CPT 64642: Neurolytic Injection for Extremity Muscle Spasm

Medicare pays $168 and commercial payers pay $463 on average nationally for this procedure.

CPT code 64642 describes injection of a chemical neurolytic agent (for example, Botox®) into one to four muscles of a single extremity to relieve pain and muscle spasms; this is a minor procedural pain-management service typically performed in an outpatient clinic, ambulatory surgical center, or office-based procedure setting under local anesthesia or monitored anesthesia care.

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National Reimbursement Benchmarks

Medicare's mean rate for CPT 64642 sits at $167.50, while BUCA’s average commercial mean is substantially higher at $463.00; this highlights a clear gap between federal reimbursement and average commercial contracting levels. Blue Cross Blue Shield ($664.10 mean) and UnitedHealth Group ($237.00 mean) also sit above Medicare, with Cigna ($222.30 mean) and Aetna ($125.50 mean) spanning the middle-to-lower portions of the national spectrum.

Examining dispersion using the interquartile spread (P75–P25), Blue Cross Blue Shield has the widest spread at $290.90 ($800.20–$541.00), indicating the greatest variability among commercial contracts. Aetna is the tightest at $96.20 ($162.20–$63.40), followed by Cigna at $132.00 ($276.20–$145.20). UnitedHealth Group’s spread is $142.70 ($293.90–$151.20), and BUCA’s interquartile spread is $201.40 ($561.90–$360.50).

National Payer Mean Reimbursement Rates

State Reimbursement Rates

State: Alaska1 / 51

Rate by payer

Clinical & Coding Specifications

Clinical Context

A 58-year-old patient with chronic, focal spasticity of the right upper extremity following a stroke presents to a pain medicine clinic for management of persistent painful muscle spasms and impaired function. The patient reports focal clonus and sustained muscle contractions in the wrist and forearm despite oral muscle relaxants and targeted physical therapy. After evaluation, the pain medicine physician discusses focal chemical neurolysis using botulinum toxin to paralyze one to four affected muscles of the right upper extremity to reduce spasm, improve comfort, and facilitate rehab. The clinical workflow includes pre-procedure assessment (history, review of prior treatments, medication reconciliation, and informed consent), identification and localization of target muscles (clinical exam, sometimes guided by EMG or ultrasound), sterile injection of the selected muscles with the neurolytic agent (documenting laterality, number of muscles injected, units/dose), immediate post-procedure observation for adverse effects, and scheduling follow-up to assess response and need for repeat injections. Typical documentation includes indication, targeted muscle(s), laterality, technique and guidance used, agent and dose, number of muscles treated (1–4 for one extremity), and any complications or patient instructions. Typical sites of service are outpatient ambulatory surgery centers, hospital outpatient departments, and office-based procedure suites. Payors involved in authorization and claims for this service commonly include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, BUCA, and Medicare.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`64643`

Related Modifiers

12 rows

Modifier	Description	When to Use
26	Modifier 26 (Professional Component) identifies and bills only the professional portion of a split service — the physician’s interpretation, report, and medical judgment — when the technical…	- Use CPT Modifier -26 when you are billing only the professional component (PC) of a split‑bill eligible service—i.e., you performed the physician interpretation, medical judgment and prepared a…
50	Modifier –50 (Bilateral Procedure) is appended to a CPT code when an identical procedure is performed on paired anatomical structures during the same operative session. The AMA states to add…	- Use modifier -50 when the same CPT surgical, diagnostic, or radiology procedure is performed on paired anatomical structures (both sides of the body) during the same operative/session by the same…
51	Modifier –51 (Multiple Procedures) is used when the same provider performs multiple procedures in the same session to identify secondary, non‑exempt procedures and indicate payment reduction logic…	- Use modifier -51 when the same provider performs multiple distinct procedures during the same patient encounter: report the highest‑valued procedure first (no modifier) and append -51 to…
52	Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…	- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
53	Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…	- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
59	Modifier 59 indicates a distinct procedural service when two procedures that are not normally billed together are clinically and procedurally separate. The CPT definition (as reiterated by CMS)…	- Use modifier -59 to report a distinct procedural service when documentation supports that the procedure reported is not normally billed together with another service on the same day because of a…
62	Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…	- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
76	Modifier -76, Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional, is appended when the same provider performs an identical, medically necessary procedure or…	- Use modifier -76 when the same physician or other qualified health care professional performs an identical procedure or service a second (or subsequent) time on the same date of service and the…
78	CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…	- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…
79	Modifier 79 indicates a surgical procedure performed during the postoperative global period of a prior surgery that is unrelated to the original procedure. Per AMA/CPT and CMS guidance, it is…	- Use modifier 79 when the same physician (or same‑specialty physician in the same group) performs a surgical procedure during the postoperative global period of a prior surgery and the new procedure…

Showing 1–10 of 12

Related Provider Taxonomies

8 rows

Taxonomy Code	Specialty	Notes
208VP0000X	Pain Medicine Physician	Pain Medicine is a primary medical specialty based on a distinct body of knowledge and a well-defined scope of clinical practice that is founded on sc…
207LP2900X	Pain Medicine (Anesthesiology) Physician	An anesthesiologist who provides a high level of care, either as a primary physician or consultant, for patients experiencing problems with acute, chr…
207R00000X	Internal Medicine Physician	A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults…
364SP0811X	Chronically Ill Psychiatric/Mental Health Clinical Nurse Specialist	Physician Assistants & Advanced Practice Nursing Providers · Clinical Nurse Specialist
261QC0050X	Critical Access Hospital Clinic/Center	An outpatient entity, facility, or distinct part of a facility within or affiliated with a Critical Access Hospital that provides access to primary ca…
2085D0003X	Diagnostic Neuroimaging (Radiology) Physician	A licensed physician, who has completed a residency program in Neurology, and who has additional training, experience, and competence in the standards…
2278C0205X	Critical Care Certified Respiratory Therapist	Respiratory emergencies are commonplace in the treatment of critical care patients. Included in the assessment measurements conducted by the respirat…
204R00000X	Electrodiagnostic Medicine Physician	Electrodiagnostic medicine is the medical subspecialty that applies neurophysiologic techniques to diagnose, evaluate, and treat patients with impairm…

Related Payer Policy Updates

Specialty: Anesthesiology1 / 3

10 rows

Policy	Payer	Effective Date
Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric or Substance Use Disorders	Premera Bluecross	2026-07-01
Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric or Substance Use Disorders	Premera Bluecross	2026-07-01
Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric or Substance Use Disorders	Premera Bluecross	2026-07-01
Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric or Substance Use Disorders	Premera Bluecross	2026-07-01
Elective Inpatient Services (for Idaho Only)	UnitedHealthcare	2026-06-01
Sites of Service	priority health	2026-06-01
Coverage for Ambulatory Surgery Unit (ASU)/Outpatient Facility and Anesthesia for Dental Services	univerahealthcare	2026-05-21
Mm_0579_Coveragepositioncriteria_Anesthesia_Services_Selected_Nerve_Blocks	Cigna	2026-05-15
Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric Disorders	Blue Cross Blue Shield - North Carolina	2026-04-01
Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric Disorders	Blue Cross Blue Shield - North Carolina	2026-04-01

CPT 64600: Trigeminal Nerve Neurodestruction by Injection

CPT-64605-TRIGEMINAL-NERVE-NEURODESTRUCTIVE-INJECTION

CPT 64605: Trigeminal Nerve Neurodestructive Injection

CPT-64610-TRIGEMINAL-NERVE-NEURODESTRUCTIVE-INJECTION

CPT 64610: Trigeminal Nerve Neurodestructive Injection

CPT-64611-SALIVARY-GLAND-CHEMICAL-DENERVATION-BILATERAL

CPT 64611: Bilateral Salivary Gland Chemical Injection for Sialorrhea

CPT-64612-FACIAL-NERVE-CHEMICAL-NEUROLYSIS-UNILATERAL

CPT 64612: Facial Nerve Chemical Neurolysis, Unilateral

CPT-64615-BILATERAL-CHEMICAL-DENERVATION-FACIAL-CERVICAL-MUSCLES

CPT 64615: Bilateral Chemical Denervation of Head and Neck Muscles

CPT-64616-UNILATERAL-CERVICAL-MUSCLE-CHEMICAL-DENERVATION

CPT 64616: Unilateral Neck Muscle Chemodenervation

CPT-64617-PERCUTANEOUS-LARYNGEAL-CHEMODENERVATION-UNILATERAL

CPT 64617: Percutaneous Chemodenervation of Larynx, Unilateral

CPT-64620-INTERCOSTAL-NERVE-ABLATION

CPT 64620: Intercostal Nerve Destruction (Chemical/Heat/Radiofrequency)

CPT-64624-GENICULAR-NERVE-NEUROLYSIS-KNEE

CPT 64624: Genicular Nerve Neurolysis for Knee Pain

Showing 1–10 of 26

Frequently Asked Questions

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

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State Reimbursement Rates

State: Alaska1 / 51

Rate by payer

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`64643`

Related Modifiers

12 rows

Modifier	Description	When to Use
26	Modifier 26 (Professional Component) identifies and bills only the professional portion of a split service — the physician’s interpretation, report, and medical judgment — when the technical…	- Use CPT Modifier -26 when you are billing only the professional component (PC) of a split‑bill eligible service—i.e., you performed the physician interpretation, medical judgment and prepared a…
50	Modifier –50 (Bilateral Procedure) is appended to a CPT code when an identical procedure is performed on paired anatomical structures during the same operative session. The AMA states to add…	- Use modifier -50 when the same CPT surgical, diagnostic, or radiology procedure is performed on paired anatomical structures (both sides of the body) during the same operative/session by the same…
51	Modifier –51 (Multiple Procedures) is used when the same provider performs multiple procedures in the same session to identify secondary, non‑exempt procedures and indicate payment reduction logic…	- Use modifier -51 when the same provider performs multiple distinct procedures during the same patient encounter: report the highest‑valued procedure first (no modifier) and append -51 to…
52	Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…	- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
53	Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…	- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
59	Modifier 59 indicates a distinct procedural service when two procedures that are not normally billed together are clinically and procedurally separate. The CPT definition (as reiterated by CMS)…	- Use modifier -59 to report a distinct procedural service when documentation supports that the procedure reported is not normally billed together with another service on the same day because of a…
62	Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…	- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
76	Modifier -76, Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional, is appended when the same provider performs an identical, medically necessary procedure or…	- Use modifier -76 when the same physician or other qualified health care professional performs an identical procedure or service a second (or subsequent) time on the same date of service and the…
78	CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…	- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…
79	Modifier 79 indicates a surgical procedure performed during the postoperative global period of a prior surgery that is unrelated to the original procedure. Per AMA/CPT and CMS guidance, it is…	- Use modifier 79 when the same physician (or same‑specialty physician in the same group) performs a surgical procedure during the postoperative global period of a prior surgery and the new procedure…

Showing 1–10 of 12

Related Provider Taxonomies

8 rows

Taxonomy Code	Specialty	Notes
208VP0000X	Pain Medicine Physician	Pain Medicine is a primary medical specialty based on a distinct body of knowledge and a well-defined scope of clinical practice that is founded on sc…
207LP2900X	Pain Medicine (Anesthesiology) Physician	An anesthesiologist who provides a high level of care, either as a primary physician or consultant, for patients experiencing problems with acute, chr…
207R00000X	Internal Medicine Physician	A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults…
364SP0811X	Chronically Ill Psychiatric/Mental Health Clinical Nurse Specialist	Physician Assistants & Advanced Practice Nursing Providers · Clinical Nurse Specialist
261QC0050X	Critical Access Hospital Clinic/Center	An outpatient entity, facility, or distinct part of a facility within or affiliated with a Critical Access Hospital that provides access to primary ca…
2085D0003X	Diagnostic Neuroimaging (Radiology) Physician	A licensed physician, who has completed a residency program in Neurology, and who has additional training, experience, and competence in the standards…
2278C0205X	Critical Care Certified Respiratory Therapist	Respiratory emergencies are commonplace in the treatment of critical care patients. Included in the assessment measurements conducted by the respirat…
204R00000X	Electrodiagnostic Medicine Physician	Electrodiagnostic medicine is the medical subspecialty that applies neurophysiologic techniques to diagnose, evaluate, and treat patients with impairm…

Related Payer Policy Updates

Specialty: Anesthesiology1 / 3

10 rows

Policy	Payer	Effective Date
Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric or Substance Use Disorders	Premera Bluecross	2026-07-01
Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric or Substance Use Disorders	Premera Bluecross	2026-07-01
Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric or Substance Use Disorders	Premera Bluecross	2026-07-01
Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric or Substance Use Disorders	Premera Bluecross	2026-07-01
Elective Inpatient Services (for Idaho Only)	UnitedHealthcare	2026-06-01
Sites of Service	priority health	2026-06-01
Coverage for Ambulatory Surgery Unit (ASU)/Outpatient Facility and Anesthesia for Dental Services	univerahealthcare	2026-05-21
Mm_0579_Coveragepositioncriteria_Anesthesia_Services_Selected_Nerve_Blocks	Cigna	2026-05-15
Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric Disorders	Blue Cross Blue Shield - North Carolina	2026-04-01
Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric Disorders	Blue Cross Blue Shield - North Carolina	2026-04-01

CPT 64600: Trigeminal Nerve Neurodestruction by Injection

CPT-64605-TRIGEMINAL-NERVE-NEURODESTRUCTIVE-INJECTION

CPT 64605: Trigeminal Nerve Neurodestructive Injection

CPT-64610-TRIGEMINAL-NERVE-NEURODESTRUCTIVE-INJECTION

CPT 64610: Trigeminal Nerve Neurodestructive Injection

CPT-64611-SALIVARY-GLAND-CHEMICAL-DENERVATION-BILATERAL

CPT 64611: Bilateral Salivary Gland Chemical Injection for Sialorrhea

CPT-64612-FACIAL-NERVE-CHEMICAL-NEUROLYSIS-UNILATERAL

CPT 64612: Facial Nerve Chemical Neurolysis, Unilateral

CPT-64615-BILATERAL-CHEMICAL-DENERVATION-FACIAL-CERVICAL-MUSCLES

CPT 64615: Bilateral Chemical Denervation of Head and Neck Muscles

CPT-64616-UNILATERAL-CERVICAL-MUSCLE-CHEMICAL-DENERVATION

CPT 64616: Unilateral Neck Muscle Chemodenervation

CPT-64617-PERCUTANEOUS-LARYNGEAL-CHEMODENERVATION-UNILATERAL

CPT 64617: Percutaneous Chemodenervation of Larynx, Unilateral

CPT-64620-INTERCOSTAL-NERVE-ABLATION

CPT 64620: Intercostal Nerve Destruction (Chemical/Heat/Radiofrequency)

CPT-64624-GENICULAR-NERVE-NEUROLYSIS-KNEE

CPT 64624: Genicular Nerve Neurolysis for Knee Pain

Showing 1–10 of 26

Frequently Asked Questions

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

CPT 64642: Neurolytic Injection for Extremity Muscle Spasm

Sign up for cpt 64642 policy alerts

National Reimbursement Benchmarks

CPT 64642: Neurolytic Injection for Extremity Muscle Spasm

Sign up for cpt 64642 policy alerts

National Reimbursement Benchmarks

State Reimbursement Rates

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related Payer Policy Updates

Related Codes

References

State Reimbursement Rates

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related Payer Policy Updates

Related Codes

References

CPT 64642: Neurolytic Injection for Extremity Muscle Spasm

Sign up for cpt 64642 policy alerts

National Reimbursement Benchmarks

CPT 64642: Neurolytic Injection for Extremity Muscle Spasm

Sign up for cpt 64642 policy alerts

National Reimbursement Benchmarks

State Reimbursement Rates

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related Payer Policy Updates

Related Codes

What procedure does CPT 64642 represent and where is it typically performed?

Which payers cover CPT 64642 and how do reimbursement levels compare?

What clinical documentation and workflow elements are typically required when billing CPT 64642?

Which related CPT codes should be considered when more muscles or additional body regions are treated?

Which modifiers are commonly referenced with CPT 64642 and where can I find payer‑specific guidance?

References

State Reimbursement Rates

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related Payer Policy Updates

Related Codes

What procedure does CPT 64642 represent and where is it typically performed?

Which payers cover CPT 64642 and how do reimbursement levels compare?

What clinical documentation and workflow elements are typically required when billing CPT 64642?

Which related CPT codes should be considered when more muscles or additional body regions are treated?

Which modifiers are commonly referenced with CPT 64642 and where can I find payer‑specific guidance?

References