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CPT code 64647: Trunk chemodenervation, six or more muscles2026 Medicare rate & RVUs in Arkansas

Reports botulinum toxin chemodenervation of six or more trunk muscles, such as paraspinal or abdominal muscles, for a documented movement or tone disorder.

CMS RVU26DEffective Oct 1, 2026One payment locality1.7K Medicare services in 2024

In Arkansas, Medicare pays $166.64 for 64647 in the office and $103.80 when it’s performed in a hospital or facility.

$166.64Office (non-facility)
$103.80Hospital or facility
−12.0%vs the national office rate ($189.38)

Check a contract rate as a % of Medicare · 64647 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 64647 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Arkansas
  2. What 64647 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 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.

How Arkansas compares for 64647

Across 109 of 109 payment localities, the office rate for 64647 runs from $166.64 in Arkansas to $235.12 in San Benito County, CA. Arkansas pays $166.64. The RVUs are the same everywhere; the geographic indexes change the dollars.

64647 in Arkansas vs other payment areas
  1. Arkansas · this page$166.64
  2. Los Angeles, CA · California$205.60+$38.96
  3. Washington, DC area · District of Columbia$213.48+$46.84
  4. Miami, FL · Florida$219.18+$52.54
  5. Chicago, IL · Illinois$212.01+$45.37
  6. Manhattan, NY · New York$220.40+$53.76
  7. Alaska · Alaska$223.04+$56.40

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

Every other payment area

64647 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$169.15$105.15
ArizonaArizona$183.76$112.88
Bakersfield, CACalifornia$194.13$113.96
Chico, CACalifornia$192.78$112.61
El Centro, CACalifornia$192.86$112.69
Fresno, CACalifornia$192.78$112.61
Hanford, CACalifornia$192.78$112.61
Madera, CACalifornia$192.78$112.61

64647 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.

$166.64

$223.04

Color shows the midpoint of each state’s locality range.

View every state and territory as a table
64647 office rate range by state
State / territoryOffice rate rangeLocalities
AK$223.041
AL$169.151
AR$166.641
AZ$183.761
CA$192.78–$235.1229
CO$193.201
CT$202.261
DC$213.481
DE$186.791
FL$193.21–$219.183
GA$181.37–$194.612
GU$196.581
HI$196.581
IA$170.481
ID$172.271
IL$189.75–$212.014
IN$173.221
KS$171.131
KY$176.431
LA$176.74–$185.532
MA$192.60–$210.522
MD$189.95–$213.483
ME$174.76–$182.292
MI$182.50–$197.202
MN$180.641
MO$174.61–$184.433
MS$170.591
MT$189.351
NC$176.391
ND$179.461
NE$171.001
NH$191.551
NJ$203.31–$211.472
NM$184.121
NV$186.701
NY$179.23–$227.735
OH$180.481
OK$174.541
OR$184.01–$197.742
PA$179.95–$198.102
PR$190.281
RI$192.311
SC$178.981
SD$178.291
TN$172.201
TX$178.85–$195.498
UT$181.451
VA$182.71–$213.482
VI$190.281
VT$180.091
WA$191.79–$213.352
WI$173.461
WV$182.971
WY$185.041

See 64647 in every payment locality

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

Office or facility?

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.

The exact Arkansas inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

7,190

Code
64647
Physician work
2.06
Practice expense
3.11
Malpractice
0.50

GPCI2026.csv

7

Locality
Arkansas
Physician work
1.000
Practice expense
0.859
Malpractice
0.515
Office calculation for 64647 in Arkansas
ComponentRVULocality factorAdjusted
Physician work2.06× 1.0002.0600
Practice expense3.11× 0.8592.6715
Malpractice0.50× 0.5150.2575
Total RVUs4.9890
Conversion factor× 33.4009

Office rate, Arkansas$166.64

Office: (2.06 × 1 + 3.11 × 0.859 + 0.5 × 0.515) × $33.4009 = $166.64

Facility: (2.06 × 1 + 0.92 × 0.859 + 0.5 × 0.515) × $33.4009 = $103.80

Open 64647 in the RVU calculator

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

RuleCMS valueWhat it means
Global period000Same-day global: pre- and post-op care on the day of the procedure is included.
Multiple procedures2Standard reduction: highest-valued procedure at 100%, others at 50%.
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.

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%).

When to use modifier 51

Codes related to 64647

Related codes aren’t interchangeable: bill the code that matches the service performed.

Codes related to 64647
CodeHow it relatesOffice range, Arkansas
Same family
64646Muscle chemodenervation, trunk, one to five musclesTrunk chemodenervation for one to five muscles; 64647 covers six or more.$149.10
Used instead
64642Chemodenervation, one extremity, 1–4 musclesChemodenervation targets one extremity with one to four muscles rather than trunk muscles.$143.40
64644Muscle chemodenervation, one extremity, five or more musclesChemodenervation targets one extremity with five or more muscles rather than trunk muscles.$167.57
64643Chemodenervation, additional extremity, 1-4 musclesAddresses additional-extremity chemodenervation, not treatment of trunk muscles.$88.75

How 64647 has changed in Arkansas

64647 · Office / nonfacility

$166.64

Effective 2026-10-01

The base rate is $10.73 higher than on 2025-10-01, moving from $155.91 to $166.64 (6.9%).

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

    $155.91changed to$166.64

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 2.11 changed to 2.06
    • Practice expense RVU 2.82 changed to 3.11
    • Malpractice RVU 0.55 changed to 0.50
    • Practice expense GPCI 0.860 changed to 0.859
    • Malpractice GPCI 0.518 changed to 0.515

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $162.00changed to$155.91

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 2.85 changed to 2.82
    • Malpractice RVU 0.59 changed to 0.55

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $159.35changed to$162.00

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $161.12changed to$159.35

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 2.76 changed to 2.85
    • Practice expense GPCI 0.853 changed to 0.860
    • Malpractice GPCI 0.492 changed to 0.518

  5. January 1, 2023

    RVU23A

    $161.92changed to$161.12

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 2.72 changed to 2.76
    • Malpractice RVU 0.57 changed to 0.59
    • Practice expense GPCI 0.847 changed to 0.853
    • Malpractice GPCI 0.465 changed to 0.492

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $160.11changed to$161.92

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 2.63 changed to 2.72
    • Malpractice RVU 0.54 changed to 0.57

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $161.70changed to$160.11

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 2.42 changed to 2.63
    • Malpractice RVU 0.56 changed to 0.54
    • Practice expense GPCI 0.859 changed to 0.847
    • Malpractice GPCI 0.521 changed to 0.465

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $164.02changed to$161.70

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 2.39 changed to 2.42
    • Malpractice RVU 0.62 changed to 0.56
    • Practice expense GPCI 0.872 changed to 0.859
    • Malpractice GPCI 0.576 changed to 0.521

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $163.42changed to$164.02

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 2.37 changed to 2.39
    • Malpractice RVU 0.63 changed to 0.62

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $161.90changed to$163.42

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 2.39 changed to 2.37
    • Malpractice RVU 0.58 changed to 0.63
    • Practice expense GPCI 0.870 changed to 0.872
    • Malpractice GPCI 0.555 changed to 0.576

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $161.66changed to$161.90

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 2.46 changed to 2.39
    • Malpractice RVU 0.51 changed to 0.58
    • Practice expense GPCI 0.867 changed to 0.870
    • Malpractice GPCI 0.534 changed to 0.555

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $162.05changed to$161.66

    • Conversion factor 35.9335 changed to 35.8043
    • Malpractice RVU 0.50 changed to 0.51

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $161.25changed to$162.05

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $157.67changed to$161.25

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 2.43 changed to 2.46
    • Malpractice RVU 0.38 changed to 0.50
    • Practice expense GPCI 0.866 changed to 0.867
    • Malpractice GPCI 0.492 changed to 0.534

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    No ratechanged to$157.67

    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$166.64$103.80RVU26D
2026-07-01$166.64$103.80RVU26C
2026-04-01$166.64$103.80RVU26B
2026-01-01$166.64$103.80RVU26A
2025-10-01$155.91$114.46RVU25D
2025-07-01$155.91$114.46RVU25C
2025-04-01$155.91$114.46RVU25B
2025-01-01$155.91$114.46RVU25A
2024-10-01$162.00$118.20RVU24D
2024-07-01$162.00$118.20RVU24C
2024-04-01$162.00$118.20RVU24B
2024-03-09$162.00$118.20RVU24AR
2024-01-01$159.35$116.27RVU24A
2023-10-01$161.12$118.34RVU23D
2023-07-01$161.12$118.34RVU23C
2023-04-01$161.12$118.34RVU23B
2023-01-01$161.12$118.34RVU23A
2022-10-01$161.92$119.71RVU22D
2022-07-01$161.92$119.71RVU22C
2022-04-01$161.92$119.71RVU22B
2022-01-01$161.92$119.71RVU22A
2021-10-01$160.11$119.92RVU21D
2021-07-01$160.11$119.92RVU21C
2021-04-01$160.11$119.92RVU21B
2021-01-01$160.11$119.92RVU21A
2020-10-01$161.70$124.50RVU20D
2020-07-01$161.70$124.50RVU20C
2020-04-01$161.70$124.50RVU20B
2020-01-01$161.70$124.50RVU20A
2019-10-01$164.02$127.57RVU19D
2019-07-01$164.02$127.57RVU19C
2019-04-01$164.02$127.57RVU19B
2019-01-01$164.02$127.57RVU19A
2018-10-01$163.42$128.58RVU18D
2018-07-01$163.42$128.58RVU18C
2018-04-01$163.42$128.58RVU18B
2018-01-01$163.42$128.58RVU18AR1
2017-10-01$161.90$127.87RVU17D
2017-07-01$161.90$127.87RVU17C
2017-04-01$161.90$127.87RVU17B
2017-01-01$161.90$127.87RVU17A
2016-10-01$161.66$126.58RVU16D
2016-07-01$161.66$126.58RVU16C
2016-04-01$161.66$126.58RVU16B
2016-01-01$161.66$126.58RVU16A
2015-10-01$162.05$126.85RVU15D
2015-07-01$162.05$126.85RVU15C
2015-04-01$161.25$126.22RVU15B
2015-01-01$161.25$126.22RVU15A
2014-10-01$157.67$123.54RVU14D
2014-07-01$157.67$123.54RVU14C
2014-04-01$157.67$123.54RVU14B
2014-01-01$157.67$123.54RVU14A
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 64647 for an earlier date of service

Where the Arkansas rate applies

Arkansas is a Medicare payment area, not a city. Our Census mapping connects it to 626 cities and communities in Arkansas. Some span more than one payment area; confirm with the service ZIP.

  • Acorn
  • Adona
  • Alexander
  • Alicia
  • Alix
  • Alleene
  • Allport
  • Alma

Browse all communities in Arkansas

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

Show the CMS file lines behind this rate
RVUs for 64647PPRRVU2026_Oct_nonQPP.csv, line 7,190 (RVU26D)
Geographic factors for ArkansasGPCI2026.csv, line 7 (RVU26D)

Open CMS sourceHow we calculate rates

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