How much does Medicare pay for CPT 64646?

Medicare allowed an average of $101.70 per service and paid $78.61 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $416.51, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 64646?

Injection of chemical for paralysis of nerve muscles on trunk, 1-5 muscles. It was billed 4,737 times to 1,858 Medicare beneficiaries by 71 providers in 2024.

Does 64646 pay differently in an office than a hospital?

Yes. The allowed amount averaged $105.85 in an office setting and $79.46 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 64646 most?

Neurology, with 3,133 services from 34 clinicians. Next are Physical Medicine and Rehabilitation, Nurse Practitioner, Pain Management.

CPT 64646

Injection of chemical for paralysis of nerve muscles on trunk, 1-5 muscles

$101.70Medicare-allowed amount per service, averaged across 4,737 services

Providers submitted

$416.51

Asking price, not received

Medicare allowed

$101.70

The fee schedule figure

Medicare paid

$78.61

Balance is patient coinsurance

Providers submitted an average of $416.51 for this code and Medicare allowed $101.70 — 4.1× 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 $78.61 (77%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $105.85
Hospital / facility: $79.46

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. 3,991 services were billed in an office setting and 746 in a facility.

Services: 4,737
Beneficiaries: 1,858
Providers billing it: 71
Total allowed: $481,753

What Medicare pays for CPT 64646

Across 4,737 services billed by 71 providers to 1,858 beneficiaries, Medicare allowed an average of $101.70 per service. That is 2.5 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 64646

Specialty	Services	Beneficiaries	Avg allowed	Providers
Neurology	3,133	1,148	$104.48	34
Physical Medicine and Rehabilitation	890	445	$106.34	20
Nurse Practitioner	173	74	$60.35	5
Pain Management	134	48	$85.37	3
Physician Assistant	132	56	$82.29	4
Obstetrics & Gynecology	97	15	$77.01	1
Interventional Pain Management	61	20	$172.85	1
Anesthesiology	50	22	$76.97	1
Internal Medicine	39	16	$78.99	1
Family Practice	28	14	$73.85	1

64646 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
Arizona	1,161	$134.87	$111.10	6
Florida	666	$95.58	$69.24	8
Alabama	315	$68.97	$63.19	3
Texas	308	$96.92	$79.67	4
Pennsylvania	288	$117.79	$86.38	6
California	285	$103.82	$75.59	3
District of Columbia	250	$106.58	$71.35	4
Colorado	237	$75.54	$58.87	5
Wisconsin	176	$69.76	$58.45	3
Ohio	147	$82.45	$65.90	4
Iowa	131	$67.01	$56.22	4
Virginia	97	$77.01	$63.40	1
New York	94	$100.86	$66.41	3
Mississippi	90	$59.19	$50.03	2
Maryland	68	$104.88	$77.58	2
Kentucky	52	$75.38	$64.61	1
North Carolina	50	$97.50	$79.09	1
Oklahoma	50	$68.80	$56.26	1
Delaware	47	$76.16	$70.37	2
West Virginia	46	$102.93	$79.30	2
New Jersey	37	$96.09	$68.25	1
Minnesota	32	$72.58	$63.82	1
Idaho	28	$73.85	$65.60	1
Illinois	28	$130.92	$82.06	1
Connecticut	27	$114.21	$84.46	1
Missouri	27	$148.95	$124.44	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.