CPT code 64647: Trunk chemodenervation, six or more muscles2026 Medicare rate & RVUs
Reports botulinum toxin chemodenervation of six or more trunk muscles, such as paraspinal or abdominal muscles, for a documented movement or tone disorder.
Medicare pays $189.38 for 64647 nationally in the office and $116.24 in a hospital or facility. Local office rates run $166.64–$235.12.
Medicare rate · 64647
Trunk chemodenervation, six or more muscles
- Work RVUs
- 2.06
- Total RVUs
- 5.67
- Global days
- 000
National rate · 2026
$189.38
Office setting, before claim adjustments.
See every locality for 64647 →Billed by an NP, PA or therapist? →
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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On this page 10 sections
What 64647 covers
This service involves injecting a chemodenervating agent, commonly botulinum toxin, into six or more distinct trunk muscles to reduce unwanted muscle activity. Neurologists, physiatrists, and other qualified clinicians may perform it in an office or outpatient facility for conditions such as trunk spasticity or dystonia. Paraspinal and abdominal muscles are examples of trunk targets; the treated muscles should be identified in the record.
Select this code based on the number of distinct trunk muscles treated, not the number of needle passes or injection points. Documentation should support the indication and identify the muscles injected; report the toxin product separately when applicable. The procedure has a 0-day global period, so same-day preoperative and postoperative care is included. When multiple procedures are performed in one session, the highest-valued procedure is paid in full and others at 50%. Modifier 50 is inappropriate. Medicare does not pay an assistant at surgery, and co-surgeons and team surgery are not permitted.
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.
Where 64647 pays more and less
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
109 payment localities
$166.64 to $235.12
109 of 109 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Alabama | $169.15 | $105.15 |
| Alaska | $223.04 | $145.14 |
| Arizona | $183.76 | $112.88 |
| Arkansas | $166.64 | $103.80 |
| Atlanta, GA | $194.61 | $120.29 |
| Austin, TX | $193.64 | $116.25 |
| Bakersfield, CA | $194.13 | $113.96 |
| Baltimore area, MD | $202.03 | $123.54 |
| Beaumont, TX | $178.85 | $112.28 |
| Brazoria, TX | $185.32 | $112.83 |
| Chicago, IL | $212.01 | $138.50 |
| Chico, CA | $192.78 | $112.61 |
| Colorado | $193.20 | $115.37 |
| Connecticut | $202.26 | $123.48 |
| Dallas, TX | $187.22 | $114.36 |
| Delaware | $186.79 | $114.52 |
| Detroit, MI | $197.20 | $126.62 |
| East St. Louis, IL | $198.01 | $130.71 |
| El Centro, CA | $192.86 | $112.69 |
| Fort Lauderdale, FL | $204.23 | $130.13 |
| Fort Worth, TX | $186.39 | $114.27 |
| Fresno, CA | $192.78 | $112.61 |
| Galveston, TX | $186.33 | $113.70 |
| Hanford, CA | $192.78 | $112.61 |
| Hawaii, Guam, HI | $196.58 | $113.41 |
| Houston, TX | $195.49 | $122.85 |
| Idaho | $172.27 | $104.98 |
| Indiana | $173.22 | $105.41 |
| Iowa | $170.48 | $103.55 |
| Kansas | $171.13 | $105.00 |
| Kentucky | $176.43 | $111.40 |
| King County, WA | $213.35 | $123.59 |
| Los Angeles, CA | $205.60 | $119.07 |
| Madera, CA | $192.78 | $112.61 |
| Manhattan, NY | $220.40 | $135.40 |
| Marin County, CA | $229.47 | $126.34 |
| Merced, CA | $192.78 | $112.61 |
| Metropolitan Boston, MA | $210.52 | $123.18 |
| Metropolitan Kansas City, MO | $182.66 | $113.98 |
| Metropolitan Philadelphia, PA | $198.10 | $121.96 |
| Metropolitan St. Louis, MO | $184.43 | $114.79 |
| Miami, FL | $219.18 | $143.03 |
| Minnesota | $180.64 | $105.37 |
| Mississippi | $170.59 | $107.61 |
| Modesto, CA | $192.78 | $112.61 |
| Montana | $189.35 | $116.20 |
| Napa, CA | $218.53 | $122.13 |
| Nebraska | $171.00 | $103.48 |
| Nevada | $186.70 | $113.48 |
| New Hampshire | $191.55 | $115.41 |
| New Mexico | $184.12 | $117.04 |
| New Orleans, LA | $185.53 | $116.69 |
| North Carolina | $176.39 | $108.15 |
| North Dakota | $179.46 | $106.32 |
| Northern New Jersey | $211.47 | $126.62 |
| NYC suburbs and Long Island, NY | $227.73 | $140.76 |
| Ohio | $180.48 | $113.70 |
| Oklahoma | $174.54 | $109.22 |
| Oxnard, CA | $203.92 | $117.46 |
| Portland, OR | $197.74 | $116.47 |
| Poughkeepsie and northern NYC suburbs, NY | $205.85 | $125.76 |
| Puerto Rico | $190.28 | $116.32 |
| Queens, NY | $220.07 | $133.61 |
| Redding, CA | $192.78 | $112.61 |
| Rest of California | $192.78 | $112.61 |
| Rest of Florida | $193.21 | $123.28 |
| Rest of Georgia | $181.37 | $116.12 |
| Rest of Illinois | $189.75 | $122.96 |
| Rest of Louisiana | $176.74 | $112.00 |
| Rest of Maine | $174.76 | $107.46 |
| Rest of Maryland | $189.95 | $115.92 |
| Rest of Massachusetts | $192.60 | $115.57 |
| Rest of Michigan | $182.50 | $115.72 |
| Rest of Missouri | $174.61 | $111.56 |
| Rest of New Jersey | $203.31 | $123.43 |
| Rest of New York | $179.23 | $109.74 |
| Rest of Oregon | $184.01 | $111.15 |
| Rest of Pennsylvania | $179.95 | $112.80 |
| Rest of Texas | $182.47 | $113.05 |
| Rest of Washington | $191.79 | $114.77 |
| Rhode Island | $192.31 | $116.75 |
| Riverside, CA | $198.14 | $117.97 |
| Sacramento, CA | $201.04 | $115.97 |
| Salinas, CA | $200.28 | $115.50 |
| San Benito County, CA | $235.12 | $129.64 |
| San Diego, CA | $204.16 | $116.67 |
| San Francisco, CA | $228.91 | $125.77 |
| San Luis Obispo, CA | $197.24 | $113.93 |
| Santa Clara County, CA | $232.79 | $127.32 |
| Santa Cruz, CA | $205.41 | $116.54 |
| Santa Maria, CA | $200.80 | $115.51 |
| Santa Rosa, CA | $207.38 | $117.56 |
| South Carolina | $178.98 | $111.39 |
| South Dakota | $178.29 | $105.15 |
| Southern Maine, ME | $182.29 | $109.80 |
| Stockton, CA | $192.78 | $112.61 |
| Suburban Chicago, IL | $205.56 | $130.44 |
| Tennessee | $172.20 | $105.71 |
| Utah | $181.45 | $112.69 |
| Vallejo, CA | $217.72 | $121.31 |
| Vermont | $180.09 | $107.68 |
| Virgin Islands, VI | $190.28 | $116.32 |
| Virginia | $182.71 | $110.80 |
| Visalia, CA | $192.78 | $112.61 |
| Washington, DC area | $213.48 | $127.31 |
| West Virginia | $182.97 | $119.41 |
| Wisconsin | $173.46 | $103.39 |
| Wyoming | $185.04 | $111.89 |
| Yuba City, CA | $192.78 | $112.61 |
64647 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.
$166.64
$223.04
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 | $223.04 | 1 |
| AL | $169.15 | 1 |
| AR | $166.64 | 1 |
| AZ | $183.76 | 1 |
| CA | $192.78–$235.12 | 29 |
| CO | $193.20 | 1 |
| CT | $202.26 | 1 |
| DC | $213.48 | 1 |
| DE | $186.79 | 1 |
| FL | $193.21–$219.18 | 3 |
| GA | $181.37–$194.61 | 2 |
| GU | $196.58 | 1 |
| HI | $196.58 | 1 |
| IA | $170.48 | 1 |
| ID | $172.27 | 1 |
| IL | $189.75–$212.01 | 4 |
| IN | $173.22 | 1 |
| KS | $171.13 | 1 |
| KY | $176.43 | 1 |
| LA | $176.74–$185.53 | 2 |
| MA | $192.60–$210.52 | 2 |
| MD | $189.95–$213.48 | 3 |
| ME | $174.76–$182.29 | 2 |
| MI | $182.50–$197.20 | 2 |
| MN | $180.64 | 1 |
| MO | $174.61–$184.43 | 3 |
| MS | $170.59 | 1 |
| MT | $189.35 | 1 |
| NC | $176.39 | 1 |
| ND | $179.46 | 1 |
| NE | $171.00 | 1 |
| NH | $191.55 | 1 |
| NJ | $203.31–$211.47 | 2 |
| NM | $184.12 | 1 |
| NV | $186.70 | 1 |
| NY | $179.23–$227.73 | 5 |
| OH | $180.48 | 1 |
| OK | $174.54 | 1 |
| OR | $184.01–$197.74 | 2 |
| PA | $179.95–$198.10 | 2 |
| PR | $190.28 | 1 |
| RI | $192.31 | 1 |
| SC | $178.98 | 1 |
| SD | $178.29 | 1 |
| TN | $172.20 | 1 |
| TX | $178.85–$195.49 | 8 |
| UT | $181.45 | 1 |
| VA | $182.71–$213.48 | 2 |
| VI | $190.28 | 1 |
| VT | $180.09 | 1 |
| WA | $191.79–$213.35 | 2 |
| WI | $173.46 | 1 |
| WV | $182.97 | 1 |
| WY | $185.04 | 1 |
How the 64647 rate is calculated
Each of 64647’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 · 64647
RVUs × geographic indexes × conversion factor
Work2.06
2.06 RVUs× 1.000 GPCI
Practice expense3.11
3.11 RVUs× 1.000 GPCI
Malpractice0.50
0.50 RVUs× 1.000 GPCI
Adjusted RVUs
5.6700
Conversion factor
$33.4009
Medicare rate
$189.38
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 64647
The CMS indicators that decide how 64647 is paid alongside other services.
CMS payment indicators · 64647
Trunk chemodenervation, six or more muscles
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 000 | Same-day global: pre- and post-op care on the day of the procedure is included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| 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. |
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
64647 without 51 · national office
$189.38
Trunk chemodenervation, six or more muscles
64647-51 · Second procedure: 50%
$94.69
When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).
64647 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 64646Muscle chemodenervationTrunk, one to five muscles
- Both codes cover trunk muscle chemodenervation. Choose 64646 for one to five muscles and 64647 for six or more.
- 64642ChemodenervationOne extremity, 1–4 muscles
- 64642 is for one extremity treated in one to four muscles. Use 64647 for six or more trunk muscles.
- 64644Muscle chemodenervationOne extremity, five or more muscles
- 64644 covers five or more muscles in one extremity; 64647 applies to six or more muscles in the trunk.
64647 billing questions
When should this code be selected instead of 64646?
Use 64647 when six or more trunk muscles are treated. Code 64646 is for one to five trunk muscles.
Do injection points determine the muscle count?
No. Select the code by the number of distinct muscles treated, not the number of needle passes or injection points. Document the muscles injected.
Can modifier 50 be used for injections on both sides of the trunk?
No. The CMS bilateral adjustment does not apply to this code, and modifier 50 is inappropriate.
Is the botulinum toxin product included in this service?
The code represents the chemodenervation procedure. Report the toxin product separately under its applicable drug code when separately reportable.
How does the 0-day global period affect same-day care?
Same-day preoperative and postoperative care is included in the procedure's payment.
Can an assistant or co-surgeon be reported?
Medicare does not pay an assistant at surgery for this code. Co-surgeons and team surgery are not permitted.
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
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