64612

💉 CPT 64612 - Chemodenervation of Muscle(s); Facial Nerve, Unilateral

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📋 Code Description

Full Official Description (Revised 1/1/2013): Chemodenervation of muscle(s); muscle(s) innervated by facial nerve, unilateral (eg, for blepharospasm, hemifacial spasm)

CPT 64612 describes the injection of a chemodenervating agent — most commonly a botulinum toxin — into one or more muscles innervated by the facial nerve (cranial nerve VII) on one side of the face. The procedure disrupts signal transmission at the neuromuscular junction, producing temporary, focal weakening of targeted musculature to reduce or eliminate involuntary contractions, spasms, or dystonic movements.

The facial nerve innervates the muscles of facial expression, including the orbicularis oculi (eyelid), corrugator, zygomaticus, mentalis, platysma, and other periocular and perioral muscles. Conditions treated with 64612 include blepharospasm (involuntary eyelid closure), hemifacial spasm (unilateral twitching/contraction of facial muscles), orofacial dystonia, spastic entropion, spastic ectropion, paralytic ptosis, and facial myokymia.

⚠️ Code Intent: 64612 is unilateral by definition. If both sides of the face are treated in the same session (e.g., bilateral blepharospasm), modifier -50 must be appended or the code must be reported on two separate lines with -RT and -LT. The MUE (Medically Unlikely Edit) is 1 — only 1 unit of service per day without a bilateral modifier.

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💰 Work RVUs & Payment

Component	Value
wRVU (Facility)	1.37
wRVU (Non-Facility)	1.37
Total RVU (Facility)	4.24
Global Period	010 (10 days)
Est. Medicare Payment	~$141.62(national;2026CF$33.40)
Assistant Payable	❌ No (indicator: 0)
Co-Surgery	❌ No
Team Surgery	❌ No
Bilateral Surgery	Indicator 1 (150% rule; facial nerve is bilateral structure)
Multiple Procedure	Indicator 2 (standard 50% reduction on subsequent procedures)
PC/TC Split	✅ Yes — modifier -26 applicable when EMG guidance is professionally interpreted but equipment is facility-owned

Note:

The work RVU (1.37) is the same regardless of care setting — the difference between facility and non-facility reimbursement lies in the practice expense (PE) RVU. 64612 is commonly performed in the non-facility (office/clinic) setting, where total RVU is higher due to office PE (physician bears equipment and staff overhead). The total facility RVU is 4.24 = 1.37 (work) + 2.58 (PE) + 0.29 (malpractice). Non-facility total RVU is higher and reflects additional practice overhead for in-office administration.

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✅ What’s Included

CPT 64612 bundles the following into a single billable unit:

• Preparation of the injection site(s) on the ipsilateral side of the face
• All needle placements and injections on the same side (unilateral) during the same session — multiple muscles on one side = still 1 unit of 64612
• Physician assessment of injection target sites at time of service
• Routine post-procedure monitoring within the 10-day global period

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🚫 Excludes / Separately Reportable

What is Excluded	Separately Reportable Code
Botulinum toxin type A (onabotulinumtoxinA / Botox®)	J0585 — per unit; must be reported on same claim as 64612
Botulinum toxin type A (abobotulinumtoxinA / Dysport™)	J0586 — per unit; same-claim requirement applies
Botulinum toxin type B (rimabotulinumtoxinB / Myobloc®)	J0587 — per 100 units; same-claim requirement applies
Botulinum toxin type A (incobotulinumtoxinA / Xeomin®)	J0588 — per unit; same-claim requirement applies
Botulinum toxin type A (daxibotulinumtoxinA-lanm / DAXXIFY®)	J0589 — per unit; same-claim requirement applies
Drug wastage from single-dose vial (discarded portion)	J0585-J0589 with modifier -JW — wastage is reimbursable; document dose given and amount discarded
No discarded amount from single-dose container (since 7/1/2023)	Append modifier -JZ on J-code line to attest zero wastage; required per CR 13056
EMG needle guidance for injection targeting (when medically necessary)	95873 — needle EMG for guidance; report per injection site
Fine wire EMG guidance (when medically necessary)	95874 — do not report with 95873 at same injection site
Bilateral treatment — contralateral side, same session	64612--50 or 64612--LT / 64612--RT on separate lines (ASC)
Chemodenervation of neck muscles (cervical dystonia)	64616 — separately reportable if neck muscles also injected at same session; append -59 or -XS
Chemodenervation of salivary glands (sialorrhea)	64611 — separate and distinct injection site
Chronic migraine chemodenervation (facial + cervical, bilateral)	64615 — never report 64615 and 64612 at the same visit — bundled per NCCI and AMA guidance

⚠️ Drug Claim Alert: Per CMS LCD, when the J-code (J0585-J0589) is denied, the associated injection code (64612) will also be denied. These must be on the same claim and the J-code drives medical necessity validation. Some MACs (e.g., Noridian) require prior authorization when J0585, J0586, J0587, or J0588 is billed with 64612 or 64615. Verify PA requirements by MAC jurisdiction before rendering service.

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🌿 Code Tree / Family

Nervous System - Destruction by Neurolytic Agent / Chemodenervation (64600-64681)
│
├── 64612  ◀ Chemodenervation of facial nerve muscle(s), UNILATERAL
│              (blepharospasm, hemifacial spasm, facial dystonia)
│
├── 64615  Chemodenervation of facial, trigeminal, cervical spinal &
│              accessory nerves, BILATERAL (chronic migraine)
│              [Never report with 64612 at same visit]
│
├── 64616  Chemodenervation of neck muscle(s), excluding larynx,
│              UNILATERAL (cervical dystonia, spasmodic torticollis)
│
├── 64617  Chemodenervation of laryngeal muscle(s), unilateral
│              (spasmodic dysphonia, laryngeal dystonia)
│
├── 64642  Chemodenervation of one extremity; 1-4 muscle(s) (limb spasticity)
├── 64643  Chemodenervation of each additional extremity; 1-4 muscle(s) [Add-on]
├── 64644  Chemodenervation of one extremity; 5 or more muscle(s)
├── 64645  Chemodenervation of each additional extremity; 5+ muscle(s) [Add-on]
│
├── 64646  Chemodenervation of trunk muscle(s); 1-5 muscles
├── 64647  Chemodenervation of trunk muscle(s); 6 or more muscles
│
├── 64650  Chemodenervation of eccrine sweat glands; both axillae
├── 64653  Chemodenervation of eccrine sweat glands; other area(s)
│
└── 64611  Chemodenervation of salivary gland(s), bilateral
               (sialorrhea, drooling)

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🏥 ICD-10-CM Commonly Paired Diagnoses

Codes below represent CMS LCD-covered indications for 64612 (per CMS Billing & Coding Article A59726, effective 02/22/2026). Always ensure the covered diagnosis is documented and links to the treatment site and laterality. Cosmetic use of botulinum toxin is statutorily non-covered; if billed for cosmetic purposes, use Z41.1.

🔴 Blepharospasm

ICD-10-CM	Description	HCC	Notes
G24.5	Blepharospasm	❌ No HCC	Most common indication; involuntary bilateral eyelid closure; use 64612-50 if both eyes treated

🔴 Blepharospasm with Orofacial Dystonia

ICD-10-CM	Description	HCC	Notes
G24.1	Genetic torsion dystonia	❌ No HCC	Meige syndrome context; inherited dystonia affecting face/jaw
G24.2	Idiopathic nonfamilial dystonia	❌ No HCC	Non-genetic, non-drug-induced orofacial involvement
G24.4	Idiopathic orofacial dystonia	❌ No HCC	Primary orofacial dystonia; Meige syndrome; perioral and jaw involvement
G24.8	Other dystonia	❌ No HCC	Use when more specific code is not available; task-specific or atypical facial dystonias

🔴 Hemifacial Spasm & Facial Dystonia

ICD-10-CM	Description	HCC	Notes
G51.31	Clonic hemifacial spasm, right	❌ No HCC	Involuntary unilateral facial contractions, right side — use with -RT on 64612
G51.32	Clonic hemifacial spasm, left	❌ No HCC	Left-sided hemifacial spasm — use with -LT on 64612
G51.33	Clonic hemifacial spasm, bilateral	❌ No HCC	Bilateral involvement; use 64612--50 or two lines with -RT/-LT
G51.4	Facial myokymia	❌ No HCC	Undulating ripple-like facial muscle contractions; rarely bilateral
G51.2	Melkersson’s syndrome	❌ No HCC	Recurrent facial palsy with edema; chemodenervation for synkinesis component
G51.8	Other disorders of facial nerve	❌ No HCC	Facial synkinesis post-Bell’s palsy; post-paralytic facial contracture

🔴 Spastic Eyelid Disorders

ICD-10-CM	Description	HCC	Notes
H02.041	Spastic entropion of right upper eyelid	❌ No HCC	Inward lid margin turning; use -RT
H02.042	Spastic entropion of right lower eyelid	❌ No HCC	Lower lid; use -RT
H02.044	Spastic entropion of left upper eyelid	❌ No HCC	Use -LT
H02.045	Spastic entropion of left lower eyelid	❌ No HCC	Use -LT
H02.141	Spastic ectropion of right upper eyelid	❌ No HCC	Outward eyelid turning; use -RT
H02.142	Spastic ectropion of right lower eyelid	❌ No HCC	Use -RT
H02.144	Spastic ectropion of left upper eyelid	❌ No HCC	Use -LT
H02.145	Spastic ectropion of left lower eyelid	❌ No HCC	Use -LT

🔴 Paralytic Ptosis & Eyelid Dysfunction

ICD-10-CM	Description	HCC	Notes
H02.431	Paralytic ptosis of right eyelid	❌ No HCC	Drooping upper lid, right; chemodenervation of antagonist muscles
H02.432	Paralytic ptosis of left eyelid	❌ No HCC	Drooping upper lid, left
H02.433	Paralytic ptosis of bilateral eyelids	❌ No HCC	Bilateral ptosis; may require 64612--50
H02.59	Other disorders affecting eyelid function	❌ No HCC	Lid lag, apraxia of lid opening, or NEC eyelid movement disorder
R25.8	Other abnormal involuntary movements	❌ No HCC	Use when specific facial movement disorder code is not available

🔴 Spastic Hemiplegia (Facial Component)

ICD-10-CM	Description	HCC	Notes
G81.11	Spastic hemiplegia affecting right dominant side	❌ No HCC	Post-stroke or CNS injury facial spasticity; document facial muscle involvement
G81.12	Spastic hemiplegia affecting left dominant side	❌ No HCC	Also capture underlying stroke etiology (I69.x) as secondary
G81.13	Spastic hemiplegia affecting right nondominant side	❌ No HCC	Right non-dominant hemispheric origin
G81.14	Spastic hemiplegia affecting left nondominant side	❌ No HCC	Left non-dominant hemispheric origin

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💡 HCC Considerations — Secondary Diagnoses

64612 primary indications (blepharospasm, hemifacial spasm, facial dystonia) do not carry HCC weights. However, the underlying etiology of facial spasm or dystonia may be HCC-relevant when documented and coded as a secondary or additional diagnosis.

Stroke Sequelae (I69.x series)

• Facial spasticity arising from prior stroke → Code the sequela (I69.x) as secondary alongside the facial movement disorder
• HCC Category: Multiple HCCs possible (e.g., HCC 96 — Specified Heart Arrhythmias if AF was stroke cause; HCC 108 — Vascular Disease)
• Documentation Tip: Neurologist must explicitly link the hemifacial spasm or spastic hemiplegia to the prior CVA for late-effect coding to apply

Multiple Sclerosis (G35.x)

• Facial myokymia or hemifacial spasm may present in the setting of MS
• HCC Category: HCC 77 — Multiple Sclerosis (varies by v28 model year)
• RAF Impact: Significant — capture MS type and activity status for maximum accuracy

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🔧 Applicable Modifiers

Modifier	Description	When to Use with 64612
-RT	Right Side	Injections to right facial musculature; required by most payers; always append when unilateral
-LT	Left Side	Injections to left facial musculature; required by most payers; always append when unilateral
-50	Bilateral Procedure	When both sides of the face are treated in the same session (e.g., bilateral blepharospasm); MUE indicator 1 — must use -50 for 2 units; not for ASC
-59	Distinct Procedural Service	When 64616 (neck) or 64611 (salivary) is also performed in the same session at a truly distinct injection site
-XS	Separate Structure	Preferred NCCI modifier over -59 when the additional injection involves a structurally separate anatomical site (e.g., neck vs. face)
-52	Reduced Services	If fewer muscles than planned were injected due to patient tolerance or clinical change
-53	Discontinued Procedure	If procedure was started and abandoned before any injection was completed
-JW	Drug Amount Discarded	Append to J-code line (e.g., J0585-JW) for unused/wasted botulinum toxin from a vial; document dose given and discarded amount
-JZ	Zero Wastage	Append to J-code line when entire contents of single-dose vial were used with no discarded amount; required since CR 13056 (7/1/2023)
-26	Professional Component	When EMG guidance (95873 / 95874) is interpreted by the physician but the EMG equipment is owned by the facility; applies to the EMG code, not typically to 64612 itself
-GY	Non-Covered / Statutorily Excluded	If botulinum toxin is being administered for cosmetic purposes; required for ABN purposes; Z41.1 as diagnosis
-GZ	Expected Denial — Not Reasonable/Necessary	When submitting a claim you expect will deny (no ABN on file); rare for covered indications

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🏨 MS-DRG (Inpatient Context)

CPT 64612 is an outpatient or office-based procedure in virtually all clinical scenarios. It is not a standard inpatient OR-level procedure. However, when botulinum toxin chemodenervation is performed during an inpatient admission — for example, as an adjunct to stroke rehabilitation or during a neurological evaluation admission — the service would be reported using ICD-10-PCS Administration codes on the UB-04, and the DRG would be primarily driven by the principal diagnosis.

ICD-10-PCS Equivalents (Inpatient)

ICD-10-PCS	Description
3E023NZ	Introduction of Other Therapeutic Substance into Muscle, Percutaneous Approach
3E0X3NZ	Introduction of Other Therapeutic Substance into Cranial Nerves, Percutaneous Approach
3E0T3NZ	Introduction of Other Therapeutic Substance into Peripheral Nerves and Plexuses, Percutaneous Approach

PCS Root Operation — Introduction (0): Putting in or on a therapeutic, diagnostic, nutritional, physiological, or prophylactic substance except blood or blood products Section: 3 — Administration Body System: E — Physiological Systems and Anatomical Regions Clinical Tip: For chemodenervation targeting the neuromuscular junction within facial muscles, 3E023NZ (muscle, percutaneous) is most anatomically appropriate. If documentation emphasizes facial nerve branch injection rather than direct muscle injection, 3E0X3NZ (cranial nerves) may better reflect the clinical intent.

Associated MS-DRGs (When Chemodenervation Occurs During Inpatient Admission)

Because 64612 is not a CMS-defined OR procedure, it typically does not drive the surgical DRG partition. The MS-DRG assignment remains based on the principal diagnosis in the medical partition.

MS-DRG	Description	Partition
073	Cranial & Peripheral Nerve Disorders with MCC	Medical
074	Cranial & Peripheral Nerve Disorders with CC	Medical
075	Cranial & Peripheral Nerve Disorders without CC/MCC	Medical
056	Degenerative Nervous System Disorders with MCC	Medical
057	Degenerative Nervous System Disorders without MCC	Medical
058	Multiple Sclerosis & Cerebellar Ataxia with MCC	Medical
059	Multiple Sclerosis & Cerebellar Ataxia with CC	Medical
060	Multiple Sclerosis & Cerebellar Ataxia without CC/MCC	Medical

Warning

⚠️ If 64612 is performed inpatient, the botulinum toxin drug (J0585-J0589) is included in the DRG payment (covered under the Part A DRG) and cannot be separately billed under Part B for the same admission. Do not submit a Part B claim for the drug during an inpatient stay.

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📝 Coding Examples

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🟢 Example 1 — Unilateral Blepharospasm, Office Setting

Clinical Scenario: A 68-year-old female with right-sided blepharospasm unresponsive to oral medications presents to neurology clinic. The neurologist injects 25 units of onabotulinumtoxinA (Botox) into the right orbicularis oculi and corrugator muscles. Documentation supports the diagnosis, prior treatment failure, dosage, and injection sites.

CPT / HCPCS Codes:

• 64612-RT — Chemodenervation of facial nerve muscle(s), unilateral, right
• J0585] x 25 units — OnabotulinumtoxinA (Botox), per unit
• J0585-JZ — Zero wastage attestation (if full vial used, or calculate wastage with -JW if vial shared)

ICD-10-CM Codes:

• G24.5 — Blepharospasm (primary indication)

Notes: Only one unit of 64612-RT, regardless of how many muscles injected on the right side. Document all injection sites, dosages, and clinical response to prior treatment.

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🟢 Example 2 — Bilateral Blepharospasm, Both Eyelids

Clinical Scenario: A 72-year-old male with bilateral blepharospasm (both eyes) presents for repeat injection. Neurologist injects 15 units of onabotulinumtoxinA per side (30 units total) into bilateral orbicularis oculi.

CPT / HCPCS Codes:

• 64612-50 — Chemodenervation of facial nerve muscle(s), bilateral
• J0585 x 30 units — Total units administered
• J0585-JW x 70 units — Unused portion of 100-unit vial (if no other patient treated)

ICD-10-CM Codes:

• G24.5 — Blepharospasm

Notes: Modifier -50 triggers 150% payment (1.5 × single-side rate). For ASC billing, use two separate lines: 64612-RT and 64612-LT (do not use -50 in ASC). MUE is 1 per day; Modifier -50 overrides the MUE at the claim level.

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🟢 Example 3 — Hemifacial Spasm with Same-Day Neck Injection

Clinical Scenario: A 61-year-old female with left hemifacial spasm and concurrent cervical dystonia presents to neurology. The provider injects 30 units of onabotulinumtoxinA into left facial muscles for the hemifacial spasm, then separately injects 50 units into left sternocleidomastoid for the cervical dystonia.

CPT / HCPCS Codes:

• 64612-LT — Chemodenervation of left facial nerve muscle(s)
• 64616-LT--59 — Chemodenervation of neck muscle(s), unilateral, left; -59 (or -XS) to override NCCI bundling edit — distinct anatomical structure
• J0585 x 80 units total — combined facial + neck dosage on same claim line
• J0585-JZ — Zero wastage (if exactly 80 units used from an 80-unit draw) or -JW for remainder

ICD-10-CM Codes:

• G51.32 — Clonic hemifacial spasm, left (primary/first condition treated)
• G24.3 — Spasmodic torticollis (cervical dystonia, secondary indication)

Notes: 64612 and 64616 are separate injection sites involving different anatomical structures (face vs. neck) and different nerve territories. The NCCI has a bundling edit between them with modifier indicator 1, so -59 or -XS is required to unbundle. Document both injection sites, their muscles, and dosages distinctly in the procedure note.

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🟢 Example 4 — Post-Stroke Facial Synkinesis (Inpatient Rehabilitation Setting)

Clinical Scenario: A 58-year-old male is admitted to inpatient rehab following a left middle cerebral artery stroke (I63.512). He has right-sided hemiplegia and right facial synkinesis causing functional impairment. The neurologist performs chemodenervation of right facial muscles with 20 units of onabotulinumtoxinA.

ICD-10-CM (UB-04):

• Principal Dx: I63.512 — Cerebral infarction due to unspecified occlusion or stenosis of left middle cerebral artery (if still primary rehab admission driver)
• Secondary Dx: G81.11 — Spastic hemiplegia affecting right dominant side
• Secondary Dx: G51.8 — Other disorders of facial nerve (synkinesis)

ICD-10-PCS Procedure Code:

• 3E023NZ — Introduction of Other Therapeutic Substance into Muscle, Percutaneous Approach

MS-DRG: Likely 073-075 (Cranial & Peripheral Nerve Disorders) or a Rehabilitation DRG depending on admission type.

🏥 Inpatient Coder Tip: The botulinum toxin drug (J0585 units) is bundled into the Part A DRG payment and cannot be separately billed to Part B during an inpatient stay. The secondary diagnoses (G81.11, G51.8) may qualify as CC/MCC depending on CMS grouper version — verify with your facility grouper before finalizing the DRG assignment.

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⚠️ Common Coding Pitfalls

• ❌ Do not bill 64615 and 64612 at the same visit — they are bundled per NCCI and represent mutually exclusive service descriptions; selecting the most appropriate code requires reviewing which nerve territories were injected
• ❌ Do not submit the J-code (J0585-J0589) on a separate claim from 64612 — CMS requires both on the same claim; if the drug is denied, 64612 will also deny
• ❌ Do not bill 64612 as multiple units for injecting multiple muscles on the same side — it is a per-session, per-side code; multiple muscles on one side = 1 unit of 64612
• ❌ Do not omit the -JW or -JZ modifier on the J-code line — Medicare requires one of these modifiers on all Part B drug claims effective 7/1/2023 per CR 13056; claims without them may be rejected or denied
• ❌ Do not bill 64612 for cosmetic botulinum toxin — cosmetic use is statutorily excluded from Medicare; if patient requests it cosmetically, issue an ABN and use -GY modifier with Z41.1 as the diagnosis
• ✅ Do always append laterality (-RT / -LT) — required by most payers and essential for auditing bilateral claims
• ✅ Do check MAC-specific prior authorization requirements before administering — Noridian and other MACs require PA for J0585-J0588 when billed with 64612; failure to obtain PA will result in claim denial
• ✅ Do document the prior treatment failure for conditions other than blepharospasm, hemifacial spasm, or focal dystonia — CMS requires documentation that the spastic condition was unresponsive to conventional treatment before approving botulinum toxin
• ✅ Do document dosage, injection site(s), and frequency in the procedure note — these are explicit CMS documentation requirements per LCD L39857

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📌 Quick Reference Summary

Field	Value
Code	64612
Type	CPT - Surgical (Neurolytic/Chemodenervation)
System	Nervous System
Body Part	Facial nerve-innervated muscle(s)
Laterality	Unilateral — use -RT or -LT always
Global Period	010 (10 days)
wRVU	1.37
Total RVU (Fac)	4.24
Est. Medicare Payment	~$141.62 (2026)
Assistant Payable	No
MUE	1 per day (bilateral = modifier -50 required)
Bilateral Rule	Indicator 1 (150%)
Required Companion	J0585 / J0586 / J0587 / J0588 / J0589 — same claim
Drug Wastage	-JW (wastage) or -JZ (no wastage) — required on J-code
Optional Companion	95873 / 95874 — EMG guidance when medically necessary
NCCI Bundled	64615 (mutually exclusive)
Common DX	G24.5, G51.31, G51.32, G24.4, H02.041
HCC Secondary DX	I69.x (stroke sequelae), G35.x (MS)

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_{AMA CPT Professional Edition 2024 · CMS Physician Fee Schedule RVU26A (2026) · CMS LCD L39857 — Botulinum Toxins (Effective 02/22/2026) · CMS Billing & Coding Article A59726 (Updated 02/22/2026) · NCCI Policy Manual for Medicare Services 2026 · CMS CR 13056 — JW/JZ Modifier Requirements (Effective 7/1/2023) · AHA Coding Clinic for ICD-10-CM/PCS · Noridian Medicare — Botulinum Toxin Injections Pre-Claim Review · AAPC Neurology & Ophthalmology Coding Guidelines}