$186.28–$201.37
64644 represents the primary extremity treated at the five-or-more-muscle level. 64645 represents each additional extremity treated at that level.
On this page
CMS RVU26D · Effective 2026-10-01
64645 Muscle chemodenervation Medicare reimbursement rates in Oregon
Reports chemodenervation of each additional extremity when five or more muscles are treated there, alongside the primary extremity service. Compare 64645 office and facility rates across CMS payment localities in Oregon.
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 64645 in Oregon?
Oregon has 2 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 2 payment areas shown below, using the same CMS release.
Office / nonfacility
$125.93–$135.50
2 of 2 localities have a supported rate.
Facility setting
$67.05–$69.82
2 of 2 localities have a supported rate.
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.
Chemodenervation
About 64645: Additional extremity muscle chemodenervation
Reports chemodenervation of each additional extremity when five or more muscles are treated there, alongside the primary extremity service.
This code represents chemodenervation in an additional arm or leg when treatment involves five or more muscles in that extremity. It commonly accompanies botulinum toxin treatment for spasticity after stroke or in neurologic conditions such as cerebral palsy, and may be performed by a neurologist, physiatrist, or another qualified clinician in an office or outpatient facility. The service is counted by extremity, not by injection or toxin dose.
Report it only with the primary code for treatment of one extremity involving five or more muscles, 64644. Use one unit for each additional extremity that meets the five-muscle threshold. Documentation should identify each treated extremity, the muscles injected, and the clinical reason for treatment. CMS classifies this as an add-on service; payment is made within the primary procedure’s global period.
CMS billing rules for 64645
- 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 RVU1.36 · 35%
- Practice expense (office) RVU2.18 · 56%
- Malpractice RVU0.34 · 9%
8.8K
Medicare services in 2024 · #1542 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.
64645 compared with similar codes
Office rates for Oregon, from the same CMS release.
$97.38–$104.36
64643 is for each additional extremity when only one to four muscles are treated there; 64645 is for five or more.
$165.20–$177.78
64646 covers trunk-muscle chemodenervation, not treatment of an additional arm or leg.
Compare 64645 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.
2 of 2 payment localities
Portland →
Office / nonfacility
$135.50
Facility
$69.82
Rest Of Oregon →
Office / nonfacility
$125.93
Facility
$67.05
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64645 billing questions
When is 64645 used instead of 64644?
Use 64644 for the initial extremity when five or more muscles are treated. Use 64645 for each additional extremity treated at that same muscle-count level.
Can 64645 be billed by itself?
No. It is an add-on code and must be reported with 64644 for the primary extremity service.
How are units counted?
Count one unit for each additional extremity in which five or more muscles are treated. The unit count is not based on the number of injections or toxin dose.
What documentation supports a unit of 64645?
Document the additional extremity, the muscles injected there, and the treatment indication. The record should support that at least five muscles were treated in that extremity.
How does the add-on status affect payment?
CMS pays 64645 within the global period of its primary procedure. It must accompany 64644 rather than stand alone.
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.
7,18564642,,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
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