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CMS RVU26D · Effective 2026-10-01

64650 in Madera

Office / nonfacility

$90.96

Base rate per service

Facility setting

$32.76

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 64650: Axillary eccrine gland chemodenervation

Reports chemodenervation of eccrine glands in both axillae, most often with botulinum toxin injections to treat axillary hyperhidrosis.

This service covers chemodenervation of the sweat glands in both armpits, usually by intradermal botulinum toxin injections for axillary hyperhidrosis. Dermatologists and other clinicians who treat excessive sweating commonly perform it in an office setting. The code represents treatment of both axillae together, rather than a separate service for each side.

Report the code when documentation identifies the axillary treatment sites and supports the clinical indication; retain the injection record and medication details. Other eccrine-gland areas are reported with 64653. Same-day preoperative and postoperative care is included in this 0-day global service. When other procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% multiple-procedure reduction. Assistant-at-surgery payment requires documented medical necessity; co-surgeons and team surgery are not permitted.

CMS billing rules for 64650

Global period
Minor procedure with a 0-day global period: same-day preoperative and postoperative care is included.
Multiple procedures
Standard multiple procedure reduction: the highest-valued procedure is paid in full and others at 50% when performed in the same session.
Bilateral procedures
Bilateral adjustment does not apply; the descriptor or anatomy makes modifier 50 inappropriate.
Assistant at surgery
Assistant at surgery is paid only with documentation of medical necessity.
Co-surgeons
Co-surgeons not permitted.
Team surgery
Team surgery not permitted.

Where the value comes from

  • Work RVU0.68 · 26%
  • Practice expense (office) RVU1.80 · 69%
  • Malpractice RVU0.11 · 4%

1.2K

Medicare services in 2024 · #2843 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.

64650 compared with similar codes

Office rates for Madera, from the same CMS release.

64653

Sweat gland treatment

Nonaxillary sites

$106.57

64650 covers both axillae. 64653 is for eccrine-gland treatment in other areas, such as the palms or scalp.

64642

Chemodenervation

One extremity, 1–4 muscles

$167.47

64642 treats muscles in one extremity, not eccrine glands. Choose 64650 for axillary hyperhidrosis treatment.

64643

Chemodenervation

Additional extremity, 1-4 muscles

$102.01

64643 is an additional-muscle code for extremity chemodenervation. It does not describe treatment of sweat glands.

The same code, a different location

How does Madera compare?

In Bakersfield, the office rate for 64650 is $91.27—$0.31 higher than the $90.96 rate in Madera. Both use the same code, release and participation basis.

64650 across payment areas

Same release and payment basis · bars start at $0

  1. Madera · This locality

    $90.96

  2. Bakersfield

    $91.27

    $0.31 higher than Madera

  3. Chico

    $90.96

    The same base rate than Madera

  4. El Centro

    $90.98

    $0.02 higher than Madera

  5. Fresno

    $90.96

    The same base rate than Madera

  6. Hanford-Corcoran

    $90.96

    The same base rate than Madera

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

    $97.21

    $6.25 higher than Madera

Other payment areas listed in California 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, 64650 ranges from $76.25 in Arkansas to $113.88 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

  • Merced

    California · 64650

    Office

    $90.96

    Facility

    $32.76

    The same base rate than Madera for the office setting.

  • Modesto

    California · 64650

    Office

    $90.96

    Facility

    $32.76

    The same base rate than Madera for the office setting.

  • Napa

    California · 64650

    Office

    $105.25

    Facility

    $35.25

    $14.29 higher than Madera for the office setting.

  • Oxnard-Thousand Oaks-Ventura

    California · 64650

    Office

    $96.70

    Facility

    $33.93

    $5.74 higher than Madera for the office setting.

  • Redding

    California · 64650

    Office

    $90.96

    Facility

    $32.76

    The same base rate than Madera for the office setting.

  • Rest Of California

    California · 64650

    Office

    $90.96

    Facility

    $32.76

    The same base rate than Madera for the office setting.

  • Riverside-San Bernardino-Ontario

    California · 64650

    Office

    $92.15

    Facility

    $33.94

    $1.19 higher than Madera for the office setting.

  • Sacramento-Roseville-Folsom

    California · 64650

    Office

    $95.42

    Facility

    $33.66

    $4.46 higher than Madera for the office setting.

  • Salinas

    California · 64650

    Office

    $95.07

    Facility

    $33.52

    $4.11 higher than Madera for the office setting.

  • San Diego-Chula Vista-Carlsbad

    California · 64650

    Office

    $97.29

    Facility

    $33.77

    $6.33 higher than Madera for the office setting.

  • San Francisco-Oakland-Berkeley (Marin Cnty)

    California · 64650

    Office

    $111.33

    Facility

    $36.45

    $20.37 higher than Madera for the office setting.

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

    California · 64650

    Office

    $111.20

    Facility

    $36.32

    $20.24 higher than Madera for the office setting.

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

    California · 64650

    Office

    $113.88

    Facility

    $37.29

    $22.92 higher than Madera for the office setting.

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

    California · 64650

    Office

    $113.36

    Facility

    $36.78

    $22.40 higher than Madera for the office setting.

  • San Luis Obispo-Paso Robles

    California · 64650

    Office

    $93.55

    Facility

    $33.06

    $2.59 higher than Madera for the office setting.

  • Santa Cruz-Watsonville

    California · 64650

    Office

    $98.21

    Facility

    $33.68

    $7.25 higher than Madera for the office setting.

  • Santa Maria-Santa Barbara

    California · 64650

    Office

    $95.42

    Facility

    $33.50

    $4.46 higher than Madera for the office setting.

  • Santa Rosa-Petaluma

    California · 64650

    Office

    $99.19

    Facility

    $33.98

    $8.23 higher than Madera for the office setting.

  • Stockton

    California · 64650

    Office

    $90.96

    Facility

    $32.76

    The same base rate than Madera for the office setting.

  • Vallejo

    California · 64650

    Office

    $105.07

    Facility

    $35.07

    $14.11 higher than Madera for the office setting.

  • Visalia

    California · 64650

    Office

    $90.96

    Facility

    $32.76

    The same base rate than Madera for the office setting.

  • Yuba City

    California · 64650

    Office

    $90.96

    Facility

    $32.76

    The same base rate than Madera for the office setting.

  • Dc + Md/Va Suburbs

    District of Columbia · 64650

    Office

    $98.85

    Facility

    $36.29

    $7.89 higher than Madera for the office setting.

  • Miami

    Florida · 64650

    Office

    $94.59

    Facility

    $39.31

    $3.63 higher than Madera for the office setting.

  • Chicago

    Illinois · 64650

    Office

    $91.73

    Facility

    $38.35

    $0.77 higher than Madera for the office setting.

  • Manhattan

    New York · 64650

    Office

    $99.85

    Facility

    $38.14

    $8.89 higher than Madera for the office setting.

  • Alaska*

    Alaska · 64650

    Office

    $100.12

    Facility

    $43.56

    $9.16 higher than Madera for the office setting.

  • Alabama

    Alabama · 64650

    Office

    $77.40

    Facility

    $30.93

    $13.56 lower than Madera for the office setting.

  • Arkansas

    Arkansas · 64650

    Office

    $76.25

    Facility

    $30.63

    $14.71 lower than Madera for the office setting.

  • Arizona

    Arizona · 64650

    Office

    $84.12

    Facility

    $32.65

    $6.84 lower than Madera for the office setting.

  • Colorado

    Colorado · 64650

    Office

    $89.82

    Facility

    $33.32

    $1.14 lower than Madera for the office setting.

  • Connecticut

    Connecticut · 64650

    Office

    $92.36

    Facility

    $35.17

    $1.40 higher than Madera for the office setting.

  • Delaware

    Delaware · 64650

    Office

    $85.53

    Facility

    $33.06

    $5.43 lower than Madera for the office setting.

  • Fort Lauderdale

    Florida · 64650

    Office

    $90.26

    Facility

    $36.46

    $0.70 lower than Madera for the office setting.

  • Rest Of Florida

    Florida · 64650

    Office

    $85.71

    Facility

    $34.94

    $5.25 lower than Madera for the office setting.

  • Atlanta

    Georgia · 64650

    Office

    $88.28

    Facility

    $34.32

    $2.68 lower than Madera for the office setting.

  • Rest Of Georgia

    Georgia · 64650

    Office

    $80.72

    Facility

    $33.35

    $10.24 lower than Madera for the office setting.

  • Hawaii, Guam

    Hawaii · 64650

    Office

    $93.20

    Facility

    $32.82

    $2.24 higher than Madera for the office setting.

  • Iowa

    Iowa · 64650

    Office

    $79.18

    Facility

    $30.59

    $11.78 lower than Madera for the office setting.

  • Idaho

    Idaho · 64650

    Office

    $79.76

    Facility

    $30.90

    $11.20 lower than Madera for the office setting.

  • East St. Louis

    Illinois · 64650

    Office

    $85.42

    Facility

    $36.57

    $5.54 lower than Madera for the office setting.

  • Rest Of Illinois

    Illinois · 64650

    Office

    $83.35

    Facility

    $34.86

    $7.61 lower than Madera for the office setting.

  • Suburban Chicago

    Illinois · 64650

    Office

    $91.13

    Facility

    $36.59

    $0.17 higher than Madera for the office setting.

  • Indiana

    Indiana · 64650

    Office

    $80.23

    Facility

    $31.00

    $10.73 lower than Madera for the office setting.

  • Kansas

    Kansas · 64650

    Office

    $78.91

    Facility

    $30.91

    $12.05 lower than Madera for the office setting.

  • Kentucky

    Kentucky · 64650

    Office

    $79.52

    Facility

    $32.31

    $11.44 lower than Madera for the office setting.

  • New Orleans

    Louisiana · 64650

    Office

    $83.46

    Facility

    $33.49

    $7.50 lower than Madera for the office setting.

  • Rest Of Louisiana

    Louisiana · 64650

    Office

    $79.44

    Facility

    $32.44

    $11.52 lower than Madera for the office setting.

  • Metropolitan Boston

    Massachusetts · 64650

    Office

    $98.70

    Facility

    $35.29

    $7.74 higher than Madera for the office setting.

  • Rest Of Massachusetts

    Massachusetts · 64650

    Office

    $89.31

    Facility

    $33.39

    $1.65 lower than Madera for the office setting.

  • Baltimore/Surr. Cntys

    Maryland · 64650

    Office

    $92.13

    Facility

    $35.15

    $1.17 higher than Madera for the office setting.

  • Rest Of Maryland

    Maryland · 64650

    Office

    $87.16

    Facility

    $33.41

    $3.80 lower than Madera for the office setting.

  • Rest Of Maine

    Maine · 64650

    Office

    $80.31

    Facility

    $31.45

    $10.65 lower than Madera for the office setting.

  • Southern Maine

    Maine · 64650

    Office

    $84.61

    Facility

    $31.98

    $6.35 lower than Madera for the office setting.

  • Detroit

    Michigan · 64650

    Office

    $86.92

    Facility

    $35.68

    $4.04 lower than Madera for the office setting.

  • Rest Of Michigan

    Michigan · 64650

    Office

    $81.75

    Facility

    $33.26

    $9.21 lower than Madera for the office setting.

  • Minnesota

    Minnesota · 64650

    Office

    $85.67

    Facility

    $31.02

    $5.29 lower than Madera for the office setting.

  • Metropolitan Kansas City

    Missouri · 64650

    Office

    $82.76

    Facility

    $32.89

    $8.20 lower than Madera for the office setting.

  • Metropolitan St. Louis

    Missouri · 64650

    Office

    $83.63

    Facility

    $33.07

    $7.33 lower than Madera for the office setting.

  • Rest Of Missouri

    Missouri · 64650

    Office

    $78.12

    Facility

    $32.34

    $12.84 lower than Madera for the office setting.

  • Mississippi

    Mississippi · 64650

    Office

    $77.19

    Facility

    $31.47

    $13.77 lower than Madera for the office setting.

  • Montana**

    Montana · 64650

    Office

    $86.50

    Facility

    $33.39

    $4.46 lower than Madera for the office setting.

  • North Carolina

    North Carolina · 64650

    Office

    $81.15

    Facility

    $31.60

    $9.81 lower than Madera for the office setting.

  • North Dakota**

    North Dakota · 64650

    Office

    $84.33

    Facility

    $31.22

    $6.63 lower than Madera for the office setting.

  • Nebraska

    Nebraska · 64650

    Office

    $79.59

    Facility

    $30.58

    $11.37 lower than Madera for the office setting.

  • New Hampshire

    New Hampshire · 64650

    Office

    $88.51

    Facility

    $33.23

    $2.45 lower than Madera for the office setting.

  • Northern Nj

    New Jersey · 64650

    Office

    $97.81

    Facility

    $36.20

    $6.85 higher than Madera for the office setting.

  • Rest Of New Jersey

    New Jersey · 64650

    Office

    $93.30

    Facility

    $35.31

    $2.34 higher than Madera for the office setting.

  • New Mexico

    New Mexico · 64650

    Office

    $82.26

    Facility

    $33.56

    $8.70 lower than Madera for the office setting.

  • Nevada**

    Nevada · 64650

    Office

    $85.95

    Facility

    $32.79

    $5.01 lower than Madera for the office setting.

  • Nyc Suburbs/Long Island

    New York · 64650

    Office

    $102.47

    Facility

    $39.33

    $11.51 higher than Madera for the office setting.

  • Poughkpsie/N Nyc Suburbs

    New York · 64650

    Office

    $94.01

    Facility

    $35.86

    $3.05 higher than Madera for the office setting.

  • Queens

    New York · 64650

    Office

    $100.53

    Facility

    $37.76

    $9.57 higher than Madera for the office setting.

  • Rest Of New York

    New York · 64650

    Office

    $82.41

    Facility

    $31.96

    $8.55 lower than Madera for the office setting.

  • Ohio

    Ohio · 64650

    Office

    $81.31

    Facility

    $32.82

    $9.65 lower than Madera for the office setting.

  • Oklahoma

    Oklahoma · 64650

    Office

    $79.26

    Facility

    $31.83

    $11.70 lower than Madera for the office setting.

  • Portland

    Oregon · 64650

    Office

    $92.60

    Facility

    $33.60

    $1.64 higher than Madera for the office setting.

  • Rest Of Oregon

    Oregon · 64650

    Office

    $85.18

    Facility

    $32.28

    $5.78 lower than Madera for the office setting.

  • Metropolitan Philadelphia

    Pennsylvania · 64650

    Office

    $90.09

    Facility

    $34.81

    $0.87 lower than Madera for the office setting.

  • Rest Of Pennsylvania

    Pennsylvania · 64650

    Office

    $81.38

    Facility

    $32.62

    $9.58 lower than Madera for the office setting.

  • Puerto Rico

    Puerto Rico · 64650

    Office

    $87.11

    Facility

    $33.42

    $3.85 lower than Madera for the office setting.

  • Rhode Island

    Rhode Island · 64650

    Office

    $88.53

    Facility

    $33.67

    $2.43 lower than Madera for the office setting.

  • South Carolina

    South Carolina · 64650

    Office

    $81.39

    Facility

    $32.32

    $9.57 lower than Madera for the office setting.

  • South Dakota**

    South Dakota · 64650

    Office

    $84.07

    Facility

    $30.96

    $6.89 lower than Madera for the office setting.

  • Tennessee

    Tennessee · 64650

    Office

    $79.34

    Facility

    $31.06

    $11.62 lower than Madera for the office setting.

  • Austin

    Texas · 64650

    Office

    $89.62

    Facility

    $33.43

    $1.34 lower than Madera for the office setting.

  • Beaumont

    Texas · 64650

    Office

    $80.84

    Facility

    $32.51

    $10.12 lower than Madera for the office setting.

  • Brazoria

    Texas · 64650

    Office

    $85.34

    Facility

    $32.71

    $5.62 lower than Madera for the office setting.

  • Dallas

    Texas · 64650

    Office

    $85.95

    Facility

    $33.06

    $5.01 lower than Madera for the office setting.

  • Fort Worth

    Texas · 64650

    Office

    $85.40

    Facility

    $33.03

    $5.56 lower than Madera for the office setting.

  • Galveston

    Texas · 64650

    Office

    $85.64

    Facility

    $32.90

    $5.32 lower than Madera for the office setting.

  • Houston

    Texas · 64650

    Office

    $87.65

    Facility

    $34.91

    $3.31 lower than Madera for the office setting.

  • Rest Of Texas

    Texas · 64650

    Office

    $83.09

    Facility

    $32.69

    $7.87 lower than Madera for the office setting.

  • Utah

    Utah · 64650

    Office

    $82.53

    Facility

    $32.61

    $8.43 lower than Madera for the office setting.

  • Virginia

    Virginia · 64650

    Office

    $84.41

    Facility

    $32.20

    $6.55 lower than Madera for the office setting.

  • Virgin Islands

    United States Virgin Islands · 64650

    Office

    $87.11

    Facility

    $33.42

    $3.85 lower than Madera for the office setting.

  • Vermont

    Vermont · 64650

    Office

    $84.09

    Facility

    $31.52

    $6.87 lower than Madera for the office setting.

  • Rest Of Washington

    Washington · 64650

    Office

    $89.11

    Facility

    $33.19

    $1.85 lower than Madera for the office setting.

  • Seattle (King Cnty)

    Washington · 64650

    Office

    $100.62

    Facility

    $35.46

    $9.66 higher than Madera for the office setting.

  • Wisconsin

    Wisconsin · 64650

    Office

    $81.44

    Facility

    $30.56

    $9.52 lower than Madera for the office setting.

  • West Virginia

    West Virginia · 64650

    Office

    $80.22

    Facility

    $34.07

    $10.74 lower than Madera for the office setting.

  • Wyoming**

    Wyoming · 64650

    Office

    $85.55

    Facility

    $32.45

    $5.41 lower than Madera for the office setting.

See how rates vary across the country

64650 · 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.

$76.25

$102.42

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

View all state and territory rates as a table
State / territoryRate rangeLocalities
AK$100.121
AL$77.401
AR$76.251
AZ$84.121
CA$90.96–$113.8829
CO$89.821
CT$92.361
DC$98.851
DE$85.531
FL$85.71–$94.593
GA$80.72–$88.282
GU$93.201
HI$93.201
IA$79.181
ID$79.761
IL$83.35–$91.734
IN$80.231
KS$78.911
KY$79.521
LA$79.44–$83.462
MA$89.31–$98.702
MD$87.16–$98.853
ME$80.31–$84.612
MI$81.75–$86.922
MN$85.671
MO$78.12–$83.633
MS$77.191
MT$86.501
NC$81.151
ND$84.331
NE$79.591
NH$88.511
NJ$93.30–$97.812
NM$82.261
NV$85.951
NY$82.41–$102.475
OH$81.311
OK$79.261
OR$85.18–$92.602
PA$81.38–$90.092
PR$87.111
RI$88.531
SC$81.391
SD$84.071
TN$79.341
TX$80.84–$89.628
UT$82.531
VA$84.41–$98.852
VI$87.111
VT$84.091
WA$89.11–$100.622
WI$81.441
WV$80.221
WY$85.551

Explore 64650 on the national rate map →

Where does this rate apply?

Madera is a Medicare payment area. Our Census mapping connects it to 17 cities and communities in California, 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 California →

Why are the office and facility amounts different?

For 64650 in Madera, the physician’s office rate is $90.96 and the facility-setting rate is $32.76: a difference of $58.20.

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 64650 in Madera. This uses the base rate on this page, so the locality and release stay consistent.

Reference amount per service

$100.06

$90.96 × 110% = $100.06

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 64650 in Madera.

PPRRVU2026_Oct_nonQPP.csv

7,191

Code
64650
Physician work
0.68
Practice expense
1.80
Malpractice
0.11

GPCI2026.csv

14

Locality
Madera
Physician work
1.017
Practice expense
1.096
Malpractice
0.536
Office / nonfacility calculation for 64650 in Madera
ComponentRVULocality factorAdjusted
Physician work0.68× 1.0170.6916
Practice expense1.80× 1.0961.9728
Malpractice0.11× 0.5360.0590
Total RVUs2.7233
Conversion factor× 33.4009

Office / nonfacility rate, Madera$90.96

Open 64650 in the RVU calculator →

Explore RVUs, geographic factors and the full formula

Office / nonfacility

Office / nonfacility calculation inputs
ComponentRVULocal GPCI
Work0.681.017
Practice expense1.81.096
Malpractice0.110.536

(0.68 × 1.017 + 1.8 × 1.096 + 0.11 × 0.536) × $33.4009 = $90.96

Facility

Facility calculation inputs
ComponentRVULocal GPCI
Work0.681.017
Practice expense0.211.096
Malpractice0.110.536

(0.68 × 1.017 + 0.21 × 1.096 + 0.11 × 0.536) × $33.4009 = $32.76

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

64650 · Office / nonfacility

$90.96

Effective 2026-10-01

The base rate is $1.83 higher than on 2025-10-01, moving from $89.13 to $90.96 (2.1%).

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

    $89.13changed to$90.96

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 0.70 changed to 0.68
    • Practice expense RVU 1.81 changed to 1.80
    • Malpractice RVU 0.12 changed to 0.11
    • Work GPCI 1.014 changed to 1.017
    • Practice expense GPCI 1.093 changed to 1.096
    • Malpractice GPCI 0.560 changed to 0.536

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    Earliest loaded release: $89.13

    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$90.96$32.76RVU26D
2026-07-01$90.96$32.76RVU26C
2026-04-01$90.96$32.76RVU26B
2026-01-01$90.96$32.76RVU26A
2025-10-01$89.13$39.28RVU25D
2025-07-01$89.13$39.28RVU25C
2025-04-01$89.13$39.28RVU25B
2025-01-01$89.13$39.28RVU25A

64650 billing questions

Should 64650 be reported once or once per axilla?

Report it once for treatment of both axillae. The bilateral anatomy is already represented, so modifier 50 is inappropriate.

When should 64653 be used instead?

Use 64653 for chemodenervation of eccrine glands in areas other than the axillae. If other areas are treated in addition to both axillae, report the applicable service for those areas as well.

Is the botulinum toxin medication included in 64650?

The procedure code describes the chemodenervation service, not a specific drug. When the practice supplies the medication, report the applicable drug code separately under the relevant billing rules.

What documentation supports 64650?

Document the indication, both axillary treatment sites, the procedure performed, and the medication and administration details. The injection record should support the service billed.

How does the multiple-procedure reduction affect 64650?

When it is performed with other procedures in the same session, the highest-valued procedure is paid in full and the others are subject to the standard 50% reduction.

Can an assistant or co-surgeon be reported?

Assistant-at-surgery payment requires documentation of medical necessity. 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 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 64650PPRRVU2026_Oct_nonQPP.csv, line 7,191 (RVU26D)
Geographic factors for MaderaGPCI2026.csv, line 14 (RVU26D)
Open CMS sourceHow this rate is calculatedBuild a fee sheet