CPT 64643: Chemodenervation of Additional Extremity, 1-4 Muscles
Medicare pays $102 and commercial payers pay $114 on average nationally for this procedure.
CPT code 64643 describes chemodenervation where a provider injects a chemical agent (for example, Botox®) into one to four muscles of an additional extremity after the first to relieve pain and muscle spasms; this is a therapeutic chemodenervation procedure typically performed in an outpatient clinic or ambulatory surgical setting using localized injections to target spastic or dystonic muscles.
For related coverage guidance, see recent payer policy updates: Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric or Substance Use Disorders, Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric or Substance Use Disorders, Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric or Substance Use Disorders.
Customize your policy alerts
Sign up for cpt 64643 policy alerts
Get alerted when payer policies referencing 64643 are released or updated.
Monitor payer policy activity
National Reimbursement Benchmarks
Medicare’s mean rate of $102.4 sits slightly below BUCA’s average commercial mean of $114.4, indicating that BUCA pays about $12 higher on average for CPT 64643 than Medicare. That differential suggests commercial contracts with BUCA are modestly above the Medicare baseline, while other commercial payers span both above and below these anchors.
Dispersion measured as the interquartile range (P75–P25) varies noticeably: Blue Cross Blue Shield’s IQR is $44.1, UnitedHealth Group’s IQR is $87.1, Cigna’s IQR is $80.9, Aetna’s IQR is $39.6, and BUCA’s IQR is $60.7. Aetna and Blue Cross Blue Shield show the tightest mid‑range spreads, while UnitedHealth Group and Cigna display the widest dispersion across the middle 50% of rates.