CPT 64645: Chemodenervation of Additional Extremity, ≥5 Muscles
Medicare pays $133 and commercial payers pay $135 on average nationally for this procedure.
CPT code 64645 describes chemodenervation with injection of a neurolytic agent (for example, botulinum toxin) into five or more muscles of an additional extremity to relieve pain and muscle spasms; service type: targeted therapeutic chemodenervation; typical site of service: outpatient procedure setting such as a hospital outpatient department, ambulatory surgery center, or clinic-based procedure room.
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.
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National Reimbursement Benchmarks
Medicare’s mean rate sits at $132.8, slightly below BUCA’s average commercial mean of $135.1, indicating commercial BUCA reimbursement is modestly higher than the Medicare baseline for CPT 64645. The proximity of those means suggests limited separation between Medicare and a representative commercial average, though individual commercial plans still show higher upper-percentile values.
Assessing dispersion using the interquartile spread (P75–P25) highlights variation across payers: Blue Cross Blue Shield’s spread is $58.9, UnitedHealth Group’s is $111.7, Cigna’s is $104.5, Aetna’s is $82.0, and BUCA’s is $77.7. Blue Cross Blue Shield exhibits the tightest IQR at $58.9, while UnitedHealth Group is the widest at $111.7, signaling the broadest middle-50% variability among the listed commercial payers.