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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 technique involves the injection of botulinum toxin, either type A or B, directly into the targeted muscles of one 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 of 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 sites of spasm. Proper preparation of the extremity is essential before the injection process, which involves administering the botulinum toxin at carefully chosen sites to ensure effective denervation. For procedures involving five or more muscles in one extremity, the appropriate code is 64644, while 64645 is designated for five or more muscles in each additional extremity.
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The procedure of chemodenervation is indicated for the treatment of involuntary muscle contractions or spasms associated with various neurological and muscular conditions. These include:
The chemodenervation procedure involves several key steps to ensure effective treatment. First, the physician evaluates the patient to determine the specific muscles that require intervention. This assessment may include the use of electromyography, which helps identify the electrical activity of muscles, or a physical examination where the physician palpates the affected extremity to locate muscle spasms.
Following the chemodenervation procedure, patients may experience temporary muscle weakness in the injected areas, which is expected as the botulinum toxin takes effect. Recovery time can vary, but patients are generally advised to avoid strenuous activities for a short period post-injection. It is important for patients to follow up with their healthcare provider to monitor the effectiveness of the treatment and to discuss any side effects or concerns. Additionally, the physician may schedule subsequent injections based on the patient's response to the initial treatment and the duration of symptom relief.
| Short Descr | CHEMODENERV 1 EXTREM 5/> EA | Medium Descr | CHEMODENERVATION 1 EXTREMITY EA ADDL 5/> MUSCLES | Long Descr | Chemodenervation of one extremity; each additional extremity, 5 or more muscles (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.
| 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) | 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) | GC | This service has been performed in part by a resident under the direction of a teaching physician | 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 | 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.) | 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 | 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) | CR | Catastrophe/disaster related | GA | Waiver of liability statement issued as required by payer policy, individual case | 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 | GZ | Item or service expected to be denied as not reasonable and necessary | 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 | 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 |
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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 |
| 2014-01-01 | Changed | Medium Descriptor Changed. Changed to show "5/>" per AMA 2014 corrections document posted 2014-03-2014 |