2025 CPT code 64645
(Active) Effective Date: N/A Revision Date: N/A Surgical Procedures on the Nervous System - Chemodenervation Surgery Feed
Chemodenervation of an additional extremity; 5 or more muscles (add-on code).
Modifiers may be applicable depending on the circumstances of the service.Consult the CPT codebook and any payer-specific guidelines.Modifiers such as -59 (distinct procedural service), -TC (technical component), and -26 (professional component) might be relevant.
Chemodenervation is medically necessary for the treatment of spasticity, dystonia, or other conditions causing muscle spasms that significantly impact the patient's function and quality of life. Documentation should clearly link the symptoms to the need for this intervention.
The physician injects a chemical agent to paralyze muscles, relieving pain and spasms. The physician must ensure appropriate patient selection, accurate injection technique, and post-procedure monitoring for potential side effects.
In simple words: This code is for a special injection to relax muscles and ease pain and spasms. It's only used if the doctor already treated one arm or leg with the same injection and needs to treat another area with many muscles.
This CPT code, 64645, represents chemodenervation of five or more muscles in an additional extremity.It's an add-on code, requiring the primary procedure code (64644) for chemodenervation of the initial extremity to also be reported. The procedure involves injecting a pharmacologic agent, such as botulinum toxin (e.g., Botox, Dysport, Xeomin), or atropine, to interrupt nerve signals, thus paralyzing the targeted muscles to alleviate pain and spasms.This code is used only when more than five muscles in an additional extremity require chemodenervation beyond the initial extremity addressed by code 64644.
Example 1: A patient with cervical dystonia presents with significant spasms affecting multiple muscles in both arms. Code 64644 is used for the initial arm treated, and 64645 is added for the second arm, involving 5 or more muscles., A patient with spasticity secondary to multiple sclerosis requires chemodenervation in both legs. Code 64644 is billed for one leg, and 64645 for the second leg, after treating 5 or more muscles., A patient with upper extremity focal dystonia has spasms in both arms. After performing chemodenervation in the right arm (64644),5 or more muscles in the left arm require treatment, necessitating code 64645.
* Detailed history and physical examination documenting the need for chemodenervation.* Imaging studies (if any) used to guide the procedure.* Documentation of muscle(s) injected and the amount of the neurolytic agent used.* Confirmation that 5 or more muscles are injected into an additional extremity after the initial one.* Post-procedure assessment and follow-up notes.
** Always verify the specific requirements of the payer for reporting this add-on code.Appropriate drug codes (J0585, J0587, J0588) must also be reported for the botulinum toxin used in the procedure.
- Revenue Code: P6C (Medicare Fee Schedule: MINOR PROCEDURES - OTHER)
- RVU: RVUs will vary depending on the location and payer.Consult the relevant fee schedule for specific values.
- Global Days: Not applicable; this is an add-on code.
- Payment Status: Active
- Modifier TC rule: A technical component modifier (-TC) may be appropriate if the physician does not personally perform the injection (e.g., uses a technician). The professional component would then be reported using modifier -26.
- Fee Schedule: Consult your payer's fee schedule for historical data.
- Specialties:Neurology, physiatry, pain management
- Place of Service:Office, hospital outpatient, ambulatory surgical center