Billing code 64645: Muscle chemodenervationMedicare rate & RVUs
Reports chemodenervation of each additional extremity when five or more muscles are treated there, alongside the primary extremity service.
Medicare pays $129.60 for 64645 nationally in the office and $70.48 in a hospital or facility. Local office rates run $113.82–$161.51.
Medicare rate · 64645
Muscle chemodenervation
Swap in your local Medicare rate.
- Work RVUs
- 1.36
- Total RVUs
- 3.88
- Global days
- ZZZ
National rate · 2026
$129.60
Office setting, before claim adjustments.
See every locality for 64645 → · 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 64645 covers
This code represents chemodenervation in an additional arm or leg when treatment involves five or more muscles in that extremity. It commonly accompanies botulinum toxin treatment for spasticity after stroke or in neurologic conditions such as cerebral palsy, and may be performed by a neurologist, physiatrist, or another qualified clinician in an office or outpatient facility. The service is counted by extremity, not by injection or toxin dose.
Report it only with the primary code for treatment of one extremity involving five or more muscles, 64644. Use one unit for each additional extremity that meets the five-muscle threshold. Documentation should identify each treated extremity, the muscles injected, and the clinical reason for treatment. CMS classifies this as an add-on service; payment is made within the primary procedure’s global period.
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 64645 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
$113.82 to $161.51
109 of 109 payment localities
64645 rates by state
Office rate range in each state. Select a state to see its payment localities.
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Local rates. Clear comparisons.
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$113.82
$151.94
Color shows the midpoint of each state’s locality range.
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| State / territory | Office rate range | Localities |
|---|---|---|
| AK | $151.94 | 1 |
| AL | $115.57 | 1 |
| AR | $113.82 | 1 |
| AZ | $125.70 | 1 |
| CA | $132.09–$161.51 | 29 |
| CO | $132.31 | 1 |
| CT | $138.50 | 1 |
| DC | $146.29 | 1 |
| DE | $127.80 | 1 |
| FL | $132.10–$149.94 | 3 |
| GA | $123.91–$133.18 | 2 |
| GU | $134.79 | 1 |
| HI | $134.79 | 1 |
| IA | $116.56 | 1 |
| ID | $117.79 | 1 |
| IL | $129.65–$144.98 | 4 |
| IN | $118.44 | 1 |
| KS | $116.97 | 1 |
| KY | $120.55 | 1 |
| LA | $120.74–$126.84 | 2 |
| MA | $131.88–$144.33 | 2 |
| MD | $129.99–$146.29 | 3 |
| ME | $119.48–$124.75 | 2 |
| MI | $124.73–$134.84 | 2 |
| MN | $123.71 | 1 |
| MO | $119.25–$126.12 | 3 |
| MS | $116.51 | 1 |
| MT | $129.57 | 1 |
| NC | $120.62 | 1 |
| ND | $122.85 | 1 |
| NE | $116.93 | 1 |
| NH | $131.16 | 1 |
| NJ | $139.21–$144.88 | 2 |
| NM | $125.83 | 1 |
| NV | $127.77 | 1 |
| NY | $122.58–$156.00 | 5 |
| OH | $123.35 | 1 |
| OK | $119.27 | 1 |
| OR | $125.93–$135.50 | 2 |
| PA | $123.00–$135.59 | 2 |
| PR | $130.23 | 1 |
| RI | $131.63 | 1 |
| SC | $122.36 | 1 |
| SD | $122.05 | 1 |
| TN | $117.71 | 1 |
| TX | $122.24–$133.72 | 8 |
| UT | $124.07 | 1 |
| VA | $125.02–$146.29 | 2 |
| VI | $130.23 | 1 |
| VT | $123.26 | 1 |
| WA | $131.33–$146.32 | 2 |
| WI | $118.68 | 1 |
| WV | $124.95 | 1 |
| WY | $126.64 | 1 |
How the 64645 rate is calculated
Each of 64645’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 · 64645
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 1.36Practice expense 2.18Malpractice 0.34
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 64645
The CMS indicators that decide how 64645 is paid alongside other services.
CMS payment indicators · 64645
Muscle chemodenervation
| Rule | CMS value | What it means |
|---|---|---|
| Global period | ZZZ | Add-on code: falls within the primary procedure’s global period. |
| Multiple procedures | 0 | No multiple-procedure reduction. |
| 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. |
64645 compared with similar codes
Compare codes
64645 vs 64644 vs 64643 vs 64646: national Medicare rates
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How to choose
- 64644Muscle chemodenervation
- 64644 represents the primary extremity treated at the five-or-more-muscle level. 64645 represents each additional extremity treated at that level.
- 64643Chemodenervation
- 64643 is for each additional extremity when only one to four muscles are treated there; 64645 is for five or more.
- 64646Muscle chemodenervation
- 64646 covers trunk-muscle chemodenervation, not treatment of an additional arm or leg.
64645 billing questions
When is 64645 used instead of 64644?
Use 64644 for the initial extremity when five or more muscles are treated. Use 64645 for each additional extremity treated at that same muscle-count level.
Can 64645 be billed by itself?
No. It is an add-on code and must be reported with 64644 for the primary extremity service.
How are units counted?
Count one unit for each additional extremity in which five or more muscles are treated. The unit count is not based on the number of injections or toxin dose.
What documentation supports a unit of 64645?
Document the additional extremity, the muscles injected there, and the treatment indication. The record should support that at least five muscles were treated in that extremity.
How does the add-on status affect payment?
CMS pays 64645 within the global period of its primary procedure. It must accompany 64644 rather than stand alone.
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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