Billing code 64644: Muscle chemodenervationMedicare rate & RVUs
Reports chemodenervation injections into five or more muscles in one arm or leg, commonly to reduce focal spasticity or other involuntary muscle activity.
Medicare pays $190.72 for 64644 nationally in the office and $103.54 in a hospital or facility. Local office rates run $167.57–$243.28.
Medicare rate · 64644
Muscle chemodenervation
Swap in your local Medicare rate.
- Work RVUs
- 1.77
- Total RVUs
- 5.71
- Global days
- 000
National rate · 2026
$190.72
Office setting, before claim adjustments.
See every locality for 64644 → · 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.
On this page 10 sections
What 64644 covers
This service covers injection of a chemodenervating agent into five or more muscles in a single extremity to reduce unwanted muscle activity. Neurologists, physiatrists, and other clinicians who manage movement disorders or spasticity commonly perform it in outpatient clinics and hospital settings. Treatment may address focal upper- or lower-extremity muscle overactivity, including patterns that interfere with positioning, movement, or daily function.
Select the code by counting the muscles treated in that extremity, not the number of injection sites or the drug units. Documentation should identify the treated extremity and muscles, the treatment plan, and the administered product and dose. A separately treated additional extremity may support an additional-extremity code. The 0-day global period includes same-day preoperative and postoperative care. When multiple procedures are performed in one session, the highest-valued procedure is paid in full and others are subject to the standard 50% reduction. Modifier 50 is inappropriate. Assistant-at-surgery payment is restricted, 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 64644 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
$167.57 to $243.28
109 of 109 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Alabama | $170.14 | $93.86 |
| Alaska* | $221.97 | $129.12 |
| Arizona | $185.13 | $100.66 |
| Arkansas | $167.57 | $92.68 |
| Atlanta | $195.47 | $106.90 |
| Austin | $196.17 | $103.94 |
| Bakersfield | $197.97 | $102.42 |
| Baltimore/Surr. Cntys | $203.46 | $109.92 |
| Beaumont | $179.13 | $99.80 |
| Brazoria | $187.19 | $100.80 |
| Chicago | $209.03 | $121.41 |
| Chico | $196.88 | $101.33 |
| Colorado | $196.07 | $103.31 |
| Connecticut | $203.81 | $109.92 |
| Dallas | $188.88 | $102.05 |
| Dc + Md/Va Suburbs | $216.47 | $113.77 |
| Delaware | $188.25 | $102.12 |
| Detroit | $195.75 | $111.62 |
| East St. Louis | $194.81 | $114.61 |
| El Centro | $196.94 | $101.40 |
| Fort Lauderdale | $203.05 | $114.74 |
| Fort Worth | $187.87 | $101.92 |
| Fresno | $196.88 | $101.33 |
| Galveston | $188.07 | $101.50 |
| Hanford-Corcoran | $196.88 | $101.33 |
| Hawaii, Guam | $201.29 | $102.17 |
| Houston | $195.39 | $108.82 |
| Idaho | $174.22 | $94.02 |
| Indiana | $175.22 | $94.41 |
| Iowa | $172.61 | $92.85 |
| Kansas | $172.74 | $93.93 |
| Kentucky | $176.46 | $98.96 |
| Los Angeles-Long Beach-Anaheim (Los Angeles/Orange Cnty) | $210.29 | $107.16 |
| Madera | $196.88 | $101.33 |
| Manhattan | $221.49 | $120.19 |
| Merced | $196.88 | $101.33 |
| Metropolitan Boston | $214.61 | $110.52 |
| Metropolitan Kansas City | $183.20 | $101.34 |
| Metropolitan Philadelphia | $199.21 | $108.46 |
| Metropolitan St. Louis | $185.07 | $102.08 |
| Miami | $215.99 | $125.24 |
| Minnesota | $184.74 | $95.04 |
| Mississippi | $170.80 | $95.74 |
| Modesto | $196.88 | $101.33 |
| Montana** | $190.69 | $103.52 |
| Napa | $225.47 | $110.57 |
| Nebraska | $173.30 | $92.84 |
| Nevada** | $188.61 | $101.34 |
| New Hampshire | $193.90 | $103.15 |
| New Mexico | $183.59 | $103.65 |
| New Orleans | $185.56 | $103.53 |
| North Carolina | $177.97 | $96.64 |
| North Dakota** | $182.78 | $95.61 |
| Northern Nj | $214.27 | $113.15 |
| Nyc Suburbs/Long Island | $228.30 | $124.65 |
| Ohio | $180.54 | $100.95 |
| Oklahoma | $175.09 | $97.24 |
| Oxnard-Thousand Oaks-Ventura | $208.86 | $105.81 |
| Portland | $201.37 | $104.52 |
| Poughkpsie/N Nyc Suburbs | $207.42 | $111.96 |
| Puerto Rico | $191.82 | $103.68 |
| Queens | $221.93 | $118.89 |
| Redding | $196.88 | $101.33 |
| Rest Of California | $196.88 | $101.33 |
| Rest Of Florida | $192.24 | $108.90 |
| Rest Of Georgia | $180.51 | $102.75 |
| Rest Of Illinois | $187.95 | $108.36 |
| Rest Of Louisiana | $176.56 | $99.41 |
| Rest Of Maine | $176.21 | $96.01 |
| Rest Of Maryland | $191.63 | $103.41 |
| Rest Of Massachusetts | $195.22 | $103.42 |
| Rest Of Michigan | $182.16 | $102.56 |
| Rest Of Missouri | $174.05 | $98.91 |
| Rest Of New Jersey | $205.26 | $110.06 |
| Rest Of New York | $180.84 | $98.02 |
| Rest Of Oregon | $186.28 | $99.45 |
| Rest Of Pennsylvania | $180.29 | $100.26 |
| Rest Of Texas | $183.39 | $100.66 |
| Rest Of Washington | $194.56 | $102.76 |
| Rhode Island | $194.30 | $104.25 |
| Riverside-San Bernardino-Ontario | $201.17 | $105.63 |
| Sacramento-Roseville-Folsom | $205.92 | $104.54 |
| Salinas | $205.15 | $104.12 |
| San Diego-Chula Vista-Carlsbad | $209.55 | $105.29 |
| San Francisco-Oakland-Berkeley (Marin Cnty) | $237.59 | $114.67 |
| San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty) | $237.13 | $114.21 |
| San Jose-Sunnyvale-Santa Clara (San Benito Cnty) | $243.28 | $117.58 |
| San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty) | $241.43 | $115.72 |
| San Luis Obispo-Paso Robles | $201.96 | $102.67 |
| Santa Cruz-Watsonville | $211.18 | $105.26 |
| Santa Maria-Santa Barbara | $205.80 | $104.16 |
| Santa Rosa-Petaluma | $213.25 | $106.20 |
| Seattle (King Cnty) | $218.07 | $111.11 |
| South Carolina | $179.73 | $99.18 |
| South Dakota** | $181.85 | $94.67 |
| Southern Maine | $184.73 | $98.33 |
| Stockton | $196.88 | $101.33 |
| Suburban Chicago | $204.64 | $115.11 |
| Tennessee | $173.77 | $94.53 |
| Utah | $182.26 | $100.32 |
| Vallejo | $224.82 | $109.92 |
| Vermont | $182.94 | $96.63 |
| Virgin Islands | $191.82 | $103.68 |
| Virginia | $184.78 | $99.09 |
| Visalia | $196.88 | $101.33 |
| West Virginia | $180.99 | $105.23 |
| Wisconsin | $176.51 | $92.99 |
| Wyoming** | $187.25 | $100.07 |
| Yuba City | $196.88 | $101.33 |
64644 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.
$167.57
$221.97
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 | $221.97 | 1 |
| AL | $170.14 | 1 |
| AR | $167.57 | 1 |
| AZ | $185.13 | 1 |
| CA | $196.88–$243.28 | 29 |
| CO | $196.07 | 1 |
| CT | $203.81 | 1 |
| DC | $216.47 | 1 |
| DE | $188.25 | 1 |
| FL | $192.24–$215.99 | 3 |
| GA | $180.51–$195.47 | 2 |
| GU | $201.29 | 1 |
| HI | $201.29 | 1 |
| IA | $172.61 | 1 |
| ID | $174.22 | 1 |
| IL | $187.95–$209.03 | 4 |
| IN | $175.22 | 1 |
| KS | $172.74 | 1 |
| KY | $176.46 | 1 |
| LA | $176.56–$185.56 | 2 |
| MA | $195.22–$214.61 | 2 |
| MD | $191.63–$216.47 | 3 |
| ME | $176.21–$184.73 | 2 |
| MI | $182.16–$195.75 | 2 |
| MN | $184.74 | 1 |
| MO | $174.05–$185.07 | 3 |
| MS | $170.80 | 1 |
| MT | $190.69 | 1 |
| NC | $177.97 | 1 |
| ND | $182.78 | 1 |
| NE | $173.30 | 1 |
| NH | $193.90 | 1 |
| NJ | $205.26–$214.27 | 2 |
| NM | $183.59 | 1 |
| NV | $188.61 | 1 |
| NY | $180.84–$228.30 | 5 |
| OH | $180.54 | 1 |
| OK | $175.09 | 1 |
| OR | $186.28–$201.37 | 2 |
| PA | $180.29–$199.21 | 2 |
| PR | $191.82 | 1 |
| RI | $194.30 | 1 |
| SC | $179.73 | 1 |
| SD | $181.85 | 1 |
| TN | $173.77 | 1 |
| TX | $179.13–$196.17 | 8 |
| UT | $182.26 | 1 |
| VA | $184.78–$216.47 | 2 |
| VI | $191.82 | 1 |
| VT | $182.94 | 1 |
| WA | $194.56–$218.07 | 2 |
| WI | $176.51 | 1 |
| WV | $180.99 | 1 |
| WY | $187.25 | 1 |
How the 64644 rate is calculated
Each of 64644’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 · 64644
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 1.77Practice expense 3.54Malpractice 0.40
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 64644
The CMS indicators that decide how 64644 is paid alongside other services.
CMS payment indicators · 64644
Muscle chemodenervation
| 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
64644 without 51 · national office
$190.72
Muscle chemodenervation
64644-51 · Second procedure: 50%
$95.36
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%).
64644 compared with similar codes
Compare codes
64644 vs 64642 vs 64645 vs 64646: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 64642Chemodenervation
- Both apply to one extremity; 64642 is selected for one to four treated muscles, while 64644 is for five or more.
- 64645Muscle chemodenervation
- 64645 describes treatment of five or more muscles in an additional extremity. This code describes the first extremity treated.
- 64646Muscle chemodenervation
- 64646 applies to chemodenervation of trunk muscles. Use 64644 for five or more muscles in one extremity.
64644 billing questions
How is this distinguished from 64642?
Both describe treatment in one extremity. Use 64644 when five or more muscles in that extremity are treated; 64642 is for one to four.
Does the muscle count refer to injections or muscles?
Count the muscles treated, not injection sites, needle passes, or units of medication. The record should identify the muscles injected.
Can another extremity be reported separately?
Yes, when treatment is performed in an additional extremity, the applicable additional-extremity code may be reported. Match that code to the number of muscles treated in the additional extremity.
Should modifier 50 be used for both sides?
No. The CMS bilateral adjustment does not apply, and modifier 50 is inappropriate for this service. Report qualifying treatment by extremity using the applicable code structure.
Is the chemodenervating drug included?
This code represents the injection service. When the practice supplies the drug, the drug may be reported separately under the applicable drug code, supported by documentation of the product and dose.
What happens when other procedures are performed in the same session?
The highest-valued procedure is paid in full, and other procedures subject to the standard multiple-procedure rule are paid at 50% when performed in the same session.
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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