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CMS RVU26D · Effective 2026-10-01

64643 in Wyoming**

Office / nonfacility

$97.87

Base rate per service

Facility setting

$57.79

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 64643: Additional-extremity chemodenervation, 1-4 muscles

Reports chemodenervation of an additional extremity when treatment targets one to four muscles there, alongside the primary extremity procedure.

This add-on code represents chemodenervation of an additional limb, treating one to four muscles in that extremity. It is commonly used when a clinician injects botulinum toxin to manage focal spasticity, such as after stroke, traumatic brain injury, or in cerebral palsy. Physicians and other qualified practitioners typically perform the injections in an office or facility setting, selecting target muscles based on the patient’s functional goals and examination findings.

Report 64643 with the primary extremity chemodenervation service, generally 64642, when another extremity is treated at the same session. The muscle count is assessed separately for each extremity; this code represents an additional extremity with one to four treated muscles, not each individual muscle or injection site. Documentation should identify the treated extremity, muscles, indication, and administered treatment. CMS classifies this as an add-on code: it is billed only with a primary procedure, and its payment falls within that procedure’s global period.

CMS billing rules for 64643

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 RVU1.19 · 40%
  • Practice expense (office) RVU1.57 · 53%
  • Malpractice RVU0.23 · 8%

38.6K

Medicare services in 2024 · #885 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.

64643 compared with similar codes

Office rates for Wyoming**, from the same CMS release.

64642

Chemodenervation

One extremity, 1–4 muscles

$159.94

64642 covers the primary extremity treated with one to four muscles. 64643 is for each additional extremity in that same muscle-count range.

64644

Muscle chemodenervation

One extremity, five or more muscles

$187.25

64644 applies to the primary extremity when five or more muscles are treated; 64643 is for an additional extremity with one to four muscles.

64645

Muscle chemodenervation

Additional extremity, five-plus muscles

$126.64

Both codes describe an additional extremity, but 64645 is used when five or more muscles are treated there; 64643 is for one to four.

The same code, a different location

How does Wyoming** compare?

64643 across payment areas

Same release and payment basis · bars start at $0

  1. Wyoming** · This locality

    $97.87

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

    $108.51

    $10.64 higher than Wyoming**

  3. Dc + Md/Va Suburbs

    $112.22

    $14.35 higher than Wyoming**

  4. Miami

    $113.76

    $15.89 higher than Wyoming**

  5. Chicago

    $110.36

    $12.49 higher than Wyoming**

  6. Manhattan

    $115.41

    $17.54 higher than Wyoming**

  7. Alaska*

    $119.70

    $21.83 higher than Wyoming**

Other payment areas listed in Wyoming 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, 64643 ranges from $88.75 in Arkansas to $123.85 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 · 64643

    Office

    $89.98

    Facility

    $54.91

    $7.89 lower than Wyoming** for the office setting.

  • Arkansas

    Arkansas · 64643

    Office

    $88.75

    Facility

    $54.32

    $9.12 lower than Wyoming** for the office setting.

  • Arizona

    Arizona · 64643

    Office

    $97.14

    Facility

    $58.30

    $0.73 lower than Wyoming** for the office setting.

  • Bakersfield

    California · 64643

    Office

    $102.65

    Facility

    $58.73

    $4.78 higher than Wyoming** for the office setting.

  • Chico

    California · 64643

    Office

    $102.01

    Facility

    $58.09

    $4.14 higher than Wyoming** for the office setting.

  • El Centro

    California · 64643

    Office

    $102.05

    Facility

    $58.12

    $4.18 higher than Wyoming** for the office setting.

  • Fresno

    California · 64643

    Office

    $102.01

    Facility

    $58.09

    $4.14 higher than Wyoming** for the office setting.

  • Hanford-Corcoran

    California · 64643

    Office

    $102.01

    Facility

    $58.09

    $4.14 higher than Wyoming** for the office setting.

  • Madera

    California · 64643

    Office

    $102.01

    Facility

    $58.09

    $4.14 higher than Wyoming** for the office setting.

  • Merced

    California · 64643

    Office

    $102.01

    Facility

    $58.09

    $4.14 higher than Wyoming** for the office setting.

  • Modesto

    California · 64643

    Office

    $102.01

    Facility

    $58.09

    $4.14 higher than Wyoming** for the office setting.

  • Napa

    California · 64643

    Office

    $115.27

    Facility

    $62.44

    $17.40 higher than Wyoming** for the office setting.

  • Oxnard-Thousand Oaks-Ventura

    California · 64643

    Office

    $107.63

    Facility

    $60.25

    $9.76 higher than Wyoming** for the office setting.

  • Redding

    California · 64643

    Office

    $102.01

    Facility

    $58.09

    $4.14 higher than Wyoming** for the office setting.

  • Rest Of California

    California · 64643

    Office

    $102.01

    Facility

    $58.09

    $4.14 higher than Wyoming** for the office setting.

  • Riverside-San Bernardino-Ontario

    California · 64643

    Office

    $104.49

    Facility

    $60.56

    $6.62 higher than Wyoming** for the office setting.

  • Sacramento-Roseville-Folsom

    California · 64643

    Office

    $106.28

    Facility

    $59.67

    $8.41 higher than Wyoming** for the office setting.

  • Salinas

    California · 64643

    Office

    $105.87

    Facility

    $59.42

    $8.00 higher than Wyoming** for the office setting.

  • San Diego-Chula Vista-Carlsbad

    California · 64643

    Office

    $107.82

    Facility

    $59.88

    $9.95 higher than Wyoming** for the office setting.

  • San Francisco-Oakland-Berkeley (Marin Cnty)

    California · 64643

    Office

    $120.99

    Facility

    $64.47

    $23.12 higher than Wyoming** for the office setting.

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

    California · 64643

    Office

    $120.73

    Facility

    $64.21

    $22.86 higher than Wyoming** for the office setting.

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

    California · 64643

    Office

    $123.85

    Facility

    $66.06

    $25.98 higher than Wyoming** for the office setting.

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

    California · 64643

    Office

    $122.79

    Facility

    $64.99

    $24.92 higher than Wyoming** for the office setting.

  • San Luis Obispo-Paso Robles

    California · 64643

    Office

    $104.27

    Facility

    $58.62

    $6.40 higher than Wyoming** for the office setting.

  • Santa Cruz-Watsonville

    California · 64643

    Office

    $108.41

    Facility

    $59.71

    $10.54 higher than Wyoming** for the office setting.

  • Santa Maria-Santa Barbara

    California · 64643

    Office

    $106.12

    Facility

    $59.39

    $8.25 higher than Wyoming** for the office setting.

  • Santa Rosa-Petaluma

    California · 64643

    Office

    $109.45

    Facility

    $60.23

    $11.58 higher than Wyoming** for the office setting.

  • Stockton

    California · 64643

    Office

    $102.01

    Facility

    $58.09

    $4.14 higher than Wyoming** for the office setting.

  • Vallejo

    California · 64643

    Office

    $114.89

    Facility

    $62.07

    $17.02 higher than Wyoming** for the office setting.

  • Visalia

    California · 64643

    Office

    $102.01

    Facility

    $58.09

    $4.14 higher than Wyoming** for the office setting.

  • Yuba City

    California · 64643

    Office

    $102.01

    Facility

    $58.09

    $4.14 higher than Wyoming** for the office setting.

  • Colorado

    Colorado · 64643

    Office

    $102.02

    Facility

    $59.37

    $4.15 higher than Wyoming** for the office setting.

  • Connecticut

    Connecticut · 64643

    Office

    $106.31

    Facility

    $63.15

    $8.44 higher than Wyoming** for the office setting.

  • Delaware

    Delaware · 64643

    Office

    $98.66

    Facility

    $59.06

    $0.79 higher than Wyoming** for the office setting.

  • Fort Lauderdale

    Florida · 64643

    Office

    $106.76

    Facility

    $66.16

    $8.89 higher than Wyoming** for the office setting.

  • Rest Of Florida

    Florida · 64643

    Office

    $101.43

    Facility

    $63.11

    $3.56 higher than Wyoming** for the office setting.

  • Atlanta

    Georgia · 64643

    Office

    $102.37

    Facility

    $61.65

    $4.50 higher than Wyoming** for the office setting.

  • Rest Of Georgia

    Georgia · 64643

    Office

    $95.68

    Facility

    $59.93

    $2.19 lower than Wyoming** for the office setting.

  • Hawaii, Guam

    Hawaii · 64643

    Office

    $103.82

    Facility

    $58.25

    $5.95 higher than Wyoming** for the office setting.

  • Iowa

    Iowa · 64643

    Office

    $90.78

    Facility

    $54.10

    $7.09 lower than Wyoming** for the office setting.

  • Idaho

    Idaho · 64643

    Office

    $91.63

    Facility

    $54.75

    $6.24 lower than Wyoming** for the office setting.

  • East St. Louis

    Illinois · 64643

    Office

    $103.46

    Facility

    $66.59

    $5.59 higher than Wyoming** for the office setting.

  • Rest Of Illinois

    Illinois · 64643

    Office

    $99.63

    Facility

    $63.04

    $1.76 higher than Wyoming** for the office setting.

  • Suburban Chicago

    Illinois · 64643

    Office

    $107.49

    Facility

    $66.33

    $9.62 higher than Wyoming** for the office setting.

  • Indiana

    Indiana · 64643

    Office

    $92.09

    Facility

    $54.94

    $5.78 lower than Wyoming** for the office setting.

  • Kansas

    Kansas · 64643

    Office

    $91.02

    Facility

    $54.79

    $6.85 lower than Wyoming** for the office setting.

  • Kentucky

    Kentucky · 64643

    Office

    $93.39

    Facility

    $57.76

    $4.48 lower than Wyoming** for the office setting.

  • New Orleans

    Louisiana · 64643

    Office

    $97.82

    Facility

    $60.10

    $0.05 lower than Wyoming** for the office setting.

  • Rest Of Louisiana

    Louisiana · 64643

    Office

    $93.52

    Facility

    $58.04

    $4.35 lower than Wyoming** for the office setting.

  • Metropolitan Boston

    Massachusetts · 64643

    Office

    $110.83

    Facility

    $62.97

    $12.96 higher than Wyoming** for the office setting.

  • Rest Of Massachusetts

    Massachusetts · 64643

    Office

    $101.72

    Facility

    $59.52

    $3.85 higher than Wyoming** for the office setting.

  • Baltimore/Surr. Cntys

    Maryland · 64643

    Office

    $106.15

    Facility

    $63.15

    $8.28 higher than Wyoming** for the office setting.

  • Rest Of Maryland

    Maryland · 64643

    Office

    $100.27

    Facility

    $59.70

    $2.40 higher than Wyoming** for the office setting.

  • Rest Of Maine

    Maine · 64643

    Office

    $92.77

    Facility

    $55.90

    $5.10 lower than Wyoming** for the office setting.

  • Southern Maine

    Maine · 64643

    Office

    $96.56

    Facility

    $56.84

    $1.31 lower than Wyoming** for the office setting.

  • Detroit

    Michigan · 64643

    Office

    $103.30

    Facility

    $64.63

    $5.43 higher than Wyoming** for the office setting.

  • Rest Of Michigan

    Michigan · 64643

    Office

    $96.30

    Facility

    $59.70

    $1.57 lower than Wyoming** for the office setting.

  • Minnesota

    Minnesota · 64643

    Office

    $95.98

    Facility

    $54.74

    $1.89 lower than Wyoming** for the office setting.

  • Metropolitan Kansas City

    Missouri · 64643

    Office

    $96.49

    Facility

    $58.86

    $1.38 lower than Wyoming** for the office setting.

  • Metropolitan St. Louis

    Missouri · 64643

    Office

    $97.37

    Facility

    $59.21

    $0.50 lower than Wyoming** for the office setting.

  • Rest Of Missouri

    Missouri · 64643

    Office

    $92.43

    Facility

    $57.88

    $5.44 lower than Wyoming** for the office setting.

  • Mississippi

    Mississippi · 64643

    Office

    $90.57

    Facility

    $56.06

    $7.30 lower than Wyoming** for the office setting.

  • Montana**

    Montana · 64643

    Office

    $99.85

    Facility

    $59.77

    $1.98 higher than Wyoming** for the office setting.

  • North Carolina

    North Carolina · 64643

    Office

    $93.58

    Facility

    $56.19

    $4.29 lower than Wyoming** for the office setting.

  • North Dakota**

    North Dakota · 64643

    Office

    $95.31

    Facility

    $55.22

    $2.56 lower than Wyoming** for the office setting.

  • Nebraska

    Nebraska · 64643

    Office

    $91.05

    Facility

    $54.06

    $6.82 lower than Wyoming** for the office setting.

  • New Hampshire

    New Hampshire · 64643

    Office

    $101.06

    Facility

    $59.33

    $3.19 higher than Wyoming** for the office setting.

  • Northern Nj

    New Jersey · 64643

    Office

    $111.29

    Facility

    $64.79

    $13.42 higher than Wyoming** for the office setting.

  • Rest Of New Jersey

    New Jersey · 64643

    Office

    $107.03

    Facility

    $63.26

    $9.16 higher than Wyoming** for the office setting.

  • New Mexico

    New Mexico · 64643

    Office

    $97.06

    Facility

    $60.31

    $0.81 lower than Wyoming** for the office setting.

  • Nevada**

    Nevada · 64643

    Office

    $98.64

    Facility

    $58.52

    $0.77 higher than Wyoming** for the office setting.

  • Nyc Suburbs/Long Island

    New York · 64643

    Office

    $118.91

    Facility

    $71.25

    $21.04 higher than Wyoming** for the office setting.

  • Poughkpsie/N Nyc Suburbs

    New York · 64643

    Office

    $108.25

    Facility

    $64.36

    $10.38 higher than Wyoming** for the office setting.

  • Queens

    New York · 64643

    Office

    $115.35

    Facility

    $67.98

    $17.48 higher than Wyoming** for the office setting.

  • Rest Of New York

    New York · 64643

    Office

    $94.97

    Facility

    $56.89

    $2.90 lower than Wyoming** for the office setting.

  • Ohio

    Ohio · 64643

    Office

    $95.37

    Facility

    $58.77

    $2.50 lower than Wyoming** for the office setting.

  • Oklahoma

    Oklahoma · 64643

    Office

    $92.54

    Facility

    $56.75

    $5.33 lower than Wyoming** for the office setting.

  • Portland

    Oregon · 64643

    Office

    $104.36

    Facility

    $59.83

    $6.49 higher than Wyoming** for the office setting.

  • Rest Of Oregon

    Oregon · 64643

    Office

    $97.38

    Facility

    $57.46

    $0.49 lower than Wyoming** for the office setting.

  • Metropolitan Philadelphia

    Pennsylvania · 64643

    Office

    $104.22

    Facility

    $62.49

    $6.35 higher than Wyoming** for the office setting.

  • Rest Of Pennsylvania

    Pennsylvania · 64643

    Office

    $95.15

    Facility

    $58.35

    $2.72 lower than Wyoming** for the office setting.

  • Puerto Rico

    Puerto Rico · 64643

    Office

    $100.33

    Facility

    $59.81

    $2.46 higher than Wyoming** for the office setting.

  • Rhode Island

    Rhode Island · 64643

    Office

    $101.52

    Facility

    $60.12

    $3.65 higher than Wyoming** for the office setting.

  • South Carolina

    South Carolina · 64643

    Office

    $94.73

    Facility

    $57.70

    $3.14 lower than Wyoming** for the office setting.

  • South Dakota**

    South Dakota · 64643

    Office

    $94.77

    Facility

    $54.69

    $3.10 lower than Wyoming** for the office setting.

  • Tennessee

    Tennessee · 64643

    Office

    $91.54

    Facility

    $55.11

    $6.33 lower than Wyoming** for the office setting.

  • Austin

    Texas · 64643

    Office

    $102.11

    Facility

    $59.71

    $4.24 higher than Wyoming** for the office setting.

  • Beaumont

    Texas · 64643

    Office

    $94.60

    Facility

    $58.13

    $3.27 lower than Wyoming** for the office setting.

  • Brazoria

    Texas · 64643

    Office

    $98.02

    Facility

    $58.30

    $0.15 higher than Wyoming** for the office setting.

  • Dallas

    Texas · 64643

    Office

    $98.93

    Facility

    $59.01

    $1.06 higher than Wyoming** for the office setting.

  • Fort Worth

    Texas · 64643

    Office

    $98.50

    Facility

    $58.98

    $0.63 higher than Wyoming** for the office setting.

  • Galveston

    Texas · 64643

    Office

    $98.50

    Facility

    $58.70

    $0.63 higher than Wyoming** for the office setting.

  • Houston

    Texas · 64643

    Office

    $102.71

    Facility

    $62.91

    $4.84 higher than Wyoming** for the office setting.

  • Rest Of Texas

    Texas · 64643

    Office

    $96.45

    Facility

    $58.41

    $1.42 lower than Wyoming** for the office setting.

  • Utah

    Utah · 64643

    Office

    $95.94

    Facility

    $58.26

    $1.93 lower than Wyoming** for the office setting.

  • Virginia

    Virginia · 64643

    Office

    $96.72

    Facility

    $57.32

    $1.15 lower than Wyoming** for the office setting.

  • Virgin Islands

    United States Virgin Islands · 64643

    Office

    $100.33

    Facility

    $59.81

    $2.46 higher than Wyoming** for the office setting.

  • Vermont

    Vermont · 64643

    Office

    $95.55

    Facility

    $55.87

    $2.32 lower than Wyoming** for the office setting.

  • Rest Of Washington

    Washington · 64643

    Office

    $101.33

    Facility

    $59.12

    $3.46 higher than Wyoming** for the office setting.

  • Seattle (King Cnty)

    Washington · 64643

    Office

    $112.35

    Facility

    $63.17

    $14.48 higher than Wyoming** for the office setting.

  • Wisconsin

    Wisconsin · 64643

    Office

    $92.35

    Facility

    $53.95

    $5.52 lower than Wyoming** for the office setting.

  • West Virginia

    West Virginia · 64643

    Office

    $96.31

    Facility

    $61.48

    $1.56 lower than Wyoming** for the office setting.

See how rates vary across the country

64643 · 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.

$88.75

$119.70

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

View all state and territory rates as a table
State / territoryRate rangeLocalities
AK$119.701
AL$89.981
AR$88.751
AZ$97.141
CA$102.01–$123.8529
CO$102.021
CT$106.311
DC$112.221
DE$98.661
FL$101.43–$113.763
GA$95.68–$102.372
GU$103.821
HI$103.821
IA$90.781
ID$91.631
IL$99.63–$110.364
IN$92.091
KS$91.021
KY$93.391
LA$93.52–$97.822
MA$101.72–$110.832
MD$100.27–$112.223
ME$92.77–$96.562
MI$96.30–$103.302
MN$95.981
MO$92.43–$97.373
MS$90.571
MT$99.851
NC$93.581
ND$95.311
NE$91.051
NH$101.061
NJ$107.03–$111.292
NM$97.061
NV$98.641
NY$94.97–$118.915
OH$95.371
OK$92.541
OR$97.38–$104.362
PA$95.15–$104.222
PR$100.331
RI$101.521
SC$94.731
SD$94.771
TN$91.541
TX$94.60–$102.718
UT$95.941
VA$96.72–$112.222
VI$100.331
VT$95.551
WA$101.33–$112.352
WI$92.351
WV$96.311
WY$97.871

Explore 64643 on the national rate map →

Where does this rate apply?

Wyoming** is a Medicare payment area. Our Census mapping connects it to 205 cities and communities in Wyoming, 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 Wyoming →

Why are the office and facility amounts different?

For 64643 in Wyoming**, the physician’s office rate is $97.87 and the facility-setting rate is $57.79: a difference of $40.08.

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 64643 in Wyoming**. This uses the base rate on this page, so the locality and release stay consistent.

Reference amount per service

$107.66

$97.87 × 110% = $107.66

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 64643 in Wyoming**.

PPRRVU2026_Oct_nonQPP.csv

7,186

Code
64643
Physician work
1.19
Practice expense
1.57
Malpractice
0.23

GPCI2026.csv

112

Locality
Wyoming**
Physician work
1.000
Practice expense
1.000
Malpractice
0.740
Office / nonfacility calculation for 64643 in Wyoming**
ComponentRVULocality factorAdjusted
Physician work1.19× 1.0001.1900
Practice expense1.57× 1.0001.5700
Malpractice0.23× 0.7400.1702
Total RVUs2.9302
Conversion factor× 33.4009

Office / nonfacility rate, Wyoming**$97.87

Open 64643 in the RVU calculator →

Explore RVUs, geographic factors and the full formula

Office / nonfacility

Office / nonfacility calculation inputs
ComponentRVULocal GPCI
Work1.191
Practice expense1.571
Malpractice0.230.74

(1.19 × 1 + 1.57 × 1 + 0.23 × 0.74) × $33.4009 = $97.87

Facility

Facility calculation inputs
ComponentRVULocal GPCI
Work1.191
Practice expense0.371
Malpractice0.230.74

(1.19 × 1 + 0.37 × 1 + 0.23 × 0.74) × $33.4009 = $57.79

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

64643 · Office / nonfacility

$97.87

Effective 2026-10-01

The base rate is $8.92 higher than on 2025-10-01, moving from $88.95 to $97.87 (10.0%).

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

    $88.95changed to$97.87

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 1.22 changed to 1.19
    • Practice expense RVU 1.36 changed to 1.57
    • Malpractice GPCI 0.739 changed to 0.740

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    Earliest loaded release: $88.95

    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$97.87$57.79RVU26D
2026-07-01$97.87$57.79RVU26C
2026-04-01$97.87$57.79RVU26B
2026-01-01$97.87$57.79RVU26A
2025-10-01$88.95$65.34RVU25D
2025-07-01$88.95$65.34RVU25C
2025-04-01$88.95$65.34RVU25B
2025-01-01$88.95$65.34RVU25A

64643 billing questions

When is 64643 used instead of 64642?

64642 reports the primary extremity treated with one to four muscles. Use 64643 for each additional extremity treated with one to four muscles during the service.

Can 64643 be billed by itself?

No. It is an add-on code and must be reported with a primary procedure, generally 64642 for the first extremity.

Is the code counted per muscle or per extremity?

It is counted per additional extremity. The extremity must have one to four muscles treated; the code is not reported once for each muscle or injection site.

When should 64645 be used instead?

Use 64645 for an additional extremity when five or more muscles are treated there. The one-to-four muscle threshold is evaluated separately for each extremity.

What documentation supports 64643?

Document the additional extremity, the muscles treated in that limb, the indication for chemodenervation, and the treatment performed.

How does the global-period rule affect 64643?

CMS treats 64643 as an add-on service paid within the primary procedure’s global period. It must accompany a primary procedure.

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 64643PPRRVU2026_Oct_nonQPP.csv, line 7,186 (RVU26D)
Geographic factors for Wyoming**GPCI2026.csv, line 112 (RVU26D)
Open CMS sourceHow this rate is calculatedBuild a fee sheet