How much does Medicare pay for CPT 64643?

Medicare allowed an average of $81.52 per service and paid $63.26 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $375.55, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 64643?

Injection of chemical for paralysis of nerve muscles on arm or leg, 1-4 muscles, each additional extremity. It was billed 20,156 times to 7,606 Medicare beneficiaries by 344 providers in 2024.

Does 64643 pay differently in an office than a hospital?

Yes. The allowed amount averaged $87.40 in an office setting and $67.39 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 64643 most?

Physical Medicine and Rehabilitation, with 14,623 services from 230 clinicians. Next are Neurology, Nurse Practitioner, Physician Assistant.

CPT 64643

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

$81.52Medicare-allowed amount per service, averaged across 20,156 services

Providers submitted

$375.55

Asking price, not received

Medicare allowed

$81.52

The fee schedule figure

Medicare paid

$63.26

Balance is patient coinsurance

Providers submitted an average of $375.55 for this code and Medicare allowed $81.52 — 4.6× 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 $63.26 (78%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $87.40
Hospital / facility: $67.39

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. 14,227 services were billed in an office setting and 5,929 in a facility.

Services: 20,156
Beneficiaries: 7,606
Providers billing it: 344
Total allowed: $1,643,117

What Medicare pays for CPT 64643

Across 20,156 services billed by 344 providers to 7,606 beneficiaries, Medicare allowed an average of $81.52 per service. That is 2.7 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 64643

Specialty	Services	Beneficiaries	Avg allowed	Providers
Physical Medicine and Rehabilitation	14,623	5,505	$79.67	230
Neurology	4,740	1,771	$88.40	96
Nurse Practitioner	212	92	$58.83	6
Physician Assistant	181	66	$74.71	3
Interventional Pain Management	88	54	$92.82	1
Pediatric Medicine	88	34	$78.08	2
Family Practice	75	19	$81.97	1
Neurosurgery	44	13	$77.11	1
Internal Medicine	39	16	$91.60	1
Neuropsychiatry	34	13	$76.22	1
Pain Management	20	12	$70.03	1
Interventional Radiology	12	11	$73.23	1

64643 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	1,602	$93.09	$66.84	24
Pennsylvania	1,527	$83.83	$66.08	21
New York	1,490	$95.87	$65.66	27
Texas	1,325	$81.47	$64.08	19
Ohio	1,176	$75.54	$61.04	22
Wisconsin	1,067	$67.29	$56.50	15
Minnesota	1,034	$72.22	$60.30	21
Massachusetts	1,008	$84.38	$62.07	16
Illinois	903	$87.13	$63.82	17
Florida	780	$91.87	$68.89	14
Connecticut	716	$95.25	$69.77	9
Iowa	573	$69.61	$60.91	6
North Carolina	557	$82.36	$67.17	9
New Jersey	551	$77.40	$56.22	6
Missouri	476	$83.45	$64.67	9
Arizona	402	$83.33	$68.14	8
Mississippi	379	$63.52	$52.76	6
Michigan	343	$82.57	$63.71	7
Washington	305	$81.21	$58.50	5
South Carolina	264	$77.82	$69.74	5
Colorado	260	$83.98	$65.73	4
Kansas	257	$74.15	$59.96	4
Arkansas	235	$60.32	$51.40	4
Indiana	226	$78.28	$67.02	4
Utah	221	$79.74	$64.65	3
Maryland	210	$86.23	$63.69	7
New Hampshire	203	$67.46	$51.57	5
Nebraska	197	$67.37	$56.35	4
North Dakota	184	$63.26	$51.67	4
District of Columbia	180	$90.71	$60.46	3
Maine	158	$56.82	$45.60	3
Kentucky	142	$67.03	$57.05	4
Montana	141	$81.76	$65.37	3
Alabama	135	$79.61	$71.48	3
Oklahoma	123	$81.58	$70.43	2
Georgia	121	$74.56	$57.80	3
Virginia	103	$87.00	$66.90	3
Idaho	103	$76.59	$67.98	2
Louisiana	91	$70.23	$54.57	3
Nevada	77	$89.87	$71.71	2
Delaware	74	$57.29	$46.53	1
Rhode Island	70	$88.88	$72.48	2
Tennessee	63	$83.15	$69.29	2
West Virginia	48	$69.99	$49.96	1
South Dakota	34	$85.33	$69.62	1
New Mexico	22	$68.31	$52.82	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
64642Injection of chemical for paralysis of nerve muscles on arm or leg$120.67
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.