© Copyright 2025 American Medical Association. All rights reserved.
Chemodenervation refers to a medical procedure aimed at reducing involuntary muscle contractions or spasms, particularly in the trunk muscles. This technique is commonly utilized for patients suffering from conditions such as dystonia, cerebral palsy, or multiple sclerosis, where muscle control is compromised. The procedure involves the injection of botulinum toxin, either type A or B, directly into the targeted muscles. This toxin works by temporarily paralyzing the muscle, effectively blocking the release of acetylcholine at the peripheral nerve endings. By interrupting the neuromuscular transmission of nerve impulses, the procedure alleviates the symptoms associated with muscle spasms. Prior to the injections, the specific muscles to be treated are identified through methods such as electromyography or physical examination, which includes palpating the muscles and assessing the areas of spasm. The trunk is then prepared for the procedure, ensuring a sterile environment. The injections are administered at carefully selected sites within the affected muscle or muscle group to achieve optimal denervation. It is important to note that CPT® Code 64647 is specifically designated for cases involving six or more trunk muscles, while CPT® Code 64646 is used for procedures involving one to five trunk muscles.
© Copyright 2025 Coding Ahead. All rights reserved.
The procedure of chemodenervation of trunk muscle(s) is indicated for various conditions characterized by involuntary muscle contractions or spasms. These indications include:
The chemodenervation procedure involves several critical steps to ensure effective treatment. These steps include:
After the chemodenervation procedure, patients may experience temporary muscle paralysis in the injected areas, which is the intended outcome. Post-procedure care typically includes monitoring for any immediate adverse reactions, such as localized pain or swelling at the injection sites. Patients are often advised to avoid strenuous activities for a short period following the injections to allow for optimal recovery. The effects of the botulinum toxin usually begin to manifest within a few days and can last for several months, after which additional treatments may be necessary to maintain symptom relief. Follow-up appointments may be scheduled to assess the effectiveness of the procedure and to determine if further interventions are required.
| Short Descr | CHEMODENERV TRUNK MUSC 6/> | Medium Descr | CHEMODENERVATION OF TRUNK 6 OR MORE MUSCLES | Long Descr | Chemodenervation of trunk muscle(s); 6 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.
| 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) |
| 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. | 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. | 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.) | 78 | Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.) | AG | Primary physician | 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 | GC | This service has been performed in part by a resident under the direction of a teaching physician | GZ | Item or service expected to be denied as not reasonable and necessary | LT | Left side (used to identify procedures performed on the left side of the body) | RT | Right side (used to identify procedures performed on the right side of the body) | 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 | X5 | Diagnostic services requested by another clinician: for reporting services by a clinician who furnishes care to the patient only as requested by another clinician or subsequent and related services requested by another clinician; this modifier is reported for patient relationships that may not be adequately captured by the above alternative categories; reporting clinician service examples include but are not limited to, the radiologist's interpretation of an imaging study requested by another clinician | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure |
|
Date
|
Action
|
Notes
|
|---|---|---|
| 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 |
Get instant expert-level medical coding assistance.