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CMS RVU26D · Effective 2026-10-01

64645 in Delaware

Office / nonfacility

$127.80

Base rate per service

Facility setting

$69.39

Base rate per service

Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.

Chemodenervation

About 64645: Additional extremity muscle chemodenervation

Reports chemodenervation of each additional extremity when five or more muscles are treated there, alongside the primary extremity service.

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.

CMS billing rules for 64645

Global period
Add-on code: billed only together with a primary procedure and paid within that procedure's global period.

Where the value comes from

  • Work RVU1.36 · 35%
  • Practice expense (office) RVU2.18 · 56%
  • Malpractice RVU0.34 · 9%

8.8K

Medicare services in 2024 · #1542 by national volume

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.

64645 compared with similar codes

Office rates for Delaware, from the same CMS release.

64644

Muscle chemodenervation

One extremity, five or more muscles

$188.25

64644 represents the primary extremity treated at the five-or-more-muscle level. 64645 represents each additional extremity treated at that level.

64643

Chemodenervation

Additional extremity, 1-4 muscles

$98.66

64643 is for each additional extremity when only one to four muscles are treated there; 64645 is for five or more.

64646

Muscle chemodenervation

Trunk, one to five muscles

$167.87

64646 covers trunk-muscle chemodenervation, not treatment of an additional arm or leg.

The same code, a different location

How does Delaware compare?

64645 across payment areas

Same release and payment basis · bars start at $0

  1. Delaware · This locality

    $127.80

  2. Los Angeles-Long Beach-Anaheim (Los Angeles/Orange Cnty)

    $140.97

    $13.17 higher than Delaware

  3. Dc + Md/Va Suburbs

    $146.29

    $18.49 higher than Delaware

  4. Miami

    $149.94

    $22.14 higher than Delaware

  5. Chicago

    $144.98

    $17.18 higher than Delaware

  6. Manhattan

    $150.95

    $23.15 higher than Delaware

  7. Alaska*

    $151.94

    $24.14 higher than Delaware

Other payment areas listed in Delaware appear first, followed by selected cross-country examples. The chart compares amounts, not distance.

Across 109 of 109 CMS payment localities with a supported office rate, 64645 ranges from $113.82 in Arkansas to $161.51 in San Jose-Sunnyvale-Santa Clara (San Benito Cnty). This is a geographic range, not an average.

The code’s RVUs stay the same in these comparisons. Geographic adjustments to work, practice expense and malpractice change the dollar amount. A city name alone may not identify the payment area for a service address.

Compare all 108 other payment areas

  • Alabama

    Alabama · 64645

    Office

    $115.57

    Facility

    $63.84

    $12.23 lower than Delaware for the office setting.

  • Arkansas

    Arkansas · 64645

    Office

    $113.82

    Facility

    $63.04

    $13.98 lower than Delaware for the office setting.

  • Arizona

    Arizona · 64645

    Office

    $125.70

    Facility

    $68.42

    $2.10 lower than Delaware for the office setting.

  • Bakersfield

    California · 64645

    Office

    $133.01

    Facility

    $68.21

    $5.21 higher than Delaware for the office setting.

  • Chico

    California · 64645

    Office

    $132.09

    Facility

    $67.29

    $4.29 higher than Delaware for the office setting.

  • El Centro

    California · 64645

    Office

    $132.15

    Facility

    $67.35

    $4.35 higher than Delaware for the office setting.

  • Fresno

    California · 64645

    Office

    $132.09

    Facility

    $67.29

    $4.29 higher than Delaware for the office setting.

  • Hanford-Corcoran

    California · 64645

    Office

    $132.09

    Facility

    $67.29

    $4.29 higher than Delaware for the office setting.

  • Madera

    California · 64645

    Office

    $132.09

    Facility

    $67.29

    $4.29 higher than Delaware for the office setting.

  • Merced

    California · 64645

    Office

    $132.09

    Facility

    $67.29

    $4.29 higher than Delaware for the office setting.

  • Modesto

    California · 64645

    Office

    $132.09

    Facility

    $67.29

    $4.29 higher than Delaware for the office setting.

  • Napa

    California · 64645

    Office

    $150.02

    Facility

    $72.11

    $22.22 higher than Delaware for the office setting.

  • Oxnard-Thousand Oaks-Ventura

    California · 64645

    Office

    $139.84

    Facility

    $69.96

    $12.04 higher than Delaware for the office setting.

  • Redding

    California · 64645

    Office

    $132.09

    Facility

    $67.29

    $4.29 higher than Delaware for the office setting.

  • Rest Of California

    California · 64645

    Office

    $132.09

    Facility

    $67.29

    $4.29 higher than Delaware for the office setting.

  • Riverside-San Bernardino-Ontario

    California · 64645

    Office

    $135.73

    Facility

    $70.94

    $7.93 higher than Delaware for the office setting.

  • Sacramento-Roseville-Folsom

    California · 64645

    Office

    $137.83

    Facility

    $69.07

    $10.03 higher than Delaware for the office setting.

  • Salinas

    California · 64645

    Office

    $137.31

    Facility

    $68.79

    $9.51 higher than Delaware for the office setting.

  • San Diego-Chula Vista-Carlsbad

    California · 64645

    Office

    $140.03

    Facility

    $69.32

    $12.23 higher than Delaware for the office setting.

  • San Francisco-Oakland-Berkeley (Marin Cnty)

    California · 64645

    Office

    $157.62

    Facility

    $74.26

    $29.82 higher than Delaware for the office setting.

  • San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty)

    California · 64645

    Office

    $157.23

    Facility

    $73.88

    $29.43 higher than Delaware for the office setting.

  • San Jose-Sunnyvale-Santa Clara (San Benito Cnty)

    California · 64645

    Office

    $161.51

    Facility

    $76.26

    $33.71 higher than Delaware for the office setting.

  • San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty)

    California · 64645

    Office

    $159.93

    Facility

    $74.68

    $32.13 higher than Delaware for the office setting.

  • San Luis Obispo-Paso Robles

    California · 64645

    Office

    $135.22

    Facility

    $67.88

    $7.42 higher than Delaware for the office setting.

  • Santa Cruz-Watsonville

    California · 64645

    Office

    $140.94

    Facility

    $69.10

    $13.14 higher than Delaware for the office setting.

  • Santa Maria-Santa Barbara

    California · 64645

    Office

    $137.69

    Facility

    $68.75

    $9.89 higher than Delaware for the office setting.

  • Santa Rosa-Petaluma

    California · 64645

    Office

    $142.29

    Facility

    $69.69

    $14.49 higher than Delaware for the office setting.

  • Stockton

    California · 64645

    Office

    $132.09

    Facility

    $67.29

    $4.29 higher than Delaware for the office setting.

  • Vallejo

    California · 64645

    Office

    $149.47

    Facility

    $71.55

    $21.67 higher than Delaware for the office setting.

  • Visalia

    California · 64645

    Office

    $132.09

    Facility

    $67.29

    $4.29 higher than Delaware for the office setting.

  • Yuba City

    California · 64645

    Office

    $132.09

    Facility

    $67.29

    $4.29 higher than Delaware for the office setting.

  • Colorado

    Colorado · 64645

    Office

    $132.31

    Facility

    $69.41

    $4.51 higher than Delaware for the office setting.

  • Connecticut

    Connecticut · 64645

    Office

    $138.50

    Facility

    $74.82

    $10.70 higher than Delaware for the office setting.

  • Fort Lauderdale

    Florida · 64645

    Office

    $139.72

    Facility

    $79.83

    $11.92 higher than Delaware for the office setting.

  • Rest Of Florida

    Florida · 64645

    Office

    $132.10

    Facility

    $75.59

    $4.30 higher than Delaware for the office setting.

  • Atlanta

    Georgia · 64645

    Office

    $133.18

    Facility

    $73.11

    $5.38 higher than Delaware for the office setting.

  • Rest Of Georgia

    Georgia · 64645

    Office

    $123.91

    Facility

    $71.18

    $3.89 lower than Delaware for the office setting.

  • Hawaii, Guam

    Hawaii · 64645

    Office

    $134.79

    Facility

    $67.57

    $6.99 higher than Delaware for the office setting.

  • Iowa

    Iowa · 64645

    Office

    $116.56

    Facility

    $62.46

    $11.24 lower than Delaware for the office setting.

  • Idaho

    Idaho · 64645

    Office

    $117.79

    Facility

    $63.40

    $10.01 lower than Delaware for the office setting.

  • East St. Louis

    Illinois · 64645

    Office

    $135.29

    Facility

    $80.90

    $7.49 higher than Delaware for the office setting.

  • Rest Of Illinois

    Illinois · 64645

    Office

    $129.65

    Facility

    $75.68

    $1.85 higher than Delaware for the office setting.

  • Suburban Chicago

    Illinois · 64645

    Office

    $140.65

    Facility

    $79.93

    $12.85 higher than Delaware for the office setting.

  • Indiana

    Indiana · 64645

    Office

    $118.44

    Facility

    $63.64

    $9.36 lower than Delaware for the office setting.

  • Kansas

    Kansas · 64645

    Office

    $116.97

    Facility

    $63.53

    $10.83 lower than Delaware for the office setting.

  • Kentucky

    Kentucky · 64645

    Office

    $120.55

    Facility

    $67.99

    $7.25 lower than Delaware for the office setting.

  • New Orleans

    Louisiana · 64645

    Office

    $126.84

    Facility

    $71.21

    $0.96 lower than Delaware for the office setting.

  • Rest Of Louisiana

    Louisiana · 64645

    Office

    $120.74

    Facility

    $68.42

    $7.06 lower than Delaware for the office setting.

  • Metropolitan Boston

    Massachusetts · 64645

    Office

    $144.33

    Facility

    $73.75

    $16.53 higher than Delaware for the office setting.

  • Rest Of Massachusetts

    Massachusetts · 64645

    Office

    $131.88

    Facility

    $69.62

    $4.08 higher than Delaware for the office setting.

  • Baltimore/Surr. Cntys

    Maryland · 64645

    Office

    $138.33

    Facility

    $74.89

    $10.53 higher than Delaware for the office setting.

  • Rest Of Maryland

    Maryland · 64645

    Office

    $129.99

    Facility

    $70.16

    $2.19 higher than Delaware for the office setting.

  • Rest Of Maine

    Maine · 64645

    Office

    $119.48

    Facility

    $65.09

    $8.32 lower than Delaware for the office setting.

  • Southern Maine

    Maine · 64645

    Office

    $124.75

    Facility

    $66.16

    $3.05 lower than Delaware for the office setting.

  • Detroit

    Michigan · 64645

    Office

    $134.84

    Facility

    $77.79

    $7.04 higher than Delaware for the office setting.

  • Rest Of Michigan

    Michigan · 64645

    Office

    $124.73

    Facility

    $70.75

    $3.07 lower than Delaware for the office setting.

  • Minnesota

    Minnesota · 64645

    Office

    $123.71

    Facility

    $62.88

    $4.09 lower than Delaware for the office setting.

  • Metropolitan Kansas City

    Missouri · 64645

    Office

    $124.89

    Facility

    $69.38

    $2.91 lower than Delaware for the office setting.

  • Metropolitan St. Louis

    Missouri · 64645

    Office

    $126.12

    Facility

    $69.84

    $1.68 lower than Delaware for the office setting.

  • Rest Of Missouri

    Missouri · 64645

    Office

    $119.25

    Facility

    $68.29

    $8.55 lower than Delaware for the office setting.

  • Mississippi

    Mississippi · 64645

    Office

    $116.51

    Facility

    $65.61

    $11.29 lower than Delaware for the office setting.

  • Montana**

    Montana · 64645

    Office

    $129.57

    Facility

    $70.45

    $1.77 higher than Delaware for the office setting.

  • North Carolina

    North Carolina · 64645

    Office

    $120.62

    Facility

    $65.46

    $7.18 lower than Delaware for the office setting.

  • North Dakota**

    North Dakota · 64645

    Office

    $122.85

    Facility

    $63.73

    $4.95 lower than Delaware for the office setting.

  • Nebraska

    Nebraska · 64645

    Office

    $116.93

    Facility

    $62.36

    $10.87 lower than Delaware for the office setting.

  • New Hampshire

    New Hampshire · 64645

    Office

    $131.16

    Facility

    $69.62

    $3.36 higher than Delaware for the office setting.

  • Northern Nj

    New Jersey · 64645

    Office

    $144.88

    Facility

    $76.30

    $17.08 higher than Delaware for the office setting.

  • Rest Of New Jersey

    New Jersey · 64645

    Office

    $139.21

    Facility

    $74.65

    $11.41 higher than Delaware for the office setting.

  • New Mexico

    New Mexico · 64645

    Office

    $125.83

    Facility

    $71.62

    $1.97 lower than Delaware for the office setting.

  • Nevada**

    Nevada · 64645

    Office

    $127.77

    Facility

    $68.59

    $0.03 lower than Delaware for the office setting.

  • Nyc Suburbs/Long Island

    New York · 64645

    Office

    $156.00

    Facility

    $85.70

    $28.20 higher than Delaware for the office setting.

  • Poughkpsie/N Nyc Suburbs

    New York · 64645

    Office

    $140.94

    Facility

    $76.21

    $13.14 higher than Delaware for the office setting.

  • Queens

    New York · 64645

    Office

    $150.77

    Facility

    $80.89

    $22.97 higher than Delaware for the office setting.

  • Rest Of New York

    New York · 64645

    Office

    $122.58

    Facility

    $66.42

    $5.22 lower than Delaware for the office setting.

  • Ohio

    Ohio · 64645

    Office

    $123.35

    Facility

    $69.38

    $4.45 lower than Delaware for the office setting.

  • Oklahoma

    Oklahoma · 64645

    Office

    $119.27

    Facility

    $66.48

    $8.53 lower than Delaware for the office setting.

  • Portland

    Oregon · 64645

    Office

    $135.50

    Facility

    $69.82

    $7.70 higher than Delaware for the office setting.

  • Rest Of Oregon

    Oregon · 64645

    Office

    $125.93

    Facility

    $67.05

    $1.87 lower than Delaware for the office setting.

  • Metropolitan Philadelphia

    Pennsylvania · 64645

    Office

    $135.59

    Facility

    $74.05

    $7.79 higher than Delaware for the office setting.

  • Rest Of Pennsylvania

    Pennsylvania · 64645

    Office

    $123.00

    Facility

    $68.73

    $4.80 lower than Delaware for the office setting.

  • Puerto Rico

    Puerto Rico · 64645

    Office

    $130.23

    Facility

    $70.46

    $2.43 higher than Delaware for the office setting.

  • Rhode Island

    Rhode Island · 64645

    Office

    $131.63

    Facility

    $70.56

    $3.83 higher than Delaware for the office setting.

  • South Carolina

    South Carolina · 64645

    Office

    $122.36

    Facility

    $67.73

    $5.44 lower than Delaware for the office setting.

  • South Dakota**

    South Dakota · 64645

    Office

    $122.05

    Facility

    $62.94

    $5.75 lower than Delaware for the office setting.

  • Tennessee

    Tennessee · 64645

    Office

    $117.71

    Facility

    $63.97

    $10.09 lower than Delaware for the office setting.

  • Austin

    Texas · 64645

    Office

    $132.61

    Facility

    $70.07

    $4.81 higher than Delaware for the office setting.

  • Beaumont

    Texas · 64645

    Office

    $122.24

    Facility

    $68.44

    $5.56 lower than Delaware for the office setting.

  • Brazoria

    Texas · 64645

    Office

    $126.81

    Facility

    $68.22

    $0.99 lower than Delaware for the office setting.

  • Dallas

    Texas · 64645

    Office

    $128.10

    Facility

    $69.22

    $0.30 higher than Delaware for the office setting.

  • Fort Worth

    Texas · 64645

    Office

    $127.52

    Facility

    $69.23

    $0.28 lower than Delaware for the office setting.

  • Galveston

    Texas · 64645

    Office

    $127.50

    Facility

    $68.79

    $0.30 lower than Delaware for the office setting.

  • Houston

    Texas · 64645

    Office

    $133.72

    Facility

    $75.01

    $5.92 higher than Delaware for the office setting.

  • Rest Of Texas

    Texas · 64645

    Office

    $124.78

    Facility

    $68.68

    $3.02 lower than Delaware for the office setting.

  • Utah

    Utah · 64645

    Office

    $124.07

    Facility

    $68.50

    $3.73 lower than Delaware for the office setting.

  • Virginia

    Virginia · 64645

    Office

    $125.02

    Facility

    $66.90

    $2.78 lower than Delaware for the office setting.

  • Virgin Islands

    United States Virgin Islands · 64645

    Office

    $130.23

    Facility

    $70.46

    $2.43 higher than Delaware for the office setting.

  • Vermont

    Vermont · 64645

    Office

    $123.26

    Facility

    $64.73

    $4.54 lower than Delaware for the office setting.

  • Rest Of Washington

    Washington · 64645

    Office

    $131.33

    Facility

    $69.08

    $3.53 higher than Delaware for the office setting.

  • Seattle (King Cnty)

    Washington · 64645

    Office

    $146.32

    Facility

    $73.78

    $18.52 higher than Delaware for the office setting.

  • Wisconsin

    Wisconsin · 64645

    Office

    $118.68

    Facility

    $62.04

    $9.12 lower than Delaware for the office setting.

  • West Virginia

    West Virginia · 64645

    Office

    $124.95

    Facility

    $73.58

    $2.85 lower than Delaware for the office setting.

  • Wyoming**

    Wyoming · 64645

    Office

    $126.64

    Facility

    $67.52

    $1.16 lower than Delaware for the office setting.

See how rates vary across the country

64645 · Office / nonfacility · Non-QP. Choose a state to explore its payment localities. A range means the amount varies within that state.

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.

$113.82

$151.94

Color shows the midpoint of each state’s locality range.

View all state and territory rates as a table
State / territoryRate rangeLocalities
AK$151.941
AL$115.571
AR$113.821
AZ$125.701
CA$132.09–$161.5129
CO$132.311
CT$138.501
DC$146.291
DE$127.801
FL$132.10–$149.943
GA$123.91–$133.182
GU$134.791
HI$134.791
IA$116.561
ID$117.791
IL$129.65–$144.984
IN$118.441
KS$116.971
KY$120.551
LA$120.74–$126.842
MA$131.88–$144.332
MD$129.99–$146.293
ME$119.48–$124.752
MI$124.73–$134.842
MN$123.711
MO$119.25–$126.123
MS$116.511
MT$129.571
NC$120.621
ND$122.851
NE$116.931
NH$131.161
NJ$139.21–$144.882
NM$125.831
NV$127.771
NY$122.58–$156.005
OH$123.351
OK$119.271
OR$125.93–$135.502
PA$123.00–$135.592
PR$130.231
RI$131.631
SC$122.361
SD$122.051
TN$117.711
TX$122.24–$133.728
UT$124.071
VA$125.02–$146.292
VI$130.231
VT$123.261
WA$131.33–$146.322
WI$118.681
WV$124.951
WY$126.641

Explore 64645 on the national rate map →

Where does this rate apply?

Delaware is a Medicare payment area. Our Census mapping connects it to 79 cities and communities in Delaware, including the examples shown here.

Some communities span more than one payment area. Follow a city link to compare all of its mapped areas, or check the service-location ZIP above for an address-level starting point.

Browse all communities in Delaware →

Why are the office and facility amounts different?

For 64645 in Delaware, the physician’s office rate is $127.80 and the facility-setting rate is $69.39: a difference of $58.41.

The calculation uses a different practice-expense RVU for each setting. Both amounts here are physician fee-schedule amounts. The facility figure does not include a hospital’s separate charges, so this comparison does not tell you the total cost of receiving care in each setting.

See the inputs behind this difference →

Use this rate

What is a percentage of Medicare worth?

Turn a percentage into dollars for 64645 in Delaware. This uses the base rate on this page, so the locality and release stay consistent.

Reference amount per service

$140.58

$127.80 × 110% = $140.58

A contract may specify another Medicare year or additional adjustments. This is percentage arithmetic on the displayed base rate, not a claim adjudication.

Working with a whole code list?

Compare an offer across your annual code mix, including an older Medicare schedule or flat per-code rates.

Compare your contract offer →

How this local rate is calculated

Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 64645 in Delaware.

PPRRVU2026_Oct_nonQPP.csv

7,188

Code
64645
Physician work
1.36
Practice expense
2.18
Malpractice
0.34

GPCI2026.csv

40

Locality
Delaware
Physician work
1.005
Practice expense
0.988
Malpractice
0.899
Office / nonfacility calculation for 64645 in Delaware
ComponentRVULocality factorAdjusted
Physician work1.36× 1.0051.3668
Practice expense2.18× 0.9882.1538
Malpractice0.34× 0.8990.3057
Total RVUs3.8263
Conversion factor× 33.4009

Office / nonfacility rate, Delaware$127.80

Values as parsed from CMS release RVU26D, effective 2026-10-01. The amount is rounded to the nearest cent only at the end.

Open 64645 in the RVU calculator →

Explore RVUs, geographic factors and the full formula

Office / nonfacility

Office / nonfacility calculation inputs
ComponentRVULocal GPCI
Work1.361.005
Practice expense2.180.988
Malpractice0.340.899

(1.36 × 1.005 + 2.18 × 0.988 + 0.34 × 0.899) × $33.4009 = $127.80

Facility

Facility calculation inputs
ComponentRVULocal GPCI
Work1.361.005
Practice expense0.410.988
Malpractice0.340.899

(1.36 × 1.005 + 0.41 × 0.988 + 0.34 × 0.899) × $33.4009 = $69.39

The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.

How this rate has changed

64645 · Office / nonfacility

$127.80

Effective 2026-10-01

The base rate is $11.02 higher than on 2025-10-01, moving from $116.78 to $127.80 (9.4%).

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

    $116.78changed to$127.80

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 1.39 changed to 1.36
    • Practice expense RVU 1.91 changed to 2.18
    • Malpractice RVU 0.33 changed to 0.34
    • Work GPCI 1.009 changed to 1.005
    • Practice expense GPCI 0.992 changed to 0.988
    • Malpractice GPCI 0.949 changed to 0.899

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    Earliest loaded release: $116.78

    Held through RVU25B, RVU25C, RVU25D.

Explore release dates and calculate this code in an earlier period →

Each row uses the accepted CMS release effective on that date and the same contractor and locality identifiers. Missing rates stay visible. Historical boundaries may differ; verify the service address for an older claim.

Inspect every release and its CMS source
Effective fromOffice / nonfacilityFacilityCMS release
2026-10-01$127.80$69.39RVU26D
2026-07-01$127.80$69.39RVU26C
2026-04-01$127.80$69.39RVU26B
2026-01-01$127.80$69.39RVU26A
2025-10-01$116.78$78.60RVU25D
2025-07-01$116.78$78.60RVU25C
2025-04-01$116.78$78.60RVU25B
2025-01-01$116.78$78.60RVU25A

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 indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.

Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.

RVUs for 64645PPRRVU2026_Oct_nonQPP.csv, line 7,188 (RVU26D)
Geographic factors for DelawareGPCI2026.csv, line 40 (RVU26D)
Open CMS sourceHow this rate is calculatedBuild a fee sheet