Billing code 64646: Muscle chemodenervationMedicare rate & RVUs
Reports botulinum toxin chemodenervation of one to five trunk muscles to manage focal muscle overactivity, such as truncal spasticity or dystonia.
Medicare pays $170.34 for 64646 nationally in the office and $103.88 in a hospital or facility. Local office rates run $149.10–$211.59.
Medicare rate · 64646
Muscle chemodenervation
- Work RVUs
- 1.76
- Total RVUs
- 5.10
- Global days
- 000
National rate · 2026
$170.34
Office setting, before claim adjustments.
See every locality for 64646 →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 64646 covers
A clinician injects a chemodenervating agent, commonly botulinum toxin, into one to five trunk muscles to reduce focal overactivity. Neurologists, physiatrists, and other clinicians who treat spasticity or dystonia may perform the service in an office or outpatient procedure setting. Trunk targets can include paraspinal or abdominal muscles; this code is not for injections into limb muscles or eccrine glands.
Select the code by the number of distinct trunk muscles treated during the session, not by the number of injection sites or toxin units. Document the treated muscles, clinical indication, and injection details. Use the six-or-more-muscle trunk code when that threshold is reached. The service has a 0-day global period, so same-day preoperative and postoperative care is included. When multiple procedures occur in one session, the highest-valued procedure is paid in full and others at 50%. Modifier 50 is inappropriate. Assistant-at-surgery payment is statutorily restricted; 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 64646 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
$149.10 to $211.59
109 of 109 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Alabama | $151.45 | $93.29 |
| Alaska* | $198.75 | $127.96 |
| Arizona | $165.07 | $100.67 |
| Arkansas | $149.10 | $92.00 |
| Atlanta | $175.27 | $107.74 |
| Austin | $174.18 | $103.85 |
| Bakersfield | $174.36 | $101.51 |
| Baltimore/Surr. Cntys | $182.06 | $110.74 |
| Beaumont | $160.61 | $100.12 |
| Brazoria | $166.43 | $100.56 |
| Chicago | $192.00 | $125.20 |
| Chico | $173.08 | $100.23 |
| Colorado | $173.65 | $102.93 |
| Connecticut | $182.24 | $110.66 |
| Dallas | $168.21 | $102.01 |
| Dc + Md/Va Suburbs | $192.33 | $114.04 |
| Delaware | $167.87 | $102.20 |
| Detroit | $178.00 | $113.86 |
| East St. Louis | $178.96 | $117.81 |
| El Centro | $173.16 | $100.31 |
| Fort Lauderdale | $184.54 | $117.21 |
| Fort Worth | $167.47 | $101.93 |
| Fresno | $173.08 | $100.23 |
| Galveston | $167.39 | $101.39 |
| Hanford-Corcoran | $173.08 | $100.23 |
| Hawaii, Guam | $176.68 | $101.11 |
| Houston | $176.17 | $110.17 |
| Idaho | $154.25 | $93.10 |
| Indiana | $155.13 | $93.51 |
| Iowa | $152.56 | $91.74 |
| Kansas | $153.22 | $93.14 |
| Kentucky | $158.38 | $99.29 |
| Los Angeles-Long Beach-Anaheim (Los Angeles/Orange Cnty) | $184.85 | $106.22 |
| Madera | $173.08 | $100.23 |
| Manhattan | $198.98 | $121.74 |
| Merced | $173.08 | $100.23 |
| Metropolitan Boston | $189.52 | $110.16 |
| Metropolitan Kansas City | $164.15 | $101.74 |
| Metropolitan Philadelphia | $178.41 | $109.22 |
| Metropolitan St. Louis | $165.79 | $102.51 |
| Miami | $198.77 | $129.58 |
| Minnesota | $161.83 | $93.43 |
| Mississippi | $152.88 | $95.65 |
| Modesto | $173.08 | $100.23 |
| Montana** | $170.31 | $103.84 |
| Napa | $196.54 | $108.93 |
| Nebraska | $153.02 | $91.67 |
| Nevada** | $167.76 | $101.23 |
| New Hampshire | $172.26 | $103.06 |
| New Mexico | $165.64 | $104.69 |
| New Orleans | $166.89 | $104.34 |
| North Carolina | $158.16 | $96.14 |
| North Dakota** | $160.82 | $94.35 |
| Northern Nj | $190.42 | $113.32 |
| Nyc Suburbs/Long Island | $205.90 | $126.87 |
| Ohio | $162.16 | $101.48 |
| Oklahoma | $156.55 | $97.19 |
| Oxnard-Thousand Oaks-Ventura | $183.33 | $104.77 |
| Portland | $177.78 | $103.94 |
| Poughkpsie/N Nyc Suburbs | $185.43 | $112.65 |
| Puerto Rico | $171.15 | $103.96 |
| Queens | $198.58 | $120.01 |
| Redding | $173.08 | $100.23 |
| Rest Of California | $173.08 | $100.23 |
| Rest Of Florida | $174.21 | $110.66 |
| Rest Of Georgia | $163.11 | $103.82 |
| Rest Of Illinois | $171.06 | $110.37 |
| Rest Of Louisiana | $158.69 | $99.86 |
| Rest Of Maine | $156.64 | $95.49 |
| Rest Of Maryland | $170.76 | $103.50 |
| Rest Of Massachusetts | $173.09 | $103.10 |
| Rest Of Michigan | $164.10 | $103.42 |
| Rest Of Missouri | $156.75 | $99.45 |
| Rest Of New Jersey | $183.04 | $110.46 |
| Rest Of New York | $160.81 | $97.66 |
| Rest Of Oregon | $165.20 | $99.00 |
| Rest Of Pennsylvania | $161.63 | $100.61 |
| Rest Of Texas | $163.92 | $100.84 |
| Rest Of Washington | $172.34 | $102.35 |
| Rhode Island | $172.88 | $104.22 |
| Riverside-San Bernardino-Ontario | $178.22 | $105.37 |
| Sacramento-Roseville-Folsom | $180.59 | $103.29 |
| Salinas | $179.92 | $102.88 |
| San Diego-Chula Vista-Carlsbad | $183.49 | $103.99 |
| San Francisco-Oakland-Berkeley (Marin Cnty) | $206.42 | $112.70 |
| San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty) | $205.88 | $112.16 |
| San Jose-Sunnyvale-Santa Clara (San Benito Cnty) | $211.59 | $115.75 |
| San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty) | $209.37 | $113.52 |
| San Luis Obispo-Paso Robles | $177.18 | $101.48 |
| Santa Cruz-Watsonville | $184.68 | $103.92 |
| Santa Maria-Santa Barbara | $180.41 | $102.91 |
| Santa Rosa-Petaluma | $186.45 | $104.83 |
| Seattle (King Cnty) | $192.03 | $110.48 |
| South Carolina | $160.68 | $99.26 |
| South Dakota** | $159.70 | $93.23 |
| Southern Maine | $163.57 | $97.70 |
| Stockton | $173.08 | $100.23 |
| Suburban Chicago | $185.71 | $117.45 |
| Tennessee | $154.23 | $93.81 |
| Utah | $162.98 | $100.50 |
| Vallejo | $195.75 | $108.15 |
| Vermont | $161.47 | $95.67 |
| Virgin Islands | $171.15 | $103.96 |
| Virginia | $164.01 | $98.67 |
| Visalia | $173.08 | $100.23 |
| West Virginia | $164.74 | $106.98 |
| Wisconsin | $155.24 | $91.56 |
| Wyoming** | $166.18 | $99.71 |
| Yuba City | $173.08 | $100.23 |
64646 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.
$149.10
$198.75
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 | $198.75 | 1 |
| AL | $151.45 | 1 |
| AR | $149.10 | 1 |
| AZ | $165.07 | 1 |
| CA | $173.08–$211.59 | 29 |
| CO | $173.65 | 1 |
| CT | $182.24 | 1 |
| DC | $192.33 | 1 |
| DE | $167.87 | 1 |
| FL | $174.21–$198.77 | 3 |
| GA | $163.11–$175.27 | 2 |
| GU | $176.68 | 1 |
| HI | $176.68 | 1 |
| IA | $152.56 | 1 |
| ID | $154.25 | 1 |
| IL | $171.06–$192.00 | 4 |
| IN | $155.13 | 1 |
| KS | $153.22 | 1 |
| KY | $158.38 | 1 |
| LA | $158.69–$166.89 | 2 |
| MA | $173.09–$189.52 | 2 |
| MD | $170.76–$192.33 | 3 |
| ME | $156.64–$163.57 | 2 |
| MI | $164.10–$178.00 | 2 |
| MN | $161.83 | 1 |
| MO | $156.75–$165.79 | 3 |
| MS | $152.88 | 1 |
| MT | $170.31 | 1 |
| NC | $158.16 | 1 |
| ND | $160.82 | 1 |
| NE | $153.02 | 1 |
| NH | $172.26 | 1 |
| NJ | $183.04–$190.42 | 2 |
| NM | $165.64 | 1 |
| NV | $167.76 | 1 |
| NY | $160.81–$205.90 | 5 |
| OH | $162.16 | 1 |
| OK | $156.55 | 1 |
| OR | $165.20–$177.78 | 2 |
| PA | $161.63–$178.41 | 2 |
| PR | $171.15 | 1 |
| RI | $172.88 | 1 |
| SC | $160.68 | 1 |
| SD | $159.70 | 1 |
| TN | $154.23 | 1 |
| TX | $160.61–$176.17 | 8 |
| UT | $162.98 | 1 |
| VA | $164.01–$192.33 | 2 |
| VI | $171.15 | 1 |
| VT | $161.47 | 1 |
| WA | $172.34–$192.03 | 2 |
| WI | $155.24 | 1 |
| WV | $164.74 | 1 |
| WY | $166.18 | 1 |
How the 64646 rate is calculated
Each of 64646’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 · 64646
RVUs × geographic indexes × conversion factor
Work1.76
1.76 RVUs× 1.000 GPCI
Practice expense2.86
2.86 RVUs× 1.000 GPCI
Malpractice0.48
0.48 RVUs× 1.000 GPCI
Adjusted RVUs
5.1000
Conversion factor
$33.4009
Medicare rate
$170.34
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 64646
The CMS indicators that decide how 64646 is paid alongside other services.
CMS payment indicators · 64646
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
64646 without 51 · national office
$170.34
Muscle chemodenervation
64646-51 · Second procedure: 50%
$85.17
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%).
64646 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 64647Trunk chemodenervation
- Both cover trunk muscle chemodenervation; choose 64646 for one to five muscles and 64647 for six or more.
- 64642Chemodenervation
- 64642 applies to one extremity with one to four muscles treated. Use 64646 for trunk muscles.
- 64644Muscle chemodenervation
- 64644 applies to one extremity with five or more muscles treated; 64646 is for one to five trunk muscles.
64646 billing questions
How is this code distinguished from the six-or-more trunk muscle code?
Count the distinct trunk muscles treated during the session. Report this code for one to five muscles and the six-or-more code when at least six are treated.
Do injection sites or toxin units determine the code?
No. The threshold is based on the number of trunk muscles treated, not the number of needle placements or units of medication.
Can modifier 50 be used for bilateral trunk injections?
No. CMS identifies bilateral adjustment as inappropriate for this code; do not use modifier 50 to represent treatment on both sides.
Is same-day evaluation or postoperative care separately included?
The code has a 0-day global period, with same-day preoperative and postoperative care included.
How are other procedures in the same session paid?
Under the standard multiple procedure reduction, the highest-valued procedure is paid in full and other procedures are paid at 50%.
Can an assistant, co-surgeon, or surgical team be reported?
Assistant-at-surgery payment is statutorily restricted. Co-surgeons and team surgery are not permitted for this code.
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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