$155.93
Both apply to one extremity; 64642 is selected for one to four treated muscles, while 64644 is for five or more.
On this page
CMS RVU26D · Effective 2026-10-01
64644 Muscle chemodenervation Medicare reimbursement rates in Vermont
Reports chemodenervation injections into five or more muscles in one arm or leg, commonly to reduce focal spasticity or other involuntary muscle activity. Compare 64644 office and facility rates across CMS payment localities in Vermont.
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 64644 in Vermont?
Vermont 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
$182.94
1 of 1 localities have a supported rate.
Payment area: Vermont
One mapped payment locality.
Facility setting
$96.63
1 of 1 localities have a supported rate.
Payment area: Vermont
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 64644: Extremity chemodenervation, five or more muscles
Reports chemodenervation injections into five or more muscles in one arm or leg, commonly to reduce focal spasticity or other involuntary muscle activity.
This service covers injection of a chemodenervating agent into five or more muscles in a single extremity to reduce unwanted muscle activity. Neurologists, physiatrists, and other clinicians who manage movement disorders or spasticity commonly perform it in outpatient clinics and hospital settings. Treatment may address focal upper- or lower-extremity muscle overactivity, including patterns that interfere with positioning, movement, or daily function.
Select the code by counting the muscles treated in that extremity, not the number of injection sites or the drug units. Documentation should identify the treated extremity and muscles, the treatment plan, and the administered product and dose. A separately treated additional extremity may support an additional-extremity code. The 0-day global period includes same-day preoperative and postoperative care. When multiple procedures are performed in one session, the highest-valued procedure is paid in full and others are subject to the standard 50% reduction. Modifier 50 is inappropriate. Assistant-at-surgery payment is restricted, and co-surgeons and team surgery are not permitted.
CMS billing rules for 64644
- 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 RVU1.77 · 31%
- Practice expense (office) RVU3.54 · 62%
- Malpractice RVU0.40 · 7%
38.6K
Medicare services in 2024 · #886 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.
64644 compared with similar codes
Office rates for Vermont, from the same CMS release.
$123.26
64645 describes treatment of five or more muscles in an additional extremity. This code describes the first extremity treated.
$161.47
64646 applies to chemodenervation of trunk muscles. Use 64644 for five or more muscles in one extremity.
Compare 64644 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
Vermont →
Office / nonfacility
$182.94
Facility
$96.63
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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 64644 in Vermont.
PPRRVU2026_Oct_nonQPP.csv
7,187
- Code
- 64644
- Physician work
- 1.77
- Practice expense
- 3.54
- Malpractice
- 0.40
GPCI2026.csv
105
- Locality
- Vermont
- Physician work
- 1.000
- Practice expense
- 0.990
- Malpractice
- 0.506
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 1.77 | × 1.000 | 1.7700 |
| Practice expense | 3.54 | × 0.990 | 3.5046 |
| Malpractice | 0.40 | × 0.506 | 0.2024 |
| Total RVUs | 5.4770 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Vermont$182.94
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 1.77 | 1 |
| Practice expense | 3.54 | 0.99 |
| Malpractice | 0.4 | 0.506 |
(1.77 × 1 + 3.54 × 0.99 + 0.4 × 0.506) × $33.4009 = $182.94
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 1.77 | 1 |
| Practice expense | 0.93 | 0.99 |
| Malpractice | 0.4 | 0.506 |
(1.77 × 1 + 0.93 × 0.99 + 0.4 × 0.506) × $33.4009 = $96.63
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.
64644 billing questions
How is this distinguished from 64642?
Both describe treatment in one extremity. Use 64644 when five or more muscles in that extremity are treated; 64642 is for one to four.
Does the muscle count refer to injections or muscles?
Count the muscles treated, not injection sites, needle passes, or units of medication. The record should identify the muscles injected.
Can another extremity be reported separately?
Yes, when treatment is performed in an additional extremity, the applicable additional-extremity code may be reported. Match that code to the number of muscles treated in the additional extremity.
Should modifier 50 be used for both sides?
No. The CMS bilateral adjustment does not apply, and modifier 50 is inappropriate for this service. Report qualifying treatment by extremity using the applicable code structure.
Is the chemodenervating drug included?
This code represents the injection service. When the practice supplies the drug, the drug may be reported separately under the applicable drug code, supported by documentation of the product and dose.
What happens when other procedures are performed in the same session?
The highest-valued procedure is paid in full, and other procedures subject to the standard multiple-procedure rule are paid at 50% when performed in the same session.
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.
7,18464640,,Injection treatment of nerve,A,,1.93,5.86,,1.19,,0.22,8.01,3.34,0,010,0.10,0.80,0.10,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
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
10204412,TX,18,HOUSTON,1.008,0.993,1.376
10304412,TX,99,REST OF TEXAS,1.000,0.949,0.903
10403502,UT,09,UTAH,1.000,0.940,0.898
10514512,VT,50,VERMONT,1.000,0.990,0.506
10611302,VA,00,VIRGINIA,1.000,0.983,0.706
10709202,VI,50,VIRGIN ISLANDS,1.000,1.011,0.985
10802402,WA,02,SEATTLE (KING CNTY),1.050,1.227,0.817