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CPT code 64645: Muscle chemodenervation, additional extremity, five-plus muscles2026 Medicare rate & RVUs in Fort Worth, TX

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 Fort Worth, TX, Medicare pays $127.52 for 64645 in the office and $69.23 when it’s performed in a hospital or facility.

$127.52Office (non-facility)
$69.23Hospital or facility
−1.6%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 Fort Worth, TX
  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 Fort Worth, TX 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. Fort Worth, TX pays $127.52. The RVUs are the same everywhere; the geographic indexes change the dollars.

64645 in Fort Worth, TX vs other payment areas
  1. Fort Worth, TX · this page$127.52
  2. Austin, TX · Texas$132.61+$5.09
  3. Beaumont, TX · Texas$122.24−$5.28
  4. Brazoria, TX · Texas$126.81−$0.71
  5. Dallas, TX · Texas$128.10+$0.58
  6. Galveston, TX · Texas$127.50−$0.02
  7. Houston, TX · Texas$133.72+$6.20

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

Every other payment area

64645 in every other Medicare payment locality
Payment localityOfficeFacility
Rest of TexasTexas$124.78$68.68
Los Angeles, CACalifornia$140.97$71.03
Washington, DC areaDistrict of Columbia$146.29$76.65
Miami, FLFlorida$149.94$88.40
Chicago, ILIllinois$144.98$85.57
Manhattan, NYNew York$150.95$82.26
AlaskaAlaska$151.94$88.98
AlabamaAlabama$115.57$63.84

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 Fort Worth, TX 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

100

Locality
Fort Worth, TX
Physician work
1.009
Practice expense
0.986
Malpractice
0.871
Office calculation for 64645 in Fort Worth, TX
ComponentRVULocality factorAdjusted
Physician work1.36× 1.0091.3722
Practice expense2.18× 0.9862.1495
Malpractice0.34× 0.8710.2961
Total RVUs3.8179
Conversion factor× 33.4009

Office rate, Fort Worth, TX$127.52

Office: (1.36 × 1.009 + 2.18 × 0.986 + 0.34 × 0.871) × $33.4009 = $127.52

Facility: (1.36 × 1.009 + 0.41 × 0.986 + 0.34 × 0.871) × $33.4009 = $69.23

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, Fort Worth, TX
Primary code
64644Muscle chemodenervation, one extremity, five or more musclesPrimary extremity chemodenervation service for five or more muscles.$187.87
Same family
64643Chemodenervation, additional extremity, 1-4 musclesAdditional-extremity service when one to four muscles are treated.$98.50
64642Chemodenervation, one extremity, 1–4 musclesInitial-extremity service when one to four muscles are treated.$160.78
Used instead
64646Muscle chemodenervation, trunk, one to five musclesChemodenervation applies to trunk muscles rather than an additional extremity.$167.47
64647Trunk chemodenervation, six or more musclesChemodenervation applies to six or more trunk muscles rather than an additional extremity.$186.39

How 64645 has changed in Fort Worth, TX

64645 · Office / nonfacility

$127.52

Effective 2026-10-01

The base rate is $10.78 higher than on 2025-10-01, moving from $116.74 to $127.52 (9.2%).

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

    $116.74changed to$127.52

    • 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 1.011 changed to 1.009
    • Practice expense GPCI 0.998 changed to 0.986
    • Malpractice GPCI 0.902 changed to 0.871

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $120.14changed to$116.74

    • Conversion factor 33.2875 changed to 32.3465

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $118.18changed to$120.14

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $119.14changed to$118.18

    • 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 1.013 changed to 1.011
    • Practice expense GPCI 0.996 changed to 0.998
    • Malpractice GPCI 0.721 changed to 0.902

  5. January 1, 2023

    RVU23A

    $120.26changed to$119.14

    • 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
    • Work GPCI 1.016 changed to 1.013
    • Practice expense GPCI 0.995 changed to 0.996
    • Malpractice GPCI 0.539 changed to 0.721

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $118.99changed to$120.26

    • 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

    $117.30changed to$118.99

    • 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 1.011 changed to 1.016
    • Practice expense GPCI 0.991 changed to 0.995
    • Malpractice GPCI 0.643 changed to 0.539

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $116.63changed to$117.30

    • 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 1.007 changed to 1.011
    • Practice expense GPCI 0.986 changed to 0.991
    • Malpractice GPCI 0.747 changed to 0.643

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $114.45changed to$116.63

    • 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

    $114.67changed to$114.45

    • 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 1.006 changed to 1.007
    • Practice expense GPCI 0.991 changed to 0.986
    • Malpractice GPCI 0.760 changed to 0.747

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $114.44changed to$114.67

    • Conversion factor 35.8043 changed to 35.8887
    • Malpractice RVU 0.32 changed to 0.33
    • Work GPCI 1.005 changed to 1.006
    • Practice expense GPCI 0.995 changed to 0.991
    • Malpractice GPCI 0.772 changed to 0.760

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $114.41changed to$114.44

    • 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

    $113.84changed to$114.41

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $111.43changed to$113.84

    • 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 1.005
    • Practice expense GPCI 0.987 changed to 0.995
    • Malpractice GPCI 0.799 changed to 0.772

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    No ratechanged to$111.43

    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$127.52$69.23RVU26D
2026-07-01$127.52$69.23RVU26C
2026-04-01$127.52$69.23RVU26B
2026-01-01$127.52$69.23RVU26A
2025-10-01$116.74$78.33RVU25D
2025-07-01$116.74$78.33RVU25C
2025-04-01$116.74$78.33RVU25B
2025-01-01$116.74$78.33RVU25A
2024-10-01$120.14$80.27RVU24D
2024-07-01$120.14$80.27RVU24C
2024-04-01$120.14$80.27RVU24B
2024-03-09$120.14$80.27RVU24AR
2024-01-01$118.18$78.96RVU24A
2023-10-01$119.14$79.65RVU23D
2023-07-01$119.14$79.65RVU23C
2023-04-01$119.14$79.65RVU23B
2023-01-01$119.14$79.65RVU23A
2022-10-01$120.26$79.63RVU22D
2022-07-01$120.26$79.63RVU22C
2022-04-01$120.26$79.63RVU22B
2022-01-01$120.26$79.63RVU22A
2021-10-01$118.99$79.76RVU21D
2021-07-01$118.99$79.76RVU21C
2021-04-01$118.99$79.76RVU21B
2021-01-01$118.99$79.76RVU21A
2020-10-01$117.30$82.25RVU20D
2020-07-01$117.30$82.25RVU20C
2020-04-01$117.30$82.25RVU20B
2020-01-01$117.30$82.25RVU20A
2019-10-01$116.63$83.58RVU19D
2019-07-01$116.63$83.58RVU19C
2019-04-01$116.63$83.58RVU19B
2019-01-01$116.63$83.58RVU19A
2018-10-01$114.45$83.57RVU18D
2018-07-01$114.45$83.57RVU18C
2018-04-01$114.45$83.57RVU18B
2018-01-01$114.45$83.57RVU18AR1
2017-10-01$114.67$84.08RVU17D
2017-07-01$114.67$84.08RVU17C
2017-04-01$114.67$84.08RVU17B
2017-01-01$114.67$84.08RVU17A
2016-10-01$114.44$83.80RVU16D
2016-07-01$114.44$83.80RVU16C
2016-04-01$114.44$83.80RVU16B
2016-01-01$114.44$83.80RVU16A
2015-10-01$114.41$84.02RVU15D
2015-07-01$114.41$84.02RVU15C
2015-04-01$113.84$83.60RVU15B
2015-01-01$113.84$83.60RVU15A
2014-10-01$111.43$82.09RVU14D
2014-07-01$111.43$82.09RVU14C
2014-04-01$111.43$82.09RVU14B
2014-01-01$111.43$82.09RVU14A
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 Fort Worth, TX rate applies

Fort Worth, TX is a Medicare payment area, not a city. Our Census mapping connects it to 45 cities and communities in Texas. Some span more than one payment area; confirm with the service ZIP.

Browse all communities in Texas

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 Fort Worth, TXGPCI2026.csv, line 100 (RVU26D)

Open CMS sourceHow we calculate rates

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