$167.47–$205.87
64642 covers the primary extremity treated with one to four muscles. 64643 is for each additional extremity in that same muscle-count range.
On this page
CMS RVU26D · Effective 2026-10-01
64643 Chemodenervation Medicare reimbursement rates in California
Reports chemodenervation of an additional extremity when treatment targets one to four muscles there, alongside the primary extremity procedure. Compare 64643 office and facility rates across CMS payment localities in California.
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.
What does Medicare pay for 64643 in California?
California has 29 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 29 payment areas shown below, using the same CMS release.
Office / nonfacility
$102.01–$123.85
29 of 29 localities have a supported rate.
Lowest: Chico
Highest: San Jose-Sunnyvale-Santa Clara (San Benito Cnty)
A spread of $21.84 per service.
Facility setting
$58.09–$66.06
29 of 29 localities have a supported rate.
Lowest: Chico
Highest: San Jose-Sunnyvale-Santa Clara (San Benito Cnty)
A spread of $7.97 per service.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Where 64643 pays more and less in California
29 payment localities
$102.01 to $123.85
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 California, from the same CMS release.
$196.88–$243.28
64644 applies to the primary extremity when five or more muscles are treated; 64643 is for an additional extremity with one to four muscles.
$132.09–$161.51
Both codes describe an additional extremity, but 64645 is used when five or more muscles are treated there; 64643 is for one to four.
Compare 64643 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
29 of 29 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Bakersfield | Office $102.65 | Facility $58.73 |
| Chico | Office $102.01 | Facility $58.09 |
| El Centro | Office $102.05 | Facility $58.12 |
| Fresno | Office $102.01 | Facility $58.09 |
| Hanford-Corcoran | Office $102.01 | Facility $58.09 |
| Los Angeles-Long Beach-Anaheim (Los Angeles/Orange Cnty) | Office $108.51 | Facility $61.10 |
| Madera | Office $102.01 | Facility $58.09 |
| Merced | Office $102.01 | Facility $58.09 |
| Modesto | Office $102.01 | Facility $58.09 |
| Napa | Office $115.27 | Facility $62.44 |
| Oxnard-Thousand Oaks-Ventura | Office $107.63 | Facility $60.25 |
| Redding | Office $102.01 | Facility $58.09 |
| Rest Of California | Office $102.01 | Facility $58.09 |
| Riverside-San Bernardino-Ontario | Office $104.49 | Facility $60.56 |
| Sacramento-Roseville-Folsom | Office $106.28 | Facility $59.67 |
| Salinas | Office $105.87 | Facility $59.42 |
| San Diego-Chula Vista-Carlsbad | Office $107.82 | Facility $59.88 |
| San Francisco-Oakland-Berkeley (Marin Cnty) | Office $120.99 | Facility $64.47 |
| San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty) | Office $120.73 | Facility $64.21 |
| San Jose-Sunnyvale-Santa Clara (San Benito Cnty) | Office $123.85 | Facility $66.06 |
| San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty) | Office $122.79 | Facility $64.99 |
| San Luis Obispo-Paso Robles | Office $104.27 | Facility $58.62 |
| Santa Cruz-Watsonville | Office $108.41 | Facility $59.71 |
| Santa Maria-Santa Barbara | Office $106.12 | Facility $59.39 |
| Santa Rosa-Petaluma | Office $109.45 | Facility $60.23 |
| Stockton | Office $102.01 | Facility $58.09 |
| Vallejo | Office $114.89 | Facility $62.07 |
| Visalia | Office $102.01 | Facility $58.09 |
| Yuba City | Office $102.01 | Facility $58.09 |
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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.
7,18364636,,Destroy l/s facet jnt addl,A,,1.13,6.29,,0.28,,0.11,7.53,1.52,0,ZZZ,0.00,0.00,0.00,0,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,18464640,,Injection treatment of nerve,A,,1.93,5.86,,1.19,,0.22,8.01,3.34,0,010,0.10,0.80,0.10,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,18564642,,Chemodenerv 1 extremity 1-4,A,,1.61,2.89,,0.88,,0.39,4.89,2.88,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,18664643,,Chemodenerv 1 extrem 1-4 ea,A,,1.19,1.57,,0.37,,0.23,2.99,1.79,0,ZZZ,0.00,0.00,0.00,0,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,18764644,,Chemodenerv 1 extrem 5/> mus,A,,1.77,3.54,,0.93,,0.40,5.71,3.10,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,18864645,,Chemodenerv 1 extrem 5/> ea,A,,1.36,2.18,,0.41,,0.34,3.88,2.11,0,ZZZ,0.00,0.00,0.00,0,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,18964646,,Chemodenerv trunk musc 1-5,A,,1.76,2.86,,0.87,,0.48,5.10,3.11,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00