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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 procedure specifically targets the muscles of one extremity, which may be affected by these involuntary movements. The technique involves the injection of botulinum toxin, either type A or B, directly into the affected muscles. 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 spasms. Prior to the procedure, the specific muscles to be injected are identified through methods such as electromyography or a physical examination, which includes palpating the muscles and observing the areas of spasm. Once the targeted muscles are determined, the extremity is prepared for the injections, and the botulinum toxin is administered at carefully selected sites to ensure effective denervation. For coding purposes, CPT® Code 64644 is used when five or more muscles in one extremity are treated, while CPT® Code 64645 is designated for five or more muscles in each additional extremity.
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Chemodenervation is indicated for the treatment of involuntary muscle contractions or spasms associated with specific neurological and muscular conditions. The following conditions are explicitly recognized as indications for this procedure:
The procedure for chemodenervation involves several critical steps to ensure effective treatment. Each step is designed to maximize the accuracy and efficacy of the muscle injections.
After the chemodenervation procedure, patients may experience some immediate effects, including temporary weakness in the injected muscles. It is important for patients to follow any post-procedure care instructions provided by their healthcare provider. This may include avoiding strenuous activities for a specified period and monitoring for any adverse reactions at the injection sites. Patients should also be informed about the expected duration of the effects of the botulinum toxin, which typically lasts for several weeks to months, after which additional treatments may be necessary to maintain symptom relief.
| Short Descr | CHEMODENERV 1 EXTREM 5/> MUS | Medium Descr | CHEMODENERVATION 1 EXTREMITY 5 OR MORE MUSCLES | Long Descr | Chemodenervation of one extremity; 5 or more muscles | Status Code | Active Code | Global Days | 000 - Endoscopic or Minor Procedure | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 2 - Standard 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 | Procedure or Service, Multiple Reduction Applies | ASC Payment Indicator | Office-based surgical procedure added to ASC list in CY 2008 or later with MPFS nonfacility PE RVUs; payment based on MPFS nonfacility PE RVUs. | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P6C - Minor procedures - other (Medicare fee schedule) | MUE | 1 |
This is a primary code that can be used with these additional add-on codes.
| 64643 | Addon Code MPFS Status: Active Code APC N ASC N1 Chemodenervation of one extremity; each additional extremity, 1-4 muscle(s) (List separately in addition to code for primary procedure) | 64645 | Addon Code MPFS Status: Active Code APC N ASC N1 Chemodenervation of one extremity; each additional extremity, 5 or more muscles (List separately in addition to code for primary procedure) | 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) |
| RT | Right side (used to identify procedures performed on the right side of the body) | GC | This service has been performed in part by a resident under the direction of a teaching physician | 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). | LT | Left side (used to identify procedures performed on the left 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 | GA | Waiver of liability statement issued as required by payer policy, individual case | 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. | 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. | CR | Catastrophe/disaster related | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure | GZ | Item or service expected to be denied as not reasonable and necessary | 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.) | 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. | 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. | AG | Primary physician | AI | Principal physician of record | 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 | KX | Requirements specified in the medical policy have been met | PO | Excepted service provided at an off-campus, outpatient, provider-based department of a hospital | Q5 | Service furnished under a reciprocal billing arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area | 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 | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
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| 2015-01-01 | Changed | Code description changed. |
| 2014-01-01 | Added | Added |
| 2014-01-01 | Changed | Description changed. Removed parentheical included in the term muscles per AMA 2014 corrections document posted 2014-03-24 |