CPT code 64645: Muscle chemodenervation, additional extremity, five-plus muscles2026 Medicare rate & RVUs in Houston, TX
Reports chemodenervation of each additional extremity when five or more muscles are treated there, alongside the primary extremity service.
In Houston, TX, Medicare pays $133.72 for 64645 in the office and $75.01 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 Houston, 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. Houston, TX pays $133.72. The RVUs are the same everywhere; the geographic indexes change the dollars.
- Houston, TX · this page$133.72
- Austin, TX · Texas$132.61−$1.11
- Beaumont, TX · Texas$122.24−$11.48
- Brazoria, TX · Texas$126.81−$6.91
- Dallas, TX · Texas$128.10−$5.62
- Fort Worth, TX · Texas$127.52−$6.20
- Galveston, TX · Texas$127.50−$6.22
Other areas in Texas first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| 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 |
| 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 |
| OhioOhio | $123.35 | $69.38 |
| 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 |
| 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 Houston, 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
102
- Locality
- Houston, TX
- Physician work
- 1.008
- Practice expense
- 0.993
- Malpractice
- 1.376
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 1.36 | × 1.008 | 1.3709 |
| Practice expense | 2.18 | × 0.993 | 2.1647 |
| Malpractice | 0.34 | × 1.376 | 0.4678 |
| Total RVUs | 4.0035 | ||
| Conversion factor | × 33.4009 | ||
Office rate, Houston, TX$133.72
Office: (1.36 × 1.008 + 2.18 × 0.993 + 0.34 × 1.376) × $33.4009 = $133.72
Facility: (1.36 × 1.008 + 0.41 × 0.993 + 0.34 × 1.376) × $33.4009 = $75.01
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 Houston, TX
64645 · Office / nonfacility
$133.72
Effective 2026-10-01
The base rate is $11.12 higher than on 2025-10-01, moving from $122.60 to $133.72 (9.1%).
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
$122.60changed to$133.72
- 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 1.014 changed to 1.008
- Practice expense GPCI 1.003 changed to 0.993
- Malpractice GPCI 1.409 changed to 1.376
Held through RVU26B, RVU26C, RVU26D.
January 1, 2025
RVU25A
$126.16changed to$122.60
- Conversion factor 33.2875 changed to 32.3465
Held through RVU25B, RVU25C, RVU25D.
March 9, 2024
RVU24AR
$124.11changed to$126.16
- Conversion factor 32.7442 changed to 33.2875
Held through RVU24B, RVU24C, RVU24D.
January 1, 2024
RVU24A
$125.87changed to$124.11
- 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 1.023 changed to 1.014
- Practice expense GPCI 1.016 changed to 1.003
- Malpractice GPCI 1.154 changed to 1.409
January 1, 2023
RVU23A
$127.27changed to$125.87
- 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 1.032 changed to 1.023
- Practice expense GPCI 1.029 changed to 1.016
- Malpractice GPCI 0.900 changed to 1.154
Held through RVU23B, RVU23C, RVU23D.
January 1, 2022
RVU22A
$125.85changed to$127.27
- 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
Held through RVU22B, RVU22C, RVU22D.
January 1, 2021
RVU21A
$122.59changed to$125.85
- 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 1.026 changed to 1.032
- Practice expense GPCI 1.020 changed to 1.029
- Malpractice GPCI 0.918 changed to 0.900
Held through RVU21B, RVU21C, RVU21D.
January 1, 2020
RVU20A
$120.97changed to$122.59
- 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 1.020 changed to 1.026
- Practice expense GPCI 1.012 changed to 1.020
- Malpractice GPCI 0.936 changed to 0.918
Held through RVU20B, RVU20C, RVU20D.
January 1, 2019
RVU19A
$118.68changed to$120.97
- 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
$118.58changed to$118.68
- 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 1.009 changed to 1.012
- Malpractice GPCI 0.946 changed to 0.936
Held through RVU18B, RVU18C, RVU18D.
January 1, 2017
RVU17A
$117.85changed to$118.58
- Conversion factor 35.8043 changed to 35.8887
- Malpractice RVU 0.32 changed to 0.33
- Work GPCI 1.019 changed to 1.020
- Practice expense GPCI 1.006 changed to 1.009
- Malpractice GPCI 0.955 changed to 0.946
Held through RVU17B, RVU17C, RVU17D.
January 1, 2016
RVU16A
$117.89changed to$117.85
- 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
$117.30changed to$117.89
- Conversion factor 35.7547 changed to 35.9335
Held through RVU15D.
January 1, 2015
RVU15A
$114.26changed to$117.30
- 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 1.014 changed to 1.019
- Practice expense GPCI 1.004 changed to 1.006
- Malpractice GPCI 0.939 changed to 0.955
Held through RVU15B.
January 1, 2014
RVU14A
No ratechanged to$114.26
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 | $133.72 | $75.01 | RVU26D |
| 2026-07-01 | $133.72 | $75.01 | RVU26C |
| 2026-04-01 | $133.72 | $75.01 | RVU26B |
| 2026-01-01 | $133.72 | $75.01 | RVU26A |
| 2025-10-01 | $122.60 | $83.99 | RVU25D |
| 2025-07-01 | $122.60 | $83.99 | RVU25C |
| 2025-04-01 | $122.60 | $83.99 | RVU25B |
| 2025-01-01 | $122.60 | $83.99 | RVU25A |
| 2024-10-01 | $126.16 | $86.10 | RVU24D |
| 2024-07-01 | $126.16 | $86.10 | RVU24C |
| 2024-04-01 | $126.16 | $86.10 | RVU24B |
| 2024-03-09 | $126.16 | $86.10 | RVU24AR |
| 2024-01-01 | $124.11 | $84.69 | RVU24A |
| 2023-10-01 | $125.87 | $85.58 | RVU23D |
| 2023-07-01 | $125.87 | $85.58 | RVU23C |
| 2023-04-01 | $125.87 | $85.58 | RVU23B |
| 2023-01-01 | $125.87 | $85.58 | RVU23A |
| 2022-10-01 | $127.27 | $85.25 | RVU22D |
| 2022-07-01 | $127.27 | $85.25 | RVU22C |
| 2022-04-01 | $127.27 | $85.25 | RVU22B |
| 2022-01-01 | $127.27 | $85.25 | RVU22A |
| 2021-10-01 | $125.85 | $85.28 | RVU21D |
| 2021-07-01 | $125.85 | $85.28 | RVU21C |
| 2021-04-01 | $125.85 | $85.28 | RVU21B |
| 2021-01-01 | $125.85 | $85.28 | RVU21A |
| 2020-10-01 | $122.59 | $86.51 | RVU20D |
| 2020-07-01 | $122.59 | $86.51 | RVU20C |
| 2020-04-01 | $122.59 | $86.51 | RVU20B |
| 2020-01-01 | $122.59 | $86.51 | RVU20A |
| 2019-10-01 | $120.97 | $87.06 | RVU19D |
| 2019-07-01 | $120.97 | $87.06 | RVU19C |
| 2019-04-01 | $120.97 | $87.06 | RVU19B |
| 2019-01-01 | $120.97 | $87.06 | RVU19A |
| 2018-10-01 | $118.68 | $86.99 | RVU18D |
| 2018-07-01 | $118.68 | $86.99 | RVU18C |
| 2018-04-01 | $118.68 | $86.99 | RVU18B |
| 2018-01-01 | $118.68 | $86.99 | RVU18AR1 |
| 2017-10-01 | $118.58 | $87.43 | RVU17D |
| 2017-07-01 | $118.58 | $87.43 | RVU17C |
| 2017-04-01 | $118.58 | $87.43 | RVU17B |
| 2017-01-01 | $118.58 | $87.43 | RVU17A |
| 2016-10-01 | $117.85 | $86.87 | RVU16D |
| 2016-07-01 | $117.85 | $86.87 | RVU16C |
| 2016-04-01 | $117.85 | $86.87 | RVU16B |
| 2016-01-01 | $117.85 | $86.87 | RVU16A |
| 2015-10-01 | $117.89 | $87.16 | RVU15D |
| 2015-07-01 | $117.89 | $87.16 | RVU15C |
| 2015-04-01 | $117.30 | $86.73 | RVU15B |
| 2015-01-01 | $117.30 | $86.73 | RVU15A |
| 2014-10-01 | $114.26 | $84.41 | RVU14D |
| 2014-07-01 | $114.26 | $84.41 | RVU14C |
| 2014-04-01 | $114.26 | $84.41 | RVU14B |
| 2014-01-01 | $114.26 | $84.41 | 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 Houston, TX rate applies
Houston, TX is a Medicare payment area, not a city. Our Census mapping connects it to 46 cities and communities in Texas. Some span more than one payment area; confirm with the service ZIP.
- 64645 in Houston · multiple payment areas
- Aldine
- Atascocita
- Barrett
- 64645 in Baytown · multiple payment areas
- Bellaire
- Bunker Hill Village
- Channelview
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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