© Copyright 2025 American Medical Association. All rights reserved.
Chemodenervation is a medical procedure aimed at alleviating involuntary muscle contractions or spasms that can occur in various conditions such as dystonia, cerebral palsy, or multiple sclerosis. This technique involves the injection of botulinum toxin, either type A or B, directly into the targeted muscles of an extremity. The primary mechanism of action is the temporary paralysis of the muscle, achieved by blocking the release of acetylcholine at the peripheral nerve endings. This interruption in neuromuscular transmission effectively reduces the muscle's ability to contract, thereby providing relief from the symptoms associated with these conditions. The selection of specific muscles for injection is typically guided by electromyography or through a physical examination of the affected extremity, where the physician palpates the muscles and identifies the precise locations of muscle spasms. Prior to the injection, the extremity is prepared to ensure a sterile environment. The procedure is designed to target the affected muscle or muscle group at carefully chosen sites to achieve optimal denervation. For coding purposes, CPT® Code 64642 is utilized for the chemodenervation of 1-4 muscles in one extremity, while CPT® Code 64643 is designated for the chemodenervation of 1-4 muscles in each additional extremity.
© Copyright 2025 Coding Ahead. All rights reserved.
Chemodenervation is indicated for the treatment of involuntary muscle contractions or muscle spasms associated with specific medical conditions. The following conditions are explicitly mentioned as indications for this procedure:
The procedure for chemodenervation involves several key steps that ensure effective treatment of the affected muscles. Each step is crucial for achieving the desired outcome of muscle relaxation and symptom relief.
Following the chemodenervation procedure, patients can expect a period of recovery that may vary depending on individual circumstances. It is common for patients to experience some temporary discomfort at the injection sites, which typically resolves within a few days. The effects of the botulinum toxin usually begin to manifest within a few days to weeks, providing relief from muscle spasms. Patients are often advised to avoid strenuous activities for a short period following the procedure to allow for optimal recovery. Additionally, follow-up appointments may be scheduled to monitor the effectiveness of the treatment and to determine if further injections are necessary. It is important for patients to report any unusual side effects or concerns to their healthcare provider promptly.
| Short Descr | CHEMODENERV 1 EXTREM 1-4 EA | Medium Descr | CHEMODENERVATION 1 EXTREMITY EA ADDL 1-4 MUSCLE | Long Descr | Chemodenervation of one extremity; each additional extremity, 1-4 muscle(s) (List separately in addition to code for primary procedure) | Status Code | Active Code | Global Days | ZZZ - Code Related to Another Service | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 0 - No payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 1 - Statutory payment restriction for assistants at surgery applies to this procedure... | Co-Surgeons (62) | 0 - Co-surgeons not permitted for this procedure. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Items and Services Packaged into APC Rates | ASC Payment Indicator | Packaged service/item; no separate payment made. | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P6C - Minor procedures - other (Medicare fee schedule) | MUE | 3 |
This is an add-on code that must be used in conjunction with one of these primary codes.
| 64642 | MPFS Status: Active Code APC T ASC P3 Chemodenervation of one extremity; 1-4 muscle(s) | 64644 | MPFS Status: Active Code APC T ASC P3 Chemodenervation of one extremity; 5 or more muscles | 95873 | Addon Code MPFS Status: Active Code APC N CPT Assistant Article Electrical stimulation for guidance in conjunction with chemodenervation (List separately in addition to code for primary procedure) | 95874 | Addon Code MPFS Status: Active Code APC N CPT Assistant Article Needle electromyography for guidance in conjunction with chemodenervation (List separately in addition to code for primary procedure) |
| LT | Left side (used to identify procedures performed on the left side of the body) | GC | This service has been performed in part by a resident under the direction of a teaching physician | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | RT | Right side (used to identify procedures performed on the right side of the body) | X2 | Continuous/focused services: for reporting services by clinicians whose expertise is needed for the ongoing management of a chronic disease or a condition that needs to be managed and followed with no planned endpoint to the relationship; reporting clinician service examples include but are not limited to: a rheumatologist taking care of the patient's rheumatoid arthritis longitudinally but not providing general primary care services | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service | CR | Catastrophe/disaster related | GZ | Item or service expected to be denied as not reasonable and necessary | GA | Waiver of liability statement issued as required by payer policy, individual case | 26 | Professional component: certain procedures are a combination of a physician or other qualified health care professional component and a technical component. when the physician or other qualified health care professional component is reported separately, the service may be identified by adding modifier 26 to the usual procedure number. | 50 | Bilateral procedure: unless otherwise identified in the listings, bilateral procedures that are performed at the same session, should be identified by adding modifier 50 to the appropriate 5 digit code. note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 58 | Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78. | 76 | Repeat procedure or service by same physician or other qualified health care professional: it may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 76 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | 79 | Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.) | 96 | Habilitative services: when a service or procedure that may be either habilitative or rehabilitative in nature is provided for habilitative purposes, the physician or other qualified health care professional may add modifier 96 to the service or procedure code to indicate that the service or procedure provided was a habilitative service. habilitative services help an individual learn skills and functioning for daily living that the individual has not yet developed, and then keep and/or improve those learned skills. habilitative services also help an individual keep, learn, or improve skills and functioning for daily living. | 97 | Rehabilitative services: when a service or procedure that may be either habilitative or rehabilitative in nature is provided for rehabilitative purposes, the physician or other qualified health care professional may add modifier 97 to the service or procedure code to indicate that the service or procedure provided was a rehabilitative service. rehabilitative services help an individual keep, get back, or improve skills and functioning for daily living that have been lost or impaired because the individual was sick, hurt, or disabled. | AG | Primary physician | AQ | Physician providing a service in an unlisted health professional shortage area (hpsa) | CC | Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed) | GV | Attending physician not employed or paid under arrangement by the patient's hospice provider | GW | Service not related to the hospice patient's terminal condition | GY | Item or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit | JZ | Zero drug amount discarded/not administered to any patient | PD | Diagnostic or related non diagnostic item or service provided in a wholly owned or operated entity to a patient who is admitted as an inpatient within 3 days | PO | Excepted service provided at an off-campus, outpatient, provider-based department of a hospital | X4 | Episodic/focused services: for reporting services by clinicians who provide focused care on particular types of treatment limited to a defined period and circumstance; the patient has a problem, acute or chronic, that will be treated with surgery, radiation, or some other type of generally time-limited intervention; reporting clinician service examples include but are not limited to, the orthopedic surgeon performing a knee replacement and seeing the patient through the postoperative period | XE | Separate encounter, a service that is distinct because it occurred during a separate encounter | XP | Separate practitioner, a service that is distinct because it was performed by a different practitioner |
|
Date
|
Action
|
Notes
|
|---|---|---|
| 2014-01-01 | Added | Added |
Get instant expert-level medical coding assistance.