CPT 64642 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
| Key Fact | Detail |
|---|---|
| Service Type | • Surgery • Surgical Procedures on the Nervous System |
| Common Place of Service | • 11 - Office • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • RT - Right side of body • PO - Services, procedures and/or surgeries furnished at off-campus provider-based outpatient departments |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 64642 |
National average reimbursement for CPT 64642 by major payers:
$199.45
$199.07
$212.14
$263.04
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
Select a payer to view fee schedule data Choose a payer from the options above to see rates for CPT 64642 | ||||||
United | 64642 | $1543.00 | 1679943989 - LIVINGSTON ASC LLC | 474735737 - (NJ) LIVINGSTON ASC LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 64642 | $721.00 | 1336658145 - BROWN UROLOGY, INC., COLLYER STREET OPERATORY | 821512459 - (RI) BROWN UROLOGY INC | RI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 64642 | $520.00 | 1558339424 - PREMIER SURGERY CENTER | 352206509 - (CA) PREMIPREMIER SURGERY CENTER | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 64642 | $655.00 | 1811914625 - PUGET SOUND GASTROENTEROLOGY, PLLC, EDMONDS ENDOSCOPY CENTER | 911123468 - (WA) PUGET SOUND GASTROENTEROLOGY, P.S. | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 64642 | $400.00 | 1821379538 - THE AESTHETIC SURGERY CENTRE, PLLC, CEDAR LASER AND SURGERY CENTER | 900210545 - (WA) AESTHETIC SURGERY CENTRE, PLLC | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 64642 | $636.00 | 1568505899 - BON SECOURS SURGERY CENTER AT HARBOUR VIEW, LLC, BON SECOURS SURGERY CENTER AT HARBOUR VIEW | 208302537 - (VA) BON SECOURS SURGERY CENTER AT HARBOUR VIEW LLC | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 64642 | $204.00 | 1023256187 - TAMPA SURGERY CENTER LLC | 264008716 - (FL) TAMPA SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 64642 | $1433.00 | 1881692036 - SAINT BARNABAS OUTPATIENT CENTERS, AMBULATORY SURGERY CENTER | 222458479 - (NJ) SAINT BARNABAS OUTPATIENT CENTERS | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 64642 | $630.00 | 1609376409 - KOKOMO AMBULATORY SURGERY CENTER | 823461246 - (IN) KOKOMO AMBULATORY SURGERY CENTER | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 64642 | $931.00 | 1871513705 - SQUAW PEAK SURGICAL FACILITY INC | 860889294 - (AZ) SQUAW PEAK SURGICAL FACILITY INC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 64642 | $618.00 | 1285251132 - WEST BOZEMAN SURGERY CENTER, LLC, BOZEMAN OUTPATIENT SURGERY CENTER | 371912708 - (MT) WEST BOZEMAN SURGERY CENTER LLC | MT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 64642 | $893.00 | 1386086411 - MARION SURGERY CENTER, LLC | 462447139 - (FL) MARION SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 64642 | $1062.00 | 1275545279 - SURGERY CENTER OF COLUMBIA LP | 205227138 - (MO) SURGERY CENTER OF COLUMBIA LP | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 64642 | $1800.00 | 1023370251 - O'CONNOR BUILDING SURGERY CENTER LLC | 455437708 - (CA) OCONNOR BUILDING SURGERY CENTER LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 64642 | $1963.00 | 1588629604 - GREENVILLE SURGERY CENTER, LLC, TEXAS HEALTH SURGERY CENTER DALLAS | 742411643 - (TX) GREENVILLE SURGERY CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
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CPT 64642 vs. Other Surgical Procedures on the Nervous System Codes
The CPT 64642 code is part of the Surgery services used for Surgical Procedures on the Nervous System. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 64642 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 64642-CPT | Low | Injection Of Chemical For Paralysis Of Nerve Muscles On Arm Or Leg, 1-4 Muscles, First Extremity |
| 64643-CPT | Low | Chemodenervation Of One Extremity; Each Additionalextremity 1-4 Muscle(S) (List Separately In Addition To Code For Primary Procedure) |
| 64644-CPT | Moderate | Injection Of Chemical For Paralysis Of Nerve Muscles On Arm Or Leg, 5 Or More Muscles, First Extremity |
| 64645-CPT | Low | Chemodenervation Of One Extremity; Each Additional Extremity, 5 Or More Muscles (List Separately In Addition To Code For Primary Procedure) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 64642. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 64642 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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