$176.43
Both cover trunk muscle chemodenervation; choose 64646 for one to five muscles and 64647 for six or more.
On this page
CMS RVU26D · Effective 2026-10-01
64646 Muscle chemodenervation Medicare reimbursement rates in Kentucky
Reports botulinum toxin chemodenervation of one to five trunk muscles to manage focal muscle overactivity, such as truncal spasticity or dystonia. Compare 64646 office and facility rates across CMS payment localities in Kentucky.
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 64646 in Kentucky?
Kentucky 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
$158.38
1 of 1 localities have a supported rate.
Payment area: Kentucky
One mapped payment locality.
Facility setting
$99.29
1 of 1 localities have a supported rate.
Payment area: Kentucky
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 64646: Trunk muscle chemodenervation, one to five muscles
Reports botulinum toxin chemodenervation of one to five trunk muscles to manage focal muscle overactivity, such as truncal spasticity or dystonia.
A clinician injects a chemodenervating agent, commonly botulinum toxin, into one to five trunk muscles to reduce focal overactivity. Neurologists, physiatrists, and other clinicians who treat spasticity or dystonia may perform the service in an office or outpatient procedure setting. Trunk targets can include paraspinal or abdominal muscles; this code is not for injections into limb muscles or eccrine glands.
Select the code by the number of distinct trunk muscles treated during the session, not by the number of injection sites or toxin units. Document the treated muscles, clinical indication, and injection details. Use the six-or-more-muscle trunk code when that threshold is reached. The service has 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 others at 50%. Modifier 50 is inappropriate. Assistant-at-surgery payment is statutorily restricted; co-surgeons and team surgery are not permitted.
CMS billing rules for 64646
- 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 RVU1.76 · 35%
- Practice expense (office) RVU2.86 · 56%
- Malpractice RVU0.48 · 9%
9.7K
Medicare services in 2024 · #1486 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.
64646 compared with similar codes
Office rates for Kentucky, from the same CMS release.
$151.51
64642 applies to one extremity with one to four muscles treated. Use 64646 for trunk muscles.
$176.46
64644 applies to one extremity with five or more muscles treated; 64646 is for one to five trunk muscles.
Compare 64646 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
Kentucky →
Office / nonfacility
$158.38
Facility
$99.29
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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 64646 in Kentucky.
PPRRVU2026_Oct_nonQPP.csv
7,189
- Code
- 64646
- Physician work
- 1.76
- Practice expense
- 2.86
- Malpractice
- 0.48
GPCI2026.csv
55
- Locality
- Kentucky
- Physician work
- 1.000
- Practice expense
- 0.889
- Malpractice
- 0.915
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 1.76 | × 1.000 | 1.7600 |
| Practice expense | 2.86 | × 0.889 | 2.5425 |
| Malpractice | 0.48 | × 0.915 | 0.4392 |
| Total RVUs | 4.7417 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Kentucky$158.38
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 1.76 | 1 |
| Practice expense | 2.86 | 0.889 |
| Malpractice | 0.48 | 0.915 |
(1.76 × 1 + 2.86 × 0.889 + 0.48 × 0.915) × $33.4009 = $158.38
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 1.76 | 1 |
| Practice expense | 0.87 | 0.889 |
| Malpractice | 0.48 | 0.915 |
(1.76 × 1 + 0.87 × 0.889 + 0.48 × 0.915) × $33.4009 = $99.29
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.
64646 billing questions
How is this code distinguished from the six-or-more trunk muscle code?
Count the distinct trunk muscles treated during the session. Report this code for one to five muscles and the six-or-more code when at least six are treated.
Do injection sites or toxin units determine the code?
No. The threshold is based on the number of trunk muscles treated, not the number of needle placements or units of medication.
Can modifier 50 be used for bilateral trunk injections?
No. CMS identifies bilateral adjustment as inappropriate for this code; do not use modifier 50 to represent treatment on both sides.
Is same-day evaluation or postoperative care separately included?
The code has a 0-day global period, with same-day preoperative and postoperative care included.
How are other procedures in the same session paid?
Under the standard multiple procedure reduction, the highest-valued procedure is paid in full and other procedures are paid at 50%.
Can an assistant, co-surgeon, or surgical team be reported?
Assistant-at-surgery payment is statutorily restricted. 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.
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
7,19064647,,Chemodenerv trunk musc 6/>,A,,2.06,3.11,,0.92,,0.50,5.67,3.48,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,19164650,,Chemodenerv eccrine glands,A,,0.68,1.80,,0.21,,0.11,2.59,1.00,0,000,0.00,0.00,0.00,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,19264653,,Chemodenerv eccrine glands,A,,0.86,2.03,,0.26,,0.17,3.06,1.29,0,000,0.00,0.00,0.00,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5208102,IN,00,INDIANA,1.000,0.927,0.486
5305102,IA,00,IOWA,1.000,0.915,0.397
5405202,KS,00,KANSAS,1.000,0.904,0.504
5515102,KY,00,KENTUCKY,1.000,0.889,0.915
5607202,LA,01,NEW ORLEANS,1.000,0.941,1.136
5707202,LA,99,REST OF LOUISIANA,1.000,0.885,0.958
5814112,ME,03,SOUTHERN MAINE,1.000,0.991,0.631