How much does Medicare pay for CPT 64645?

Medicare allowed an average of $104.94 per service and paid $81.74 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $444.98, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 64645?

Injection of chemical for paralysis of nerve muscles on arm or leg, 5 or more muscles, each additional extremity. It was billed 2,397 times to 919 Medicare beneficiaries by 41 providers in 2024.

Does 64645 pay differently in an office than a hospital?

Yes. The allowed amount averaged $114.28 in an office setting and $79.35 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 64645 most?

Physical Medicine and Rehabilitation, with 1,486 services from 25 clinicians. Next are Neurology, Family Practice, Hand Surgery.

CPT 64645

Injection of chemical for paralysis of nerve muscles on arm or leg, 5 or more muscles, each additional extremity

$104.94Medicare-allowed amount per service, averaged across 2,397 services

Providers submitted

$444.98

Asking price, not received

Medicare allowed

$104.94

The fee schedule figure

Medicare paid

$81.74

Balance is patient coinsurance

Providers submitted an average of $444.98 for this code and Medicare allowed $104.94 — 4.2× 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 $81.74 (78%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $114.28
Hospital / facility: $79.35

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. 1,756 services were billed in an office setting and 641 in a facility.

Services: 2,397
Beneficiaries: 919
Providers billing it: 41
Total allowed: $251,541

What Medicare pays for CPT 64645

Across 2,397 services billed by 41 providers to 919 beneficiaries, Medicare allowed an average of $104.94 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 64645

Specialty	Services	Beneficiaries	Avg allowed	Providers
Physical Medicine and Rehabilitation	1,486	570	$103.95	25
Neurology	813	327	$108.18	14
Family Practice	56	11	$107.02	1
Hand Surgery	42	11	$74.25	1

64645 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
Missouri	384	$108.05	$83.29	3
California	348	$107.40	$79.28	5
Texas	166	$100.37	$79.70	4
Massachusetts	143	$99.67	$72.25	2
Connecticut	136	$129.29	$94.17	2
Kansas	134	$101.15	$82.98	3
Illinois	118	$127.57	$94.39	1
New Jersey	116	$102.95	$72.93	2
Minnesota	96	$92.86	$78.21	2
Ohio	84	$108.37	$93.61	2
Washington	74	$97.05	$71.56	2
Delaware	74	$105.02	$95.42	1
Pennsylvania	72	$113.77	$94.55	2
Wisconsin	71	$71.38	$60.14	1
Idaho	56	$107.02	$91.84	1
Iowa	56	$71.50	$60.72	1
Nebraska	53	$103.92	$91.67	1
Kentucky	44	$78.36	$59.73	1
North Carolina	42	$74.25	$55.09	1
Florida	39	$134.74	$93.54	1
Indiana	37	$108.08	$94.40	1
New York	30	$144.16	$94.44	1
Virginia	24	$72.54	$67.91	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
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

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.