$80.84–$89.62
64650 is for axillary eccrine-gland treatment; 64653 is for other sites, including palms, face, and scalp.
On this page
CMS RVU26D · Effective 2026-10-01
64653 Sweat gland treatment Medicare reimbursement rates in Texas
Reports chemodenervation injections for focal hyperhidrosis at nonaxillary sites such as the palms, face, or scalp, counted per day. Compare 64653 office and facility rates across CMS payment localities in Texas.
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 64653 in Texas?
Texas has 8 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 8 payment areas shown below, using the same CMS release.
Office / nonfacility
$95.70–$105.55
8 of 8 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.
Where 64653 pays more and less in Texas
8 payment localities
$95.70 to $105.55
Chemodenervation
About 64653: Nonaxillary eccrine gland chemodenervation
Reports chemodenervation injections for focal hyperhidrosis at nonaxillary sites such as the palms, face, or scalp, counted per day.
This service involves injecting a chemodenervating medication into eccrine sweat-producing areas to reduce excessive sweating. Dermatologists and other clinicians may treat focal hyperhidrosis on nonaxillary sites such as the palms, face, or scalp, typically in an office setting. The code covers treatment of these other areas, rather than axillary treatment reported with 64650.
Report the service per day, not per injection or treated site, and document the condition, the locations treated, and the medication and administration details. The drug may be separately reportable when supplied and payable. The code has a 0-day global period, so same-day preoperative and postoperative care is included. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and the others at 50%. Modifier 50 is inappropriate for this code. Assistant-at-surgery payment requires medical-necessity documentation; co-surgeons and team surgery are not permitted.
CMS billing rules for 64653
- 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 RVU0.86 · 28%
- Practice expense (office) RVU2.03 · 66%
- Malpractice RVU0.17 · 6%
381
Medicare services in 2024 · #3779 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.
64653 compared with similar codes
Office rates for Texas, from the same CMS release.
$153.72–$167.98
64642 describes chemodenervation of a limited number of muscles in one extremity. Use 64653 when the treatment target is eccrine glands rather than muscle.
$179.13–$196.17
64644 is for chemodenervation of five or more muscles in one extremity. It does not describe treatment of sweat glands.
Compare 64653 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.
8 of 8 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Austin | Office $105.55 | Facility $43.00 |
| Beaumont | Office $95.70 | Facility $41.90 |
| Brazoria | Office $100.58 | Facility $41.99 |
| Dallas | Office $101.39 | Facility $42.50 |
| Fort Worth | Office $100.78 | Facility $42.49 |
| Galveston | Office $100.99 | Facility $42.28 |
| Houston | Office $104.10 | Facility $45.39 |
| Rest Of Texas | Office $98.20 | Facility $42.09 |
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.
64653 billing questions
When should I report 64653 instead of 64650?
Use 64653 for treatment of eccrine glands at nonaxillary sites, such as the palms, face, or scalp. Code 64650 is for axillary treatment.
Is the code reported for each injection or site?
No. Report it per day for the nonaxillary eccrine-gland treatment, and document the treated locations.
Should I append modifier 50 for both sides?
No. CMS identifies bilateral adjustment as inapplicable because the descriptor or anatomy makes modifier 50 inappropriate.
Can the medication be billed separately?
The drug may be separately reportable when it is supplied and payable. Document the medication and administration details.
How does the multiple-procedure rule affect payment?
When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and the others at 50%.
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.
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.
7,18964646,,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
7,19564656,,Revj/rplcmt bat mod sys pg,A,,8.01,2.80,NA,2.80,,1.98,12.79,12.79,0,090,0.11,0.76,0.13,2,1,0,1,1,9,,33.4009,09,0,99,0.00,0.00,0.00