACalifornia | $157.23 | $73.88 |
| San Benito County, CACalifornia | $161.51 | $76.26 |
| Santa Clara County, CACalifornia | $159.93 | $74.68 |
| San Luis Obispo, CACalifornia | $135.22 | $67.88 |
| Santa Cruz, CACalifornia | $140.94 | $69.10 |
| Santa Maria, CACalifornia | $137.69 | $68.75 |
| Santa Rosa, CACalifornia | $142.29 | $69.69 |
| Stockton, CACalifornia | $132.09 | $67.29 |
| Vallejo, CACalifornia | $149.47 | $71.55 |
| Visalia, CACalifornia | $132.09 | $67.29 |
| Yuba City, CACalifornia | $132.09 | $67.29 |
| ColoradoColorado | $132.31 | $69.41 |
| ConnecticutConnecticut | $138.50 | $74.82 |
| DelawareDelaware | $127.80 | $69.39 |
| Fort Lauderdale, FLFlorida | $139.72 | $79.83 |
| Rest of FloridaFlorida | $132.10 | $75.59 |
| Atlanta, GAGeorgia | $133.18 | $73.11 |
| Rest of GeorgiaGeorgia | $123.91 | $71.18 |
| Hawaii, Guam, HIHawaii | $134.79 | $67.57 |
| IowaIowa | $116.56 | $62.46 |
| IdahoIdaho | $117.79 | $63.40 |
| East St. Louis, ILIllinois | $135.29 | $80.90 |
| Rest of IllinoisIllinois | $129.65 | $75.68 |
| Suburban Chicago, ILIllinois | $140.65 | $79.93 |
| IndianaIndiana | $118.44 | $63.64 |
| KansasKansas | $116.97 | $63.53 |
| KentuckyKentucky | $120.55 | $67.99 |
| New Orleans, LALouisiana | $126.84 | $71.21 |
| Rest of LouisianaLouisiana | $120.74 | $68.42 |
| Metropolitan Boston, MAMassachusetts | $144.33 | $73.75 |
| Rest of MassachusettsMassachusetts | $131.88 | $69.62 |
| Baltimore area, MDMaryland | $138.33 | $74.89 |
| Rest of MarylandMaryland | $129.99 | $70.16 |
| Rest of MaineMaine | $119.48 | $65.09 |
| Southern Maine, MEMaine | $124.75 | $66.16 |
| Detroit, MIMichigan | $134.84 | $77.79 |
| Rest of MichiganMichigan | $124.73 | $70.75 |
| MinnesotaMinnesota | $123.71 | $62.88 |
| Metropolitan Kansas City, MOMissouri | $124.89 | $69.38 |
| Metropolitan St. Louis, MOMissouri | $126.12 | $69.84 |
| Rest of MissouriMissouri | $119.25 | $68.29 |
| MississippiMississippi | $116.51 | $65.61 |
| MontanaMontana | $129.57 | $70.45 |
| North CarolinaNorth Carolina | $120.62 | $65.46 |
| North DakotaNorth Dakota | $122.85 | $63.73 |
| NebraskaNebraska | $116.93 | $62.36 |
| New HampshireNew Hampshire | $131.16 | $69.62 |
| Northern New JerseyNew Jersey | $144.88 | $76.30 |
| Rest of New JerseyNew Jersey | $139.21 | $74.65 |
| New MexicoNew Mexico | $125.83 | $71.62 |
| NevadaNevada | $127.77 | $68.59 |
| NYC suburbs and Long Island, NYNew York | $156.00 | $85.70 |
| Poughkeepsie and northern NYC suburbs, NYNew York | $140.94 | $76.21 |
| Queens, NYNew York | $150.77 | $80.89 |
| Rest of New YorkNew York | $122.58 | $66.42 |
| OklahomaOklahoma | $119.27 | $66.48 |
| Portland, OROregon | $135.50 | $69.82 |
| Rest of OregonOregon | $125.93 | $67.05 |
| Metropolitan Philadelphia, PAPennsylvania | $135.59 | $74.05 |
| Rest of PennsylvaniaPennsylvania | $123.00 | $68.73 |
| Puerto RicoPuerto Rico | $130.23 | $70.46 |
| Rhode IslandRhode Island | $131.63 | $70.56 |
| South CarolinaSouth Carolina | $122.36 | $67.73 |
| South DakotaSouth Dakota | $122.05 | $62.94 |
| TennesseeTennessee | $117.71 | $63.97 |
| Austin, TXTexas | $132.61 | $70.07 |
| Beaumont, TXTexas | $122.24 | $68.44 |
| Brazoria, TXTexas | $126.81 | $68.22 |
| Dallas, TXTexas | $128.10 | $69.22 |
| Fort Worth, TXTexas | $127.52 | $69.23 |
| Galveston, TXTexas | $127.50 | $68.79 |
| Houston, TXTexas | $133.72 | $75.01 |
| Rest of TexasTexas | $124.78 | $68.68 |
| UtahUtah | $124.07 | $68.50 |
| VirginiaVirginia | $125.02 | $66.90 |
| Virgin Islands, VIUnited States Virgin Islands | $130.23 | $70.46 |
| VermontVermont | $123.26 | $64.73 |
| Rest of WashingtonWashington | $131.33 | $69.08 |
| King County, WAWashington | $146.32 | $73.78 |
| WisconsinWisconsin | $118.68 | $62.04 |
| West VirginiaWest Virginia | $124.95 | $73.58 |
| WyomingWyoming | $126.64 | $67.52 |
64645 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.
$113.82
$151.94
Color shows the midpoint of each state’s locality range.
View every state and territory as a table
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | $151.94 | 1 |
| AL | $115.57 | 1 |
| AR | $113.82 | 1 |
| AZ | $125.70 | 1 |
| CA | $132.09–$161.51 | 29 |
| CO | $132.31 | 1 |
| CT | $138.50 | 1 |
| DC | $146.29 | 1 |
| DE | $127.80 | 1 |
| FL | $132.10–$149.94 | 3 |
| GA | $123.91–$133.18 | 2 |
| GU | $134.79 | 1 |
| HI | $134.79 | 1 |
| IA | $116.56 | 1 |
| ID | $117.79 | 1 |
| IL | $129.65–$144.98 | 4 |
| IN | $118.44 | 1 |
| KS | $116.97 | 1 |
| KY | $120.55 | 1 |
| LA | $120.74–$126.84 | 2 |
| MA | $131.88–$144.33 | 2 |
| MD | $129.99–$146.29 | 3 |
| ME | $119.48–$124.75 | 2 |
| MI | $124.73–$134.84 | 2 |
| MN | $123.71 | 1 |
| MO | $119.25–$126.12 | 3 |
| MS | $116.51 | 1 |
| MT | $129.57 | 1 |
| NC | $120.62 | 1 |
| ND | $122.85 | 1 |
| NE | $116.93 | 1 |
| NH | $131.16 | 1 |
| NJ | $139.21–$144.88 | 2 |
| NM | $125.83 | 1 |
| NV | $127.77 | 1 |
| NY | $122.58–$156.00 | 5 |
| OH | $123.35 | 1 |
| OK | $119.27 | 1 |
| OR | $125.93–$135.50 | 2 |
| PA | $123.00–$135.59 | 2 |
| PR | $130.23 | 1 |
| RI | $131.63 | 1 |
| SC | $122.36 | 1 |
| SD | $122.05 | 1 |
| TN | $117.71 | 1 |
| TX | $122.24–$133.72 | 8 |
| UT | $124.07 | 1 |
| VA | $125.02–$146.29 | 2 |
| VI | $130.23 | 1 |
| VT | $123.26 | 1 |
| WA | $131.33–$146.32 | 2 |
| WI | $118.68 | 1 |
| WV | $124.95 | 1 |
| WY | $126.64 | 1 |
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
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 Ohio 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
85
- Locality
- Ohio
- Physician work
- 1.000
- Practice expense
- 0.913
- Malpractice
- 1.008
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 1.36 | × 1.000 | 1.3600 |
| Practice expense | 2.18 | × 0.913 | 1.9903 |
| Malpractice | 0.34 | × 1.008 | 0.3427 |
| Total RVUs | 3.6931 | ||
| Conversion factor | × 33.4009 | ||
Office rate, Ohio$123.35
Office: (1.36 × 1 + 2.18 × 0.913 + 0.34 × 1.008) × $33.4009 = $123.35
Facility: (1.36 × 1 + 0.41 × 0.913 + 0.34 × 1.008) × $33.4009 = $69.38
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
| Rule | CMS value | What it means |
|---|---|---|
| Global period | ZZZ | Add-on code: falls within the primary procedure’s global period. |
| Multiple procedures | 0 | No multiple-procedure reduction. |
| 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. |
How 64645 has changed in Ohio
64645 · Office / nonfacility
$123.35
Effective 2026-10-01
The base rate is $11.08 higher than on 2025-10-01, moving from $112.27 to $123.35 (9.9%).
It is unchanged from the immediately preceding available release, effective 2026-07-01.
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
January 1, 2026
RVU26A
$112.27changed to$123.35
- 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 0.911 changed to 0.913
- Malpractice GPCI 1.033 changed to 1.008
Held through RVU26B, RVU26C, RVU26D.
January 1, 2025
RVU25A
$115.54changed to$112.27
- Conversion factor 33.2875 changed to 32.3465
Held through RVU25B, RVU25C, RVU25D.
March 9, 2024
RVU24AR
$113.65changed to$115.54
- Conversion factor 32.7442 changed to 33.2875
Held through RVU24B, RVU24C, RVU24D.
January 1, 2024
RVU24A
$117.14changed to$113.65
- 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
- Practice expense GPCI 0.912 changed to 0.911
- Malpractice GPCI 1.063 changed to 1.033
January 1, 2023
RVU23A
$120.25changed to$117.14
- 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
- Practice expense GPCI 0.913 changed to 0.912
- Malpractice GPCI 1.094 changed to 1.063
Held through RVU23B, RVU23C, RVU23D.
January 1, 2022
RVU22A
$118.95changed to$120.25
- 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.
January 1, 2021
RVU21A
$116.24changed to$118.95
- 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
- Practice expense GPCI 0.915 changed to 0.913
- Malpractice GPCI 1.049 changed to 1.094
Held through RVU21B, RVU21C, RVU21D.
January 1, 2020
RVU20A
$115.22changed to$116.24
- 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
- Practice expense GPCI 0.917 changed to 0.915
- Malpractice GPCI 1.005 changed to 1.049
Held through RVU20B, RVU20C, RVU20D.
January 1, 2019
RVU19A
$113.08changed to$115.22
- 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.
January 1, 2018
RVU18AR1
$113.11changed to$113.08
- 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
- Practice expense GPCI 0.918 changed to 0.917
- Malpractice GPCI 0.999 changed to 1.005
Held through RVU18B, RVU18C, RVU18D.
January 1, 2017
RVU17A
$112.42changed to$113.11
- Conversion factor 35.8043 changed to 35.8887
- Malpractice RVU 0.32 changed to 0.33
- Malpractice GPCI 0.993 changed to 0.999
Held through RVU17B, RVU17C, RVU17D.
January 1, 2016
RVU16A
$112.52changed to$112.42
- 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.
July 1, 2015
RVU15C
$111.96changed to$112.52
- Conversion factor 35.7547 changed to 35.9335
Held through RVU15D.
January 1, 2015
RVU15A
$110.79changed to$111.96
- 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
- Practice expense GPCI 0.923 changed to 0.918
- Malpractice GPCI 1.117 changed to 0.993
Held through RVU15B.
January 1, 2014
RVU14A
No ratechanged to$110.79
Held through RVU14B, RVU14C, RVU14D.
January 1, 2013
RVU13AR
Earliest loaded release: No rate
Held through RVU13B, RVU13C, RVU13D.
| Effective from | Office | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | $123.35 | $69.38 | RVU26D |
| 2026-07-01 | $123.35 | $69.38 | RVU26C |
| 2026-04-01 | $123.35 | $69.38 | RVU26B |
| 2026-01-01 | $123.35 | $69.38 | RVU26A |
| 2025-10-01 | $112.27 | $77.20 | RVU25D |
| 2025-07-01 | $112.27 | $77.20 | RVU25C |
| 2025-04-01 | $112.27 | $77.20 | RVU25B |
| 2025-01-01 | $112.27 | $77.20 | RVU25A |
| 2024-10-01 | $115.54 | $79.15 | RVU24D |
| 2024-07-01 | $115.54 | $79.15 | RVU24C |
| 2024-04-01 | $115.54 | $79.15 | RVU24B |
| 2024-03-09 | $115.54 | $79.15 | RVU24AR |
| 2024-01-01 | $113.65 | $77.86 | RVU24A |
| 2023-10-01 | $117.14 | $80.98 | RVU23D |
| 2023-07-01 | $117.14 | $80.98 | RVU23C |
| 2023-04-01 | $117.14 | $80.98 | RVU23B |
| 2023-01-01 | $117.14 | $80.98 | RVU23A |
| 2022-10-01 | $120.25 | $82.97 | RVU22D |
| 2022-07-01 | $120.25 | $82.97 | RVU22C |
| 2022-04-01 | $120.25 | $82.97 | RVU22B |
| 2022-01-01 | $120.25 | $82.97 | RVU22A |
| 2021-10-01 | $118.95 | $82.95 | RVU21D |
| 2021-07-01 | $118.95 | $82.95 | RVU21C |
| 2021-04-01 | $118.95 | $82.95 | RVU21B |
| 2021-01-01 | $118.95 | $82.95 | RVU21A |
| 2020-10-01 | $116.24 | $83.88 | RVU20D |
| 2020-07-01 | $116.24 | $83.88 | RVU20C |
| 2020-04-01 | $116.24 | $83.88 | RVU20B |
| 2020-01-01 | $116.24 | $83.88 | RVU20A |
| 2019-10-01 | $115.22 | $84.49 | RVU19D |
| 2019-07-01 | $115.22 | $84.49 | RVU19C |
| 2019-04-01 | $115.22 | $84.49 | RVU19B |
| 2019-01-01 | $115.22 | $84.49 | RVU19A |
| 2018-10-01 | $113.08 | $84.36 | RVU18D |
| 2018-07-01 | $113.08 | $84.36 | RVU18C |
| 2018-04-01 | $113.08 | $84.36 | RVU18B |
| 2018-01-01 | $113.08 | $84.36 | RVU18AR1 |
| 2017-10-01 | $113.11 | $84.78 | RVU17D |
| 2017-07-01 | $113.11 | $84.78 | RVU17C |
| 2017-04-01 | $113.11 | $84.78 | RVU17B |
| 2017-01-01 | $113.11 | $84.78 | RVU17A |
| 2016-10-01 | $112.42 | $84.15 | RVU16D |
| 2016-07-01 | $112.42 | $84.15 | RVU16C |
| 2016-04-01 | $112.42 | $84.15 | RVU16B |
| 2016-01-01 | $112.42 | $84.15 | RVU16A |
| 2015-10-01 | $112.52 | $84.48 | RVU15D |
| 2015-07-01 | $112.52 | $84.48 | RVU15C |
| 2015-04-01 | $111.96 | $84.06 | RVU15B |
| 2015-01-01 | $111.96 | $84.06 | RVU15A |
| 2014-10-01 | $110.79 | $83.34 | RVU14D |
| 2014-07-01 | $110.79 | $83.34 | RVU14C |
| 2014-04-01 | $110.79 | $83.34 | RVU14B |
| 2014-01-01 | $110.79 | $83.34 | RVU14A |
| 2013-10-01 | Not in this release | Not in this release | RVU13D |
| 2013-07-01 | Not in this release | Not in this release | RVU13C |
| 2013-04-01 | Not in this release | Not in this release | RVU13B |
| 2013-01-01 | Not in this release | Not in this release | RVU13AR |
Where the Ohio rate applies
Ohio is a Medicare payment area, not a city. Our Census mapping connects it to 1265 cities and communities in Ohio. Some span more than one payment area; confirm with the service ZIP.
- Aberdeen
- Ada
- Adamsville
- Addyston
- Adelphi
- Adena
- Ai
- Akron
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
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