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

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 Utah, Medicare pays $181.45 for 64647 in the office and $112.69 when it’s performed in a hospital or facility.

$181.45Office (non-facility)
$112.69Hospital or facility
−4.2%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 Utah
  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 Utah 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. Utah pays $181.45. The RVUs are the same everywhere; the geographic indexes change the dollars.

64647 in Utah vs other payment areas
  1. Utah · this page$181.45
  2. Los Angeles, CA · California$205.60+$24.15
  3. Washington, DC area · District of Columbia$213.48+$32.03
  4. Miami, FL · Florida$219.18+$37.73
  5. Chicago, IL · Illinois$212.01+$30.56
  6. Manhattan, NY · New York$220.40+$38.95
  7. Alaska · Alaska$223.04+$41.59

Other areas in Utah 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
ArkansasArkansas$166.64$103.80
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

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 Utah 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

104

Locality
Utah
Physician work
1.000
Practice expense
0.940
Malpractice
0.898
Office calculation for 64647 in Utah
ComponentRVULocality factorAdjusted
Physician work2.06× 1.0002.0600
Practice expense3.11× 0.9402.9234
Malpractice0.50× 0.8980.4490
Total RVUs5.4324
Conversion factor× 33.4009

Office rate, Utah$181.45

Office: (2.06 × 1 + 3.11 × 0.94 + 0.5 × 0.898) × $33.4009 = $181.45

Facility: (2.06 × 1 + 0.92 × 0.94 + 0.5 × 0.898) × $33.4009 = $112.69

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, Utah
Same family
64646Muscle chemodenervation, trunk, one to five musclesTrunk chemodenervation for one to five muscles; 64647 covers six or more.$162.98
Used instead
64642Chemodenervation, one extremity, 1–4 musclesChemodenervation targets one extremity with one to four muscles rather than trunk muscles.$156.21
64644Muscle chemodenervation, one extremity, five or more musclesChemodenervation targets one extremity with five or more muscles rather than trunk muscles.$182.26
64643Chemodenervation, additional extremity, 1-4 musclesAddresses additional-extremity chemodenervation, not treatment of trunk muscles.$95.94

How 64647 has changed in Utah

64647 · Office / nonfacility

$181.45

Effective 2026-10-01

The base rate is $11.55 higher than on 2025-10-01, moving from $169.90 to $181.45 (6.8%).

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

    $169.90changed to$181.45

    • 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 0.933 changed to 0.940
    • Malpractice GPCI 0.930 changed to 0.898

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $177.01changed to$169.90

    • 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

    $174.13changed to$177.01

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $175.40changed to$174.13

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 2.76 changed to 2.85
    • Practice expense GPCI 0.926 changed to 0.933
    • Malpractice GPCI 0.865 changed to 0.930

  5. January 1, 2023

    RVU23A

    $175.28changed to$175.40

    • 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 0.919 changed to 0.926
    • Malpractice GPCI 0.799 changed to 0.865

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $173.01changed to$175.28

    • 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

    $176.61changed to$173.01

    • 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 0.923 changed to 0.919
    • Malpractice GPCI 0.982 changed to 0.799

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $181.92changed to$176.61

    • 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 0.927 changed to 0.923
    • Malpractice GPCI 1.165 changed to 0.982

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $181.47changed to$181.92

    • 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

    $179.36changed to$181.47

    • 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 0.925 changed to 0.927
    • Malpractice GPCI 1.167 changed to 1.165

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $178.10changed to$179.36

    • 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 0.922 changed to 0.925
    • Malpractice GPCI 1.169 changed to 1.167

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $178.32changed to$178.10

    • 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

    $177.44changed to$178.32

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $171.05changed to$177.44

    • 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 0.919 changed to 0.922
    • Malpractice GPCI 1.136 changed to 1.169

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    No ratechanged to$171.05

    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$181.45$112.69RVU26D
2026-07-01$181.45$112.69RVU26C
2026-04-01$181.45$112.69RVU26B
2026-01-01$181.45$112.69RVU26A
2025-10-01$169.90$124.93RVU25D
2025-07-01$169.90$124.93RVU25C
2025-04-01$169.90$124.93RVU25B
2025-01-01$169.90$124.93RVU25A
2024-10-01$177.01$129.50RVU24D
2024-07-01$177.01$129.50RVU24C
2024-04-01$177.01$129.50RVU24B
2024-03-09$177.01$129.50RVU24AR
2024-01-01$174.13$127.38RVU24A
2023-10-01$175.40$128.96RVU23D
2023-07-01$175.40$128.96RVU23C
2023-04-01$175.40$128.96RVU23B
2023-01-01$175.40$128.96RVU23A
2022-10-01$175.28$129.49RVU22D
2022-07-01$175.28$129.49RVU22C
2022-04-01$175.28$129.49RVU22B
2022-01-01$175.28$129.49RVU22A
2021-10-01$173.01$129.40RVU21D
2021-07-01$173.01$129.40RVU21C
2021-04-01$173.01$129.40RVU21B
2021-01-01$173.01$129.40RVU21A
2020-10-01$176.61$136.63RVU20D
2020-07-01$176.61$136.63RVU20C
2020-04-01$176.61$136.63RVU20B
2020-01-01$176.61$136.63RVU20A
2019-10-01$181.92$143.17RVU19D
2019-07-01$181.92$143.17RVU19C
2019-04-01$181.92$143.17RVU19B
2019-01-01$181.92$143.17RVU19A
2018-10-01$181.47$144.43RVU18D
2018-07-01$181.47$144.43RVU18C
2018-04-01$181.47$144.43RVU18B
2018-01-01$181.47$144.43RVU18AR1
2017-10-01$179.36$143.17RVU17D
2017-07-01$179.36$143.17RVU17C
2017-04-01$179.36$143.17RVU17B
2017-01-01$179.36$143.17RVU17A
2016-10-01$178.10$140.80RVU16D
2016-07-01$178.10$140.80RVU16C
2016-04-01$178.10$140.80RVU16B
2016-01-01$178.10$140.80RVU16A
2015-10-01$178.32$140.89RVU15D
2015-07-01$178.32$140.89RVU15C
2015-04-01$177.44$140.19RVU15B
2015-01-01$177.44$140.19RVU15A
2014-10-01$171.05$134.84RVU14D
2014-07-01$171.05$134.84RVU14C
2014-04-01$171.05$134.84RVU14B
2014-01-01$171.05$134.84RVU14A
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 Utah rate applies

Utah is a Medicare payment area, not a city. Our Census mapping connects it to 334 cities and communities in Utah. Some span more than one payment area; confirm with the service ZIP.

  • Alpine
  • Alta
  • Altamont
  • Alton
  • Amalga
  • American Fork
  • Aneth
  • Annabella

Browse all communities in Utah

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 UtahGPCI2026.csv, line 104 (RVU26D)

Open CMS sourceHow we calculate rates

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