How much does Medicare pay for CPT 64642?

Medicare allowed an average of $120.67 per service and paid $91.02 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $527.54, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 64642?

Injection of chemical for paralysis of nerve muscles on arm or leg, 1-4 muscles, first extremity. It was billed 23,395 times to 10,633 Medicare beneficiaries by 479 providers in 2024.

Does 64642 pay differently in an office than a hospital?

Yes. The allowed amount averaged $129.79 in an office setting and $95.49 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 64642 most?

Physical Medicine and Rehabilitation, with 12,366 services from 233 clinicians. Next are Neurology, Nurse Practitioner, Physician Assistant.

CPT 64642

Injection of chemical for paralysis of nerve muscles on arm or leg, 1-4 muscles, first extremity

$120.67Medicare-allowed amount per service, averaged across 23,395 services

Providers submitted

$527.54

Asking price, not received

Medicare allowed

$120.67

The fee schedule figure

Medicare paid

$91.02

Balance is patient coinsurance

Providers submitted an average of $527.54 for this code and Medicare allowed $120.67 — 4.4× 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 $91.02 (75%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $129.79
Hospital / facility: $95.49

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. 17,169 services were billed in an office setting and 6,226 in a facility.

Services: 23,395
Beneficiaries: 10,633
Providers billing it: 479
Total allowed: $2,823,075

What Medicare pays for CPT 64642

Across 23,395 services billed by 479 providers to 10,633 beneficiaries, Medicare allowed an average of $120.67 per service. That is 2.2 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 64642

Specialty	Services	Beneficiaries	Avg allowed	Providers
Physical Medicine and Rehabilitation	12,366	5,826	$122.14	233
Neurology	10,192	4,375	$120.64	225
Nurse Practitioner	288	148	$86.05	7
Physician Assistant	154	77	$101.20	3
Pediatric Medicine	101	43	$115.48	2
Interventional Pain Management	88	54	$129.58	1
Neuropsychiatry	83	38	$102.16	3
Internal Medicine	73	30	$81.58	2
Orthopedic Surgery	21	15	$100.19	1
Interventional Radiology	15	14	$109.68	1
Pain Management	14	13	$100.67	1

64642 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	2,513	$124.79	$88.10	45
New York	1,941	$154.03	$102.28	38
Pennsylvania	1,918	$117.99	$88.38	32
Massachusetts	1,352	$134.09	$93.68	23
Texas	1,290	$122.84	$93.57	26
Ohio	1,110	$99.63	$77.15	25
Florida	1,012	$127.16	$94.08	23
Minnesota	911	$104.66	$84.19	22
Illinois	722	$135.46	$95.07	17
Connecticut	665	$151.92	$107.93	12
Wisconsin	659	$95.91	$79.69	14
Arizona	629	$108.67	$85.02	12
North Carolina	592	$125.58	$100.22	12
Delaware	563	$126.39	$98.71	4
Oklahoma	464	$92.62	$71.21	3
Virginia	461	$108.53	$81.56	13
Missouri	430	$125.11	$93.92	10
South Carolina	412	$115.91	$97.05	10
New Jersey	358	$134.57	$92.69	8
Washington	344	$121.99	$88.92	10
Michigan	343	$127.81	$95.15	8
Colorado	339	$122.75	$90.71	8
Arkansas	329	$85.14	$70.75	6
Iowa	327	$105.01	$87.91	6
Kentucky	301	$102.90	$82.19	8
Mississippi	279	$84.60	$67.12	5
Maryland	260	$108.40	$77.66	8
Georgia	253	$122.21	$93.13	5
New Hampshire	241	$98.43	$73.31	6
Indiana	212	$122.24	$105.26	4
Maine	193	$100.39	$77.44	4
Tennessee	185	$99.65	$85.93	6
District of Columbia	183	$135.58	$87.12	4
Utah	182	$112.35	$86.79	3
Nevada	165	$99.77	$75.20	3
Kansas	161	$121.02	$94.36	4
Alabama	150	$131.46	$106.68	4
Nebraska	148	$81.33	$64.08	4
North Dakota	140	$94.59	$74.53	4
Louisiana	135	$116.47	$94.54	5
South Dakota	133	$112.61	$89.11	4
Montana	112	$111.23	$87.52	3
Rhode Island	75	$140.76	$113.49	2
New Mexico	71	$102.33	$74.61	2
West Virginia	47	$84.85	$58.74	1
Vermont	37	$87.90	$70.30	1
Idaho	25	$87.11	$77.15	1
Alaska	23	$156.91	$100.25	1

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
64612Injection of chemical for paralysis of nerve muscles on side of face$170.37
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.