How much does Medicare pay for CPT 64612?

Medicare allowed an average of $170.37 per service and paid $126.20 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $679.56, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 64612?

Injection of chemical for paralysis of nerve muscles on side of face. It was billed 45,088 times to 17,034 Medicare beneficiaries by 811 providers in 2024.

Does 64612 pay differently in an office than a hospital?

Yes. The allowed amount averaged $171.76 in an office setting and $155.67 in a facility. The office rate is generally higher because the practice supplies the room, staff and equipment out of that single payment; in a hospital those are billed separately by the facility.

Which specialty bills 64612 most?

Ophthalmology, with 25,188 services from 429 clinicians. Next are Neurology, Otolaryngology, Plastic and Reconstructive Surgery.

CPT 64612

Injection of chemical for paralysis of nerve muscles on side of face

$170.37Medicare-allowed amount per service, averaged across 45,088 services

Providers submitted

$679.56

Asking price, not received

Medicare allowed

$170.37

The fee schedule figure

Medicare paid

$126.20

Balance is patient coinsurance

Providers submitted an average of $679.56 for this code and Medicare allowed $170.37 — 4.0× less. That gap is normal and means nothing on its own: Medicare pays its fee schedule regardless of what is billed, so the submitted figure describes a hospital chargemaster, not a price anyone paid. Of the allowed amount Medicare paid $126.20 (74%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $171.76
Hospital / facility: $155.67

The office rate is higher because the practice supplies the room, staff and equipment out of that payment. In a hospital the facility bills those separately, so the clinician's share is smaller — the total cost to Medicare is usually higher, not lower. 41,196 services were billed in an office setting and 3,892 in a facility.

Services: 45,088
Beneficiaries: 17,034
Providers billing it: 811
Total allowed: $7,681,643

What Medicare pays for CPT 64612

Across 45,088 services billed by 811 providers to 17,034 beneficiaries, Medicare allowed an average of $170.37 per service. That is 2.6 services per beneficiary, so this is a code patients typically receive more than once. The allowed amount is the figure that matters: it is what Medicare and the patient together owe, set by the fee schedule and adjusted for local practice costs. What a provider chose to submit has no bearing on it.

Who bills 64612

Specialty	Services	Beneficiaries	Avg allowed	Providers
Ophthalmology	25,188	9,410	$171.48	429
Neurology	14,747	5,422	$169.87	285
Otolaryngology	1,536	695	$176.57	37
Plastic and Reconstructive Surgery	778	292	$159.74	11
Nurse Practitioner	649	324	$140.08	15
Physician Assistant	551	215	$145.61	9
Physical Medicine and Rehabilitation	471	171	$128.40	8
Oral Surgery (Dentist only)	337	172	$225.34	2
Neuropsychiatry	170	55	$203.59	3
Nephrology	147	48	$195.26	1
Neurosurgery	93	33	$186.67	2
Pain Management	89	30	$177.80	2
Psychiatry	69	23	$172.08	1
Maxillofacial Surgery	66	35	$211.80	1
Dentist	59	48	$220.00	1

64612 reimbursement by state

Two different numbers. Allowed is what Medicare actually allowed in that state, which includes the local practice-cost adjustment. Standardized strips that geographic adjustment out of the payment, so it is the column to use when comparing states — a difference there reflects how the code was billed, not what it costs to run a practice locally.

State	Services	Allowed	Standardized pmt	Providers
California	6,261	$190.59	$122.54	106
Florida	3,726	$168.53	$121.26	62
Texas	3,224	$165.17	$122.06	58
New York	2,654	$195.57	$126.60	49
North Carolina	1,936	$167.76	$126.28	32
Pennsylvania	1,831	$163.29	$117.79	36
Ohio	1,800	$135.90	$104.31	33
Massachusetts	1,657	$185.07	$120.86	27
Virginia	1,476	$172.21	$124.79	22
Arizona	1,430	$167.02	$127.63	26
Illinois	1,317	$168.60	$116.25	26
Maryland	1,222	$168.30	$116.94	23
Tennessee	1,198	$151.76	$120.67	24
Georgia	1,098	$168.57	$127.08	22
New Jersey	941	$196.18	$128.32	18
Michigan	919	$165.68	$117.99	16
Washington	824	$191.17	$123.04	14
South Carolina	801	$153.67	$122.77	16
Indiana	754	$158.36	$120.99	12
Colorado	742	$183.58	$114.92	17
Oklahoma	742	$154.88	$124.59	10
Kansas	714	$152.65	$113.92	13
Alabama	676	$161.35	$132.48	10
Missouri	673	$158.60	$118.26	12
Minnesota	662	$178.34	$124.45	16
Wisconsin	593	$146.03	$116.34	13
Iowa	583	$149.75	$119.01	11
Arkansas	462	$144.84	$120.36	5
Mississippi	450	$150.87	$127.48	9
Kentucky	378	$162.18	$130.28	9
Louisiana	357	$149.24	$122.88	4
Utah	351	$167.17	$129.09	6
Nevada	285	$158.28	$111.99	6
Hawaii	233	$176.01	$122.26	6
New Mexico	232	$146.27	$104.70	3
Connecticut	212	$186.21	$124.36	4
Nebraska	193	$149.49	$120.51	4
District of Columbia	191	$206.94	$135.30	3
Rhode Island	177	$168.47	$125.88	3
Oregon	172	$166.59	$117.26	5
Vermont	167	$149.91	$121.74	2
South Dakota	150	$147.67	$109.98	3
Montana	145	$156.38	$121.69	4
New Hampshire	130	$156.60	$117.78	2
Delaware	123	$170.97	$124.04	3
Idaho	93	$168.07	$122.66	3
Puerto Rico	76	$145.50	$116.60	1
Maine	57	$155.35	$113.50	2

Related codes

64635Destruction of lower or sacral spinal facet joint nerves$498.61
64636Destruction of lower or sacral spinal facet joint nerves$170.99
64615Injection of chemical for paralysis of facial and neck nerve muscles o$139.05
64633Destruction of upper or middle spinal facet joint nerves$505.48
64640Destruction of peripheral nerve or branch$128.51
64616Injection of chemical for paralysis of nerve muscles on side of neck e$175.81
64634Destruction of upper or middle spinal facet joint nerves$174.09
64642Injection of chemical for paralysis of nerve muscles on arm or leg$120.67
64643Injection of chemical for paralysis of nerve muscles on arm or leg$81.52
64644Injection of chemical for paralysis of nerve muscles on arm or leg$147.30
64624Destruction of nerve branches of knee$425.22
64617Injection of chemical for paralysis of nerve muscles on side of voice$193.92

Billing this code is not the same as earning it

An allowed amount is revenue to a practice, not income to a clinician. It funds staff, premises, equipment and supplies before anyone is paid. What clinicians actually earn is published separately by the Department of Labor, and what industry pays them is published separately again by CMS — this site carries both.

What doctors are paid →·Look up a clinician →·All procedure codes →

Where this comes from. CMS Medicare Physician & Other Practitioners, by Provider and Service, 2024. It covers fee-for-service Original Medicare Part B only — not Medicare Advantage, not Medicaid, and not commercial insurance, which typically pays more for the same code.

How it is averaged. CMS publishes one average per provider per code. Every figure here is re-weighted by the number of services, so a clinician who billed the code 4,000 times counts 4,000 times more than one who billed it twice. CMS also suppresses any provider-code pair with fewer than 11 beneficiaries, so low-volume practice is missing from these totals by design.