Billing code 64650: Eccrine chemodenervationMedicare rate & RVUs in Rhode Island
Reports chemodenervation of eccrine glands in both axillae, most often with botulinum toxin injections to treat axillary hyperhidrosis.
Medicare pays $88.53 for 64650 in the office in Rhode Island (Rhode Island). Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 9 sections
What 64650 covers
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.
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 in Rhode Island
| Payment locality | Office | Facility |
|---|---|---|
| Rhode Island | $88.53 | $33.67 |
How the 64650 rate is calculated
Each of 64650’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 64650
RVUs × geographic indexes × conversion factor
Work0.68
0.68 RVUs× 1.000 GPCI
Practice expense1.80
1.80 RVUs× 1.000 GPCI
Malpractice0.11
0.11 RVUs× 1.000 GPCI
Adjusted RVUs
2.5900
Conversion factor
$33.4009
Medicare rate
$86.51
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 64650
The CMS indicators that decide how 64650 is paid alongside other services.
CMS payment indicators · 64650
Eccrine chemodenervation
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 000 | Same-day global: pre- and post-op care on the day of the procedure is included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 0 | Not paid without supporting documentation. |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
64650 without 51 · national office
$86.51
Eccrine chemodenervation
64650-51 · Second procedure: 50%
$43.26
When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).
64650 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 64653Sweat gland treatment
- 64650 covers both axillae. 64653 is for eccrine-gland treatment in other areas, such as the palms or scalp.
- 64642Chemodenervation
- 64642 treats muscles in one extremity, not eccrine glands. Choose 64650 for axillary hyperhidrosis treatment.
- 64643Chemodenervation
- 64643 is an additional-muscle code for extremity chemodenervation. It does not describe treatment of sweat glands.
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 indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file lines behind this rate
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