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

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 Houston, TX, Medicare pays $195.49 for 64647 in the office and $122.85 when it’s performed in a hospital or facility.

$195.49Office (non-facility)
$122.85Hospital or facility
+3.2%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 Houston, TX
  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 Houston, TX 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. Houston, TX pays $195.49. The RVUs are the same everywhere; the geographic indexes change the dollars.

64647 in Houston, TX vs other payment areas
  1. Houston, TX · this page$195.49
  2. Austin, TX · Texas$193.64−$1.85
  3. Beaumont, TX · Texas$178.85−$16.64
  4. Brazoria, TX · Texas$185.32−$10.17
  5. Dallas, TX · Texas$187.22−$8.27
  6. Fort Worth, TX · Texas$186.39−$9.10
  7. Galveston, TX · Texas$186.33−$9.16

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

Every other payment area

64647 in every other Medicare payment locality
Payment localityOfficeFacility
Rest of TexasTexas$182.47$113.05
Los Angeles, CACalifornia$205.60$119.07
Washington, DC areaDistrict of Columbia$213.48$127.31
Miami, FLFlorida$219.18$143.03
Chicago, ILIllinois$212.01$138.50
Manhattan, NYNew York$220.40$135.40
AlaskaAlaska$223.04$145.14
AlabamaAlabama$169.15$105.15

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 Houston, TX 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

102

Locality
Houston, TX
Physician work
1.008
Practice expense
0.993
Malpractice
1.376
Office calculation for 64647 in Houston, TX
ComponentRVULocality factorAdjusted
Physician work2.06× 1.0082.0765
Practice expense3.11× 0.9933.0882
Malpractice0.50× 1.3760.6880
Total RVUs5.8527
Conversion factor× 33.4009

Office rate, Houston, TX$195.49

Office: (2.06 × 1.008 + 3.11 × 0.993 + 0.5 × 1.376) × $33.4009 = $195.49

Facility: (2.06 × 1.008 + 0.92 × 0.993 + 0.5 × 1.376) × $33.4009 = $122.85

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, Houston, TX
Same family
64646Muscle chemodenervation, trunk, one to five musclesTrunk chemodenervation for one to five muscles; 64647 covers six or more.$176.17
Used instead
64642Chemodenervation, one extremity, 1–4 musclesChemodenervation targets one extremity with one to four muscles rather than trunk muscles.$167.98
64644Muscle chemodenervation, one extremity, five or more musclesChemodenervation targets one extremity with five or more muscles rather than trunk muscles.$195.39
64643Chemodenervation, additional extremity, 1-4 musclesAddresses additional-extremity chemodenervation, not treatment of trunk muscles.$102.71

How 64647 has changed in Houston, TX

64647 · Office / nonfacility

$195.49

Effective 2026-10-01

The base rate is $9.73 higher than on 2025-10-01, moving from $185.76 to $195.49 (5.2%).

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

    $185.76changed to$195.49

    • 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
    • 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.

  2. January 1, 2025

    RVU25A

    $194.05changed to$185.76

    • 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

    $190.88changed to$194.05

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $191.24changed to$190.88

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 2.76 changed to 2.85
    • 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

  5. January 1, 2023

    RVU23A

    $189.97changed to$191.24

    • 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
    • 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.

  6. January 1, 2022

    RVU22A

    $187.37changed to$189.97

    • 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

    $185.77changed to$187.37

    • 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
    • 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.

  8. January 1, 2020

    RVU20A

    $185.64changed to$185.77

    • 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
    • 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.

  9. January 1, 2019

    RVU19A

    $185.05changed to$185.64

    • 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

    $183.48changed to$185.05

    • 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 1.009 changed to 1.012
    • Malpractice GPCI 0.946 changed to 0.936

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $183.03changed to$183.48

    • 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
    • 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.

  12. January 1, 2016

    RVU16A

    $183.35changed to$183.03

    • 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

    $182.43changed to$183.35

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $176.82changed to$182.43

    • 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
    • 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.

  15. January 1, 2014

    RVU14A

    No ratechanged to$176.82

    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$195.49$122.85RVU26D
2026-07-01$195.49$122.85RVU26C
2026-04-01$195.49$122.85RVU26B
2026-01-01$195.49$122.85RVU26A
2025-10-01$185.76$137.42RVU25D
2025-07-01$185.76$137.42RVU25C
2025-04-01$185.76$137.42RVU25B
2025-01-01$185.76$137.42RVU25A
2024-10-01$194.05$142.96RVU24D
2024-07-01$194.05$142.96RVU24C
2024-04-01$194.05$142.96RVU24B
2024-03-09$194.05$142.96RVU24AR
2024-01-01$190.88$140.63RVU24A
2023-10-01$191.24$140.29RVU23D
2023-07-01$191.24$140.29RVU23C
2023-04-01$191.24$140.29RVU23B
2023-01-01$191.24$140.29RVU23A
2022-10-01$189.97$138.69RVU22D
2022-07-01$189.97$138.69RVU22C
2022-04-01$189.97$138.69RVU22B
2022-01-01$189.97$138.69RVU22A
2021-10-01$187.37$138.54RVU21D
2021-07-01$187.37$138.54RVU21C
2021-04-01$187.37$138.54RVU21B
2021-01-01$187.37$138.54RVU21A
2020-10-01$185.77$141.59RVU20D
2020-07-01$185.77$141.59RVU20C
2020-04-01$185.77$141.59RVU20B
2020-01-01$185.77$141.59RVU20A
2019-10-01$185.64$143.34RVU19D
2019-07-01$185.64$143.34RVU19C
2019-04-01$185.64$143.34RVU19B
2019-01-01$185.64$143.34RVU19A
2018-10-01$185.05$144.61RVU18D
2018-07-01$185.05$144.61RVU18C
2018-04-01$185.05$144.61RVU18B
2018-01-01$185.05$144.61RVU18AR1
2017-10-01$183.48$144.01RVU17D
2017-07-01$183.48$144.01RVU17C
2017-04-01$183.48$144.01RVU17B
2017-01-01$183.48$144.01RVU17A
2016-10-01$183.03$142.33RVU16D
2016-07-01$183.03$142.33RVU16C
2016-04-01$183.03$142.33RVU16B
2016-01-01$183.03$142.33RVU16A
2015-10-01$183.35$142.50RVU15D
2015-07-01$183.35$142.50RVU15C
2015-04-01$182.43$141.79RVU15B
2015-01-01$182.43$141.79RVU15A
2014-10-01$176.82$137.26RVU14D
2014-07-01$176.82$137.26RVU14C
2014-04-01$176.82$137.26RVU14B
2014-01-01$176.82$137.26RVU14A
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 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.

Browse all communities in Texas

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 Houston, TXGPCI2026.csv, line 102 (RVU26D)

Open CMS sourceHow we calculate rates

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