$100.25–$108.74
64650 covers both axillae. 64653 is for eccrine-gland treatment in other areas, such as the palms or scalp.
On this page
CMS RVU26D · Effective 2026-10-01
64650 Eccrine chemodenervation Medicare reimbursement rates in Oregon
Reports chemodenervation of eccrine glands in both axillae, most often with botulinum toxin injections to treat axillary hyperhidrosis. Compare 64650 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 64650 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
$85.18–$92.60
2 of 2 localities have a supported rate.
Facility setting
$32.28–$33.60
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 64650: Axillary eccrine gland chemodenervation
Reports chemodenervation of eccrine glands in both axillae, most often with botulinum toxin injections to treat axillary hyperhidrosis.
This service covers chemodenervation of the sweat glands in both armpits, usually by intradermal botulinum toxin injections for axillary hyperhidrosis. Dermatologists and other clinicians who treat excessive sweating commonly perform it in an office setting. The code represents treatment of both axillae together, rather than a separate service for each side.
Report the code when documentation identifies the axillary treatment sites and supports the clinical indication; retain the injection record and medication details. Other eccrine-gland areas are reported with 64653. Same-day preoperative and postoperative care is included in this 0-day global service. When other procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% multiple-procedure reduction. Assistant-at-surgery payment requires documented medical necessity; co-surgeons and team surgery are not permitted.
CMS billing rules for 64650
- 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
- Assistant at surgery is paid only with documentation of medical necessity.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU0.68 · 26%
- Practice expense (office) RVU1.80 · 69%
- Malpractice RVU0.11 · 4%
1.2K
Medicare services in 2024 · #2843 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.
64650 compared with similar codes
Office rates for Oregon, from the same CMS release.
$159.08–$171.57
64642 treats muscles in one extremity, not eccrine glands. Choose 64650 for axillary hyperhidrosis treatment.
$97.38–$104.36
64643 is an additional-muscle code for extremity chemodenervation. It does not describe treatment of sweat glands.
Compare 64650 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
$92.60
Facility
$33.60
Rest Of Oregon →
Office / nonfacility
$85.18
Facility
$32.28
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64650 billing questions
Should 64650 be reported once or once per axilla?
Report it once for treatment of both axillae. The bilateral anatomy is already represented, so modifier 50 is inappropriate.
When should 64653 be used instead?
Use 64653 for chemodenervation of eccrine glands in areas other than the axillae. If other areas are treated in addition to both axillae, report the applicable service for those areas as well.
Is the botulinum toxin medication included in 64650?
The procedure code describes the chemodenervation service, not a specific drug. When the practice supplies the medication, report the applicable drug code separately under the relevant billing rules.
What documentation supports 64650?
Document the indication, both axillary treatment sites, the procedure performed, and the medication and administration details. The injection record should support the service billed.
How does the multiple-procedure reduction affect 64650?
When it is performed with other procedures in the same session, the highest-valued procedure is paid in full and the others are subject to the standard 50% reduction.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment requires documentation of medical necessity. 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.
7,18864645,,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
7,19364654,,1st opn implt bat modulj sys,A,,11.00,2.96,NA,2.96,,2.79,16.75,16.75,0,090,0.11,0.76,0.13,2,1,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,19464655,,Revj/rplcmt bat mod sys lead,A,,11.30,5.40,NA,5.40,,2.59,19.29,19.29,0,090,0.11,0.76,0.13,2,1,0,1,1,9,,33.4009,09,0,99,0.00,0.00,0.00