2025 CPT code 64642

Chemodenervation of one extremity; 1-4 muscle(s).

Report only one base code (64642 or 64644) per session. Use add-on code 64643 for additional extremities with 1-4 muscles injected.The supply of the chemodenervation agent is reported separately using HCPCS Level II J codes (e.g., J0585 for Botulinum toxin type A).

Modifiers like 50, RT or LTare not appropriate with codes 64642-64647. If the service was discontinued prior to or after administration of anesthesia then modifier codes 73 or 74 can be applied. For multiple procedures use modifier 51. For distinct procedural service use modifier 59.

Medical necessity must be established by documenting the underlying medical condition causing the muscle spasms or pain, and how the chemodenervation procedure is expected to improve the patient's functional status or quality of life.

The physician is responsible for administering the chemodenervating agent into the targeted muscles, ensuring proper localization and dosage. They also evaluate the patient's condition to determine the appropriate treatment strategy.

IMPORTANT For chemodenervation of 5 or more muscles in one extremity, use 64644. For each additional extremity with 1-4 muscles injected, use add-on code 64643. For each additional extremity with 5 or more muscles injected, use add-on code 64645.For chemodenervation of trunk muscles, use 64646 or 64647. For chemodenervation guided by needle electromyography, use 95874. For chemodenervation guided by electrical stimulation, see 95873. Do not report modifier 50 with this code.

In simple words: A chemical injection into one to four muscles in a limb (arm or leg) to relieve pain and spasms.

This code represents the injection of a chemodenervating agent (e.g., botulinum toxin) into 1 to 4 muscles of a single extremity to treat conditions such as muscle spasms and pain. This procedure involves injecting a pharmacologic compound to interrupt nerve signals, effectively paralyzing the targeted muscles to alleviate symptoms.

Example 1: A patient with spasticity in their right hand due to cerebral palsy receives injections in 3 muscles of the right arm., A patient with chronic pain in the left foot due to plantar fasciitis receives injections in 2 muscles of the left leg., A patient with muscle spasms in their left arm due to a brachial plexus injury receives injections into 4 muscles of the left arm.

Documentation should include the diagnosis, the specific muscles injected, the dosage of the chemodenervating agent, the needle placement technique (e.g., anatomical landmarks, ultrasound guidance), and the patient's response to treatment.

** It is essential to document the number of units of the chemodenervation agent used, discarded, and the national drug code number.

  • Payment Status: Active
  • Modifier TC rule: Modifiers TC and 26 are applicable when the provider is billing only for the technical component or the professional component.
  • Specialties:Neurology, Physical Medicine and Rehabilitation, Pain Management, Orthopedic Surgery
  • Place of Service:Office, Outpatient Hospital, Ambulatory Surgical Center
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