64616

💉 CPT 64616 - Chemodenervation of Muscle(s); Neck Muscle(s), Unilateral (Cervical Dystonia)

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📋 Code Description

Full Official Description (Effective 1/1/2014): Chemodenervation of muscle(s); neck muscle(s), excluding muscles of the larynx, unilateral (eg, for cervical dystonia, spasmodic torticollis)

CPT 64616 describes the injection of a chemodenervating agent — most commonly a botulinum toxin — into one or more neck muscles on a single side, targeting musculature innervated by the cervical spinal nerves (C1-C7) and the accessory nerve (CN XI). The procedure produces focal, temporary weakening of overactive neck musculature to reduce the abnormal head posture, involuntary movements, and pain associated with cervical dystonia and related conditions.

CPT 64616 replaced the now-deleted code 64613 effective January 1, 2014, when the AMA restructured the chemodenervation family to separate neck injections from laryngeal injections. The key anatomical exclusion in the descriptor — “excluding muscles of the larynx” — means intrinsic laryngeal muscles (injected for spasmodic dysphonia) are captured by 64617, not 64616. Cervical muscles commonly targeted include:

Muscle	Primary Head Position Abnormality	Max Dose (onabotulinumtoxinA)
Sternocleidomastoid (SCM)	Torticollis (head rotation), laterocollis	Up to 100 U per side
Splenius capitis	Torticollis, retrocollis	Up to 200 U
Semispinalis capitis	Retrocollis	Up to 200 U
Trapezius (upper)	Elevation, laterocollis	Up to 100 U
Levator scapulae	Laterocollis, shoulder elevation	Up to 100 U
Scalenes (anterior/middle)	Laterocollis, anterocollis	Up to 50 U
Longissimus capitis	Retrocollis, torticollis	Up to 100 U

⚠️ Unilateral by Definition: 64616 is a unilateral code — laterality modifiers -RT or -LT are required and must reflect the side(s) injected. If both sides are treated in a single session, modifier -50 must be appended (bilateral surgery indicator = 1, 150% rule applies). A single unit of 64616 covers all injections on one side regardless of how many muscles are treated.

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💰 Work RVUs & Payment

Component	Value
wRVU (Facility)	1.56
wRVU (Non-Facility)	1.56
Total RVU (Facility)	~4.04
Global Period	010 (10 days)
Est. Medicare Payment	~$134.90(national;2026CF$33.40)
Assistant Payable	❌ No (indicator: 0)
Co-Surgery	❌ No
Team Surgery	❌ No
Bilateral Surgery	Indicator 1 — standard bilateral rule; modifier -50 required if both sides treated; 150% of single-side rate
Multiple Procedure	Indicator 2 (standard 50% reduction on subsequent procedures same session)
PC/TC Split	✅ Yes — modifier -26 applicable when EMG guidance (95873 / 95874) is professionally interpreted separately from facility-owned equipment

Note:

The work RVU (1.56) is the same regardless of care setting — the difference in total reimbursement between facility and non-facility lies in the practice expense (PE) component. 64616 is frequently performed in non-facility (office/clinic) settings where total RVU and payment are higher due to physician-borne overhead. Estimated 2026 Medicare payment is approximately $134.90basedonAAN2022-2023feescheduledataextrapolatedtothe2026CFof$33.40. Verify against RVU26A for your specific locality.

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✅ What’s Included

CPT 64616 bundles the following into a single billable unit per side per session:

• All needle placements and injections into ipsilateral neck muscle(s) during the same encounter — multiple muscles on one side = still 1 unit of 64616
• Any combination of cervical musculature (SCM, splenius, semispinalis, trapezius, levator scapulae, scalenes, longissimus, suboccipitals)
• Local preparation, patient positioning, and standard post-injection assessment
• 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 on same claim as 64616; typical dose range 200-400 U total for cervical dystonia
Botulinum toxin type A (abobotulinumtoxinA / Dysport™)	J0586 — per unit (note: dose conversion differs; Dysport:Botox ≈ 2.5:1 to 3:1)
Botulinum toxin type B (rimabotulinumtoxinB / Myobloc®)	J0587 — per 100 units; FDA-approved for cervical dystonia
Botulinum toxin type A (incobotulinumtoxinA / Xeomin®)	J0588 — per unit; FDA-approved for cervical dystonia
Botulinum toxin type A (daxibotulinumtoxinA-lanm / DAXXIFY®)	J0589 — per unit; FDA-approved for cervical dystonia; only G24.3 is a covered diagnosis per CMS Group 7
Drug wastage from vial (discarded portion)	J0585-J0589 with modifier -JW — document dose given and discarded amount
No discarded amount (since 7/1/2023)	Append -JZ to J-code line to attest zero wastage; required per CR 13056
EMG (electrical stimulation) guidance for chemodenervation	95873 — needle EMG guidance; list separately in addition to 64616; use per injection site when medically necessary
Fine wire EMG guidance	95874 — fine wire EMG; list separately; do not report 95873 and 95874 at the same injection site
Ultrasound guidance for needle placement (when documented)	76942 — ultrasonic guidance, imaging S&I; separately reportable when documented with full supervision and interpretation report; check NCCI bundling status
Chemodenervation of intrinsic laryngeal muscle(s), unilateral	64617 — separately reportable when laryngeal injection is performed as a distinct service at the same session; different anatomical structure; verify NCCI modifier indicator
Contralateral side neck injection, same session	64616--50 (bilateral) OR 64616--LT + 64616--RT on two claim lines (ASC/facility preference)
Chemodenervation of limb muscles, same session (spasticity)	64642 / 64644 — separately reportable for upper extremity spasticity; distinct anatomical sites; append -59 or -XS
E/M service for cervical dystonia management (same visit)	Not separately reportable unless a distinct, separately identifiable medical service for a different diagnosis is also rendered; if so, append -25 to E/M code

⚠️ Critical NCCI Trap — 64615 vs. 64616: 64616 and 64615 are bundled per NCCI — if the patient receives PREEMPT migraine injections (64615) at the same session, the cervical/neck component is already included within 64615 (which covers facial, trigeminal, cervical spinal, and accessory nerves bilaterally). Reporting both 64615 and 64616 at the same visit constitutes unbundling. By contrast, 64612 (facial nerve, unilateral) and 64616 (neck muscle, unilateral) can be reported together at the same session with modifier -59 or -XS, as they involve distinct anatomical territories (face vs. neck) under different nerve groups.

⚠️ Prior Authorization Note: Per Noridian Medicare (JE/JF jurisdictions), prior authorization is required when J0585, J0586, J0587, or J0588 is billed with 64612 or 64615 specifically. 64616 is NOT currently included in Noridian’s PA program — botulinum toxin for cervical dystonia with 64616 does not require PA at Noridian. However, many commercial payers (UHC, Aetna, BCBS) DO require prior authorization for cervical dystonia injections; verify by payer before service.

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🌿 Code Tree / Family

Nervous System - Chemodenervation (64611-64653)
│
├── 64611  Chemodenervation of salivary gland(s), bilateral (sialorrhea)
│
├── 64612  Chemodenervation of facial nerve muscle(s), UNILATERAL
│              (blepharospasm, hemifacial spasm, facial dystonia)
│              [Can be reported with 64616; append -59/-XS]
│
├── 64615  Chemodenervation of facial, trigeminal, cervical spinal &
│              accessory nerves, BILATERAL (chronic migraine / PREEMPT)
│              [Bundles 64616 — cervical neck muscles included in 64615]
│
├── 64616  ◀ Chemodenervation of neck muscle(s), excluding larynx,
│              UNILATERAL (cervical dystonia, spasmodic torticollis)
│              [Replaced deleted code 64613 effective 1/1/2014]
│              [Bilateral indicator 1: -50 required if both sides treated]
│
├── 64617  Chemodenervation of laryngeal muscle(s), unilateral, percutaneous
│              (spasmodic dysphonia, laryngeal dystonia)
│              [Includes EMG guidance when performed — do NOT separately bill
│              95873/95874 with 64617]
│
├── 64642  Chemodenervation of one extremity; 1-4 muscle(s)
├── 64643  Each additional extremity; 1-4 muscle(s) [Add-on to 64642]
├── 64644  Chemodenervation of one extremity; 5+ muscle(s)
├── 64645  Each additional extremity; 5+ muscle(s) [Add-on to 64644]
│
├── 64646  Chemodenervation of trunk muscle(s); 1-5 muscles
└── 64647  Chemodenervation of trunk muscle(s); 6+ muscles

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🏥 ICD-10-CM Commonly Paired Diagnoses

Codes below represent CMS LCD-covered indications for 64616 per CMS Billing & Coding Article A59726 (effective 02/22/2026). The primary covered diagnosis is G24.3 — the only ICD-10-CM code that supports coverage for J0589 (DAXXIFY) with 64616 per CMS Group 7. Documentation must establish the diagnosis, severity (TWSTRS score recommended), and failure of conservative treatment when required by the payer.

🔴 Cervical Dystonia / Spasmodic Torticollis (Primary Indication)

ICD-10-CM	Description	HCC	Notes
G24.3	Spasmodic torticollis	❌ No HCC	Primary covered diagnosis; only code covering J0589 (DAXXIFY) per CMS Group 7; supports all 4 botulinum toxin J-codes with 64616

🔴 Other Dystonia with Cervical Involvement

ICD-10-CM	Description	HCC	Notes
G24.1	Genetic torsion dystonia	❌ No HCC	Hereditary cervical dystonia with genetic etiology documented; familial
G24.2	Idiopathic nonfamilial dystonia	❌ No HCC	Non-genetic, sporadic adult-onset cervical dystonia; confirm no drug causation
G24.8	Other dystonia	❌ No HCC	Includes task-specific, secondary, and atypical cervical dystonias
G24.9	Dystonia, unspecified	❌ No HCC	Avoid if more specific dystonia code is available

🔴 Non-Dystonic Torticollis & Neck Muscle Disorders

ICD-10-CM	Description	HCC	Notes
M43.6	Torticollis	❌ No HCC	Structural or biomechanical torticollis without dystonic mechanism; note Excludes1 vs G24.3 — use G24.3 when spasmodic (dystonic)
R25.2	Cramp and spasm	❌ No HCC	Secondary code for muscle spasm component; rarely primary indication alone
M54.2	Cervicalgia	❌ No HCC	Secondary code only; cervical pain as a component of dystonia — do not use as sole indication for chemodenervation

🔴 Spasticity with Cervical Component (Post-CNS Injury)

ICD-10-CM	Description	HCC	Notes
G81.11	Spastic hemiplegia affecting right dominant side	❌ No HCC	Post-stroke or TBI neck spasticity; use when cervical spasticity is documented as distinct from extremity spasticity
G81.12	Spastic hemiplegia affecting left dominant side	❌ No HCC	Document cervical muscle involvement specifically
G81.13	Spastic hemiplegia affecting right nondominant side	❌ No HCC	Capture underlying etiology (I69.x, S14.x) as secondary for full clinical picture
G81.14	Spastic hemiplegia affecting left nondominant side	❌ No HCC	Left non-dominant hemispheric origin
G82.20	Paraplegia, unspecified	❌ No HCC	Cervical muscle involvement in spinal cord injury; rare indication for 64616
G35.-	Multiple sclerosis	✅ HCC 77	Cervical spasticity in the context of MS; HCC capture opportunity — document MS type and activity alongside dystonia/spasticity

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💡 HCC Considerations — Secondary Diagnoses

The primary diagnosis for 64616 — cervical dystonia (G24.3) — does not carry HCC weight in the CMS-HCC v28 model. However, the underlying neurological condition causing or comorbid with cervical dystonia may be HCC-relevant when documented and coded as a secondary or additional diagnosis.

Multiple Sclerosis (G35.-)

• HCC Category: HCC 77 — Multiple Sclerosis (varies by v28 model year)
• RAF Impact: Significant; MS with cervical spasticity is a recognized indication for 64616
• Documentation Tip: Specify MS type (relapsing-remitting, primary progressive, secondary progressive) and whether currently relapsing or stable; G35 is the only ICD-10 code for MS — type specificity comes from documentation, not code variation

Parkinson’s Disease (G20.x)

• Cervical dystonia may co-occur with Parkinson’s disease; G20.xx codes carry HCC weight
• Documentation Tip: Parkinson’s-related dystonia should be clearly distinguished from primary dystonia; if the cervical dystonia is a manifestation of Parkinson’s, the Parkinson’s code may be appropriate as the primary diagnosis

Sequelae of Stroke (I69.x Series)

• Post-stroke cervical spasticity → Code I69.x as secondary alongside G81.1x
• HCC Category: Cerebrovascular disease sequelae may carry HCC based on functional deficit level; capture for full risk adjustment accuracy

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🔧 Applicable Modifiers

Modifier	Description	When to Use with 64616
-RT	Right Side	Injections into right neck muscle(s); required by most payers; always append for unilateral procedures
-LT	Left Side	Injections into left neck muscle(s); required by most payers; always append for unilateral procedures
-50	Bilateral Procedure	When both sides of the neck are treated in the same session (bilateral cervical dystonia); bilateral indicator = 1 → 150% payment; not typically used in ASC — use two separate lines instead
-59	Distinct Procedural Service	Required when billing 64612 (facial nerve) and 64616 (neck) at the same session — different anatomical territories; also for contralateral-side injection documented as distinct service
-XS	Separate Structure	Preferred NCCI modifier over -59 when the additional injection is at a structurally separate anatomical site (e.g., face vs. neck for 64612 + 64616)
-25	Significant, Separately Identifiable E/M Service	Append to the E/M code only (not to 64616) when a truly separate E/M is documented for a different diagnosis on the same day
-52	Reduced Services	If fewer muscles than planned were injected due to patient tolerance, dose limits, or change in clinical plan
-53	Discontinued Procedure	If the procedure was abandoned before any injection was completed due to medical complication or safety concern
-JW	Drug Amount Discarded	Append to J-code line (e.g., J0585--JW) for discarded/unused portion of botulinum toxin vial; document administered and discarded amounts in the medical record
-JZ	Zero Wastage	Append to J-code line when entire vial contents were administered with no discarded amount; required per CR 13056 since 7/1/2023
-26	Professional Component	Apply to 95873 or 95874 when the physician interprets EMG guidance but the equipment belongs to the facility; not typically applied to 64616 itself
-GY	Non-Covered / Statutorily Excluded	For cosmetic use of botulinum toxin; use Z41.1 as diagnosis; ABN required
-GZ	Expected Denial — Not Reasonable/Necessary	When claim is submitted without ABN but denial is anticipated; rare for appropriately documented cervical dystonia

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🏨 MS-DRG (Inpatient Context)

CPT 64616 is performed in the outpatient or office setting in virtually all clinical scenarios. However, a patient may be admitted inpatient for status dystonicus (sustained, severe dystonic storm), acute cervical dystonia with airway compromise, or significant dehydration/aspiration related to torticollis severity — at which point chemodenervation may be performed during the inpatient stay and reported using ICD-10-PCS Administration codes on the UB-04.

ICD-10-PCS Equivalents (Inpatient)

ICD-10-PCS	Description
3E023NZ	Introduction of Other Therapeutic Substance into Muscle, 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, excluding blood products Section: 3 (Administration) | Body System: E (Physiological Systems and Anatomical Regions) Clinical Tip: For cervical muscle-targeted injection, 3E023NZ (Muscle, Percutaneous) is most appropriate. Botulinum toxin acts at the neuromuscular junction within the muscle itself, making the muscle body part character the most anatomically accurate selection. Drug Note: Inpatient botulinum toxin (J0585, etc.) is bundled into the DRG payment under Part A and cannot be billed separately under Part B during an inpatient stay.

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

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

⚠️ MS-DRG assignment for an inpatient admission involving cervical dystonia treatment is driven by the principal diagnosis — the condition that, after study, is chiefly responsible for the admission. Cervical dystonia itself (G24.3) does not carry MCC/CC status in most grouper versions, meaning secondary diagnoses (MS, Parkinson’s, aspiration pneumonia, dehydration) will heavily influence the DRG partition and weight.

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📝 Coding Examples

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🟢 Example 1 — Standard Unilateral Cervical Dystonia, Office Setting

Clinical Scenario: A 54-year-old female with a 4-year history of right-sided cervical dystonia (rotational torticollis, TWSTRS severity score 18) who has failed oral baclofen and trihexyphenidyl presents for repeat botulinum toxin injection. The neurologist injects 200 units of onabotulinumtoxinA into the right splenius capitis (100U) and right SCM (100U) under EMG guidance.

CPT / HCPCS Codes:

• 64616-RT — Chemodenervation of right neck muscle(s), unilateral
• 95873 × 2 — EMG guidance, one per muscle site (splenius capitis and SCM)
• J0585 × 200 — OnabotulinumtoxinA, 200 units administered
• J0585--JW × 100 — Wastage from two 100-unit vials (300 units available; 100 discarded)

ICD-10-CM Codes:

• G24.3 — Spasmodic torticollis

Notes: 64616 is reported once regardless of 2 muscles injected on the right side. 95873 is reported per muscle site injected under EMG guidance — 2 sites = 2 units of 95873. Do not use 95873 when billing 64617 (EMG guidance is already included in 64617’s descriptor), but it is separately reportable with 64616.

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🟢 Example 2 — Bilateral Cervical Dystonia (Both Sides Injected)

Clinical Scenario: A 62-year-old male presents with bilateral retrocollis (bilateral splenius capitis overactivity). The neurologist injects 150 units of onabotulinumtoxinA per side (300 units total): right splenius capitis 100U + right semispinalis capitis 50U; left splenius capitis 100U + left semispinalis capitis 50U.

CPT / HCPCS Codes:

• 64616-50 — Chemodenervation of neck muscle(s), bilateral (OR two lines: 64616-RT + 64616-LT for ASC billing)
• J0585 × 300 — OnabotulinumtoxinA, 300 units total
• J0585--JW × 0 (use -JZ if exactly 300U used from vials)

ICD-10-CM Codes:

• G24.3 — Spasmodic torticollis (bilateral)

Notes: Bilateral indicator = 1 for 64616 — CMS pays 150% of the single-side rate when -50 is appended. For ASC settings, most facilities prefer two separate lines (RT + LT) over the -50 modifier; verify your facility’s billing preference. MUE is 1 per side (2 units total for bilateral).

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🟢 Example 3 — Cervical Dystonia + Facial Injection Same Session

Clinical Scenario: A 49-year-old female has both right-sided cervical dystonia AND left hemifacial spasm. The neurologist injects the right neck (SCM + trapezius, 150U total) for torticollis and the left facial musculature (orbicularis oculi, 25U) for hemifacial spasm in the same office visit.

CPT / HCPCS Codes:

• 64616-RT — Chemodenervation of right neck muscle(s) (cervical dystonia)
• 64612-LT--59 — Chemodenervation of left facial nerve muscle(s) (hemifacial spasm); -59 (or -XS) overrides NCCI bundling — distinct anatomical structure and distinct nerve territory
• J0585 × 175 — OnabotulinumtoxinA, combined 150U (neck) + 25U (face) = 175 total units
• J0585--JW × 25 — Wastage (200U vials available; 25U discarded)

ICD-10-CM Codes:

• G24.3 — Spasmodic torticollis (linked to 64616-RT)
• G51.32 — Clonic hemifacial spasm, left (linked to 64612-LT)

Notes: Unlike 64615 + 64616 (bundled — cannot unbundle), 64612 + 64616 can be separately reported with modifier -59 or -XS, because these codes cover entirely different nerve territories (facial CN VII vs. cervical spinal nerves) and distinct anatomical sites. Document each injection site, nerve territory, dosage, and clinical indication separately in the procedure note.

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🟢 Example 4 — Inpatient Cervical Dystonia Crisis (Inpatient Coding)

Clinical Scenario: A 41-year-old male with severe refractory cervical dystonia is admitted for status dystonicus causing aspiration pneumonia and dehydration. After medical stabilization on Day 3, the neurologist performs botulinum toxin chemodenervation of bilateral neck muscles as part of the inpatient treatment plan.

ICD-10-CM (UB-04):

• Principal Dx: J69.0 — Pneumonitis due to inhalation of food and vomit (aspiration pneumonia; reason for admission)
• Secondary Dx: G24.3 — Spasmodic torticollis (underlying condition driving aspiration)
• Secondary Dx: E86.0 — Dehydration (documented and treated)

ICD-10-PCS Procedure Codes:

• 3E023NZ — Introduction of Other Therapeutic Substance into Muscle, Percutaneous Approach (bilateral; code once — PCS does not require laterality coding for Administration section)

MS-DRG: Likely 073 (Cranial & Peripheral Nerve Disorders with MCC) if aspiration pneumonia qualifies as MCC; or 074 with CC. Verify with your facility grouper — J69.0 often acts as MCC.

🏥 Inpatient Coder Tip: Sequence aspiration pneumonia (J69.0) as principal diagnosis per UHDDS — it is the condition that, after study, drove the admission. G24.3 is critical as a secondary diagnosis to fully capture the clinical picture and risk profile. The botulinum toxin drug (J0585) is NOT separately billable under Part B during an inpatient stay — it is covered under the Part A DRG payment.

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⚠️ Common Coding Pitfalls

• ❌ Do not bill 64616 and 64615 together at the same session — they are bundled per NCCI; the cervical/neck injection component is already included in 64615’s bilateral migraine PREEMPT paradigm; no modifier can override this edit
• ❌ Do not skip laterality modifiers — -RT or -LT is required for all unilateral 64616 claims; missing laterality modifiers will trigger edits or denials at most payers
• ❌ Do not bill multiple units of 64616 for multiple muscles on the same side — it is a per-session, per-side code; 3 muscles on the right side = 1 unit of 64616-RT
• ❌ Do not omit the -JW or -JZ modifier on the J-code line — required on all Part B drug claims per CR 13056 (effective 7/1/2023)
• ❌ Do not separately bill 95873 or 95874 when billing 64617 (laryngeal chemodenervation) — EMG guidance is included in 64617’s descriptor; however, these EMG codes are separately billable with 64616 (neck), which does NOT include guidance in its descriptor
• ❌ Do not use modifier -50 in ASC/facility settings for bilateral 64616 — ASC facilities typically require two separate line items with -RT and -LT rather than the -50 modifier; verify with your facility biller
• ✅ Do document the TWSTRS (Toronto Western Spasmodic Torticollis Rating Scale) score when required by commercial payers (UHC, Aetna, BCBS) — CMS does not explicitly require TWSTRS but most commercial payers use it for medical necessity determination and PA
• ✅ Do document prior treatment failures (oral medications, physical therapy) — most commercial payers require evidence of failure of at least one conservative treatment before approving chemodenervation for cervical dystonia
• ✅ Do bill 64612--59 or -XS when adding a facial injection at the same session — unlike 64615 + 64616, the combination of 64612 + 64616 is permissible with the appropriate NCCI modifier
• ✅ Do verify commercial payer PA requirements independently from Medicare — Noridian does NOT require PA for 64616 + botulinum toxin J-codes, but most commercial insurers DO require prior authorization for cervical dystonia chemodenervation

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📌 Quick Reference Summary

Field	Value
Code	64616
Type	CPT - Surgical (Neurolytic/Chemodenervation)
System	Nervous System
Body Part	Neck muscle(s), excluding larynx
Laterality	Unilateral — -RT or -LT required; -50 for bilateral
Global Period	010 (10 days)
wRVU	~1.56
Total RVU (Fac)	~4.04
Est. Medicare Payment	~$134.90 (2026)
Assistant Payable	No
MUE	1 per side per session
Bilateral Rule	Indicator 1 (150% rule; -50 required for bilateral)
Required Companion	J0585 / J0586 / J0587 / J0588 / J0589 — same claim
Drug Wastage	-JW (wastage) or -JZ (zero wastage) — required on J-code
Optional Add-On	95873 / 95874 — EMG guidance, separately reportable
NCCI Bundled	64615 (mutually exclusive at same session)
Compatible with -59	64612 (facial), 64617 (laryngeal), 64642/64644 (extremity)
Primary DX	G24.3 — only code covering J0589 (DAXXIFY) per CMS Group 7
Other Covered DX	G24.1, G24.2, G24.8, M43.6
HCC Secondary DX	G35.- (MS → HCC 77), I69.x (stroke sequelae), G20.x (Parkinson’s)
PA Required (Medicare)	❌ No (Noridian: PA not required for 64616 + J0585-J0588)
PA Required (Commercial)	✅ Most commercial payers — verify by plan
Inpatient PCS	3E023NZ

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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) · CMS Billing & Coding Article A57185 · NCCI Policy Manual for Medicare Services 2026 · CMS CR 13056 — JW/JZ Modifier Requirements (Effective 7/1/2023) · Noridian Medicare JE/JF — Botulinum Toxin Pre-Claim Review (Updated 02/22/2026) · AAN Medicare Physician Fee Schedule Reference Table 2022-2023 · UHC Commercial Medical Drug Policy — Botulinum Toxins A and B · AAPC Otolaryngology Coding Alert — New Chemodenervation Codes 64616/64617 (2014) · AHA Coding Clinic for ICD-10-CM/PCS · DAXXIFY® (daxibotulinumtoxinA-lanm) Prescribing Information — REVANCE Therapeutics}