$103.82
64643 is for each additional extremity treated in the one-to-four-muscle range; 64642 reports the first extremity in that range.
On this page
CMS RVU26D · Effective 2026-10-01
64642 Chemodenervation Medicare reimbursement rates in Guam
Reports botulinum toxin chemodenervation of one extremity when treatment targets one to four muscles, commonly for focal spasticity or dystonia. Compare 64642 office and facility rates across CMS payment localities in Guam.
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 64642 in Guam?
Guam has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
$171.07
1 of 1 localities have a supported rate.
Payment area: Hawaii, Guam
One mapped payment locality.
Facility setting
$94.74
1 of 1 localities have a supported rate.
Payment area: Hawaii, Guam
One mapped payment locality.
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.
Neurology procedure
About 64642: Extremity chemodenervation, one to four muscles
Reports botulinum toxin chemodenervation of one extremity when treatment targets one to four muscles, commonly for focal spasticity or dystonia.
A clinician injects a chemodenervating agent, commonly botulinum toxin, into one to four muscles in a single arm or leg. Neurologists and physical medicine and rehabilitation physicians commonly perform this treatment for focal spasticity, such as after stroke or in cerebral palsy, and for focal dystonia. Services may occur in an office or outpatient hospital. The code represents the treated extremity and muscle-count range, not the number of injection sites or the amount of drug administered.
Document the treated extremity, each muscle injected, and the condition being treated. For another extremity in the same one-to-four-muscle range, report the additional-extremity code 64643 rather than modifier 50. Medicare assigns 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 other procedures are subject to the standard 50% multiple-procedure reduction. Medicare does not pay an assistant at surgery for this service; co-surgeon and team-surgery reporting are not permitted.
CMS billing rules for 64642
- 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
- Statutory restriction: assistant at surgery is not paid.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU1.61 · 33%
- Practice expense (office) RVU2.89 · 59%
- Malpractice RVU0.39 · 8%
44.8K
Medicare services in 2024 · #823 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.
64642 compared with similar codes
Office rates for Guam, from the same CMS release.
$201.29
Choose 64644 when five or more muscles are treated in one extremity. Choose 64642 for one to four muscles in that extremity.
$134.79
64645 reports each additional extremity when five or more muscles are treated there; it is not the additional-extremity code for the one-to-four-muscle range.
$176.68
64646 is for chemodenervation of trunk muscles. Code 64642 is for one extremity treated in the one-to-four-muscle range.
Compare 64642 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.
1 of 1 payment localities
Hawaii, Guam →
Office / nonfacility
$171.07
Facility
$94.74
Need rates for a whole code list?
Fee-sheet and API access are in early access. Tell us which codes and locations your team needs.
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 64642 in Hawaii, Guam.
PPRRVU2026_Oct_nonQPP.csv
7,185
- Code
- 64642
- Physician work
- 1.61
- Practice expense
- 2.89
- Malpractice
- 0.39
GPCI2026.csv
46
- Locality
- Hawaii, Guam
- Physician work
- 1.000
- Practice expense
- 1.137
- Malpractice
- 0.579
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 1.61 | × 1.000 | 1.6100 |
| Practice expense | 2.89 | × 1.137 | 3.2859 |
| Malpractice | 0.39 | × 0.579 | 0.2258 |
| Total RVUs | 5.1217 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Hawaii, Guam$171.07
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 1.61 | 1 |
| Practice expense | 2.89 | 1.137 |
| Malpractice | 0.39 | 0.579 |
(1.61 × 1 + 2.89 × 1.137 + 0.39 × 0.579) × $33.4009 = $171.07
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 1.61 | 1 |
| Practice expense | 0.88 | 1.137 |
| Malpractice | 0.39 | 0.579 |
(1.61 × 1 + 0.88 × 1.137 + 0.39 × 0.579) × $33.4009 = $94.74
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.
64642 billing questions
Is 64642 reported per muscle or per extremity?
It represents one extremity treated in the one-to-four-muscle range. Document the individual muscles treated; do not count each muscle or injection site as a separate unit of 64642.
How should treatment of both arms or both legs be reported?
Report 64642 for one extremity and, when the additional extremity is treated in the same one-to-four-muscle range, report 64643 for that additional extremity. Do not use modifier 50.
When should 64644 be used instead?
Use 64644 when five or more muscles are treated in one extremity. The distinction is the number of muscles treated in that extremity, not the number of injection sites.
Are toxin units or injection sites counted as units of 64642?
No. The code is selected by the number of muscles treated in the extremity. Drug quantity and injection sites are not the basis for counting this procedure code.
What same-day care is included in 64642?
Medicare assigns a 0-day global period, which includes same-day preoperative and postoperative care. Other procedures performed in the same session are subject to the standard multiple-procedure reduction.
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.
7,18264635,,Destroy lumb/sac facet jnt,A,,3.24,10.39,,1.65,,0.29,13.92,5.18,0,010,0.10,0.80,0.10,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,18364636,,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
4309102,FL,99,REST OF FLORIDA,1.000,0.956,1.503
4410212,GA,01,ATLANTA,1.003,1.016,1.201
4510212,GA,99,REST OF GEORGIA,1.000,0.892,1.192
4601212,HI,01,"HAWAII, GUAM",1.000,1.137,0.579
4702202,ID,00,IDAHO,1.000,0.920,0.473
4806102,IL,16,CHICAGO,1.007,1.005,2.295
4906102,IL,12,EAST ST. LOUIS,1.000,0.920,2.014