64617

🗣️ CPT 64617 - Chemodenervation of Muscle(s); Larynx, Unilateral, Percutaneous (Spasmodic Dysphonia)

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📋 Code Description

Full Official Description (Effective 1/1/2014, Revised Context 2017): Chemodenervation of muscle(s); larynx, unilateral, percutaneous (eg, for spasmodic dysphonia), includes guidance by needle electromyography, when performed

CPT 64617 describes a percutaneous, EMG-guided injection of a chemodenervating agent — most commonly onabotulinumtoxinA (Botox) — into intrinsic laryngeal muscle(s) on one side, targeting the neuromuscular junction to produce focal, temporary weakening of overactive vocal cord musculature. The procedure is the first-line treatment for spasmodic dysphonia (SD), a focal laryngeal dystonia characterized by involuntary spasms of the vocal cord muscles that disrupt speech.

The defining features of 64617 are:

1. Percutaneous approach — needle inserted through the skin of the anterior neck (typically via the cricothyroid membrane or directly through the thyroid cartilage); this is the traditional technique requiring no laryngoscope
2. Laryngeal EMG (LEMG) guidance — needle electromyography for anatomic localization of target muscle is included in the code descriptor and cannot be separately billed
3. Unilateral — covers injection into muscle(s) on one side, with modifier -50 for bilateral treatment

The two main subtypes of spasmodic dysphonia determine laterality and target muscle:

SD Type	Prevalence	Mechanism	Target Muscle	Typical Approach
Adductor SD (ADSD)	~85-90%	Involuntary hyperadduction (closing) of vocal cords during voiced speech; strained, effortful voice	Thyroarytenoid (TA) muscle, bilateral	64617--50 (bilateral TA injection)
Abductor SD (ABSD)	~10-15%	Involuntary abduction (opening) of vocal cords during unvoiced consonants; breathy, whispered breaks	Posterior cricoarytenoid (PCA) muscle, unilateral	64617--RT or -LT (one side only)
Mixed SD	~5%	Features of both subtypes	TA + PCA	Case-by-case; -50 or RT/LT as appropriate

⚠️ 2017 CPT Context Shift: Effective 2017, the AMA introduced 31573 (Laryngoscopy, flexible, with therapeutic injection[s], unilateral) for laryngeal chemodenervation performed via flexible laryngoscopic visualization (transoral or via endoscope channel). 64617 remains the correct code for the percutaneous, through-the-neck approach with LEMG guidance. These two approaches are mutually exclusive for the same larynx at the same session — use 64617 OR 31573, never both. When 31573 is used, LEMG guidance (95874) IS separately reportable (unlike with 64617).

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💰 Work RVUs & Payment

Component	Value
wRVU (Facility)	1.85
wRVU (Non-Facility)	1.85
Total RVU (Facility)	4.76
Global Period	010 (10 days)
Est. Medicare Payment	~$158.98(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 when both sides of larynx are injected (typical for adductor SD bilateral TA injection); 150% of single-side rate
Multiple Procedure	Indicator 2 (standard 50% reduction on subsequent procedures same session)
PC/TC Split	❌ No — EMG guidance is included in 64617 descriptor; no separate PC/TC split applies to the bundled EMG component

Note:

CPT 64617 carries a higher wRVU (1.85) than 64616 (~1.56) because EMG guidance is built into the descriptor, reflecting the greater physician work required for the specialized skill of percutaneous LEMG-guided laryngeal injection. The work RVU of 1.85 is the same in facility and non-facility settings; total reimbursement is higher in the non-facility (office) setting due to larger practice expense. Total facility RVU: 1.85 (work) + 2.65 (PE) + 0.26 (malpractice) = 4.76 total. Data sourced from CMS RVU26A.

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✅ What’s Included

CPT 64617 bundles the following into a single billable unit per side per session:

• All needle placements and injections into ipsilateral intrinsic laryngeal muscle(s) (e.g., TA, PCA, LCA, cricothyroid) during the same encounter
• Laryngeal EMG (LEMG) guidance — needle electromyography used to confirm needle placement within the target muscle by monitoring EMG waveforms; included “when performed” per the descriptor
• Skin preparation, anesthesia (local if used), and anterior neck landmark identification
• EMG waveform assessment and interpretation in support of injection localization
• Standard 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 64617; typical dose 1.5-2.5 U per side for ADSD (TA); 5-10 U for ABSD (PCA)
Botulinum toxin type A (abobotulinumtoxinA / Dysport™)	J0586 — per unit; not commonly used for SD but reportable if administered
Botulinum toxin type A (incobotulinumtoxinA / Xeomin®)	J0588 — per unit; note Xeomin has similar dosing profile to Botox
Botulinum toxin type A (daxibotulinumtoxinA-lanm / DAXXIFY®)	J0589 — per unit; verify FDA approval status for spasmodic dysphonia indication before billing
Drug wastage from vial (discarded portion)	J0585-J0589 with modifier -JW — critical for SD: typical dose (1.5-5 U) is very small; large vial wastage expected; document administered vs. discarded
No discarded amount (since 7/1/2023)	Append -JZ to J-code line to attest zero wastage; required per CR 13056
EMG guidance — needle electromyography	95873 — BUNDLED per NCCI; do NOT separately bill; included in 64617 descriptor
EMG guidance — fine wire electromyography	95874 — BUNDLED per NCCI with 64617; do NOT separately bill
Diagnostic laryngeal EMG — as a separate standalone procedure	95865 — Needle electromyography, larynx; may be separately reportable IF performed as a genuinely distinct diagnostic study at a separate time from the injection; check NCCI bundling and payer policy before billing
Flexible laryngoscopy-guided laryngeal injection (transoral/endoscopic approach)	31573 — Mutually exclusive with 64617 for the same larynx at the same session; represents a fundamentally different surgical approach; if 31573 is used, 95874 IS separately billable for EMG guidance
Direct laryngoscopy with vocal cord injection	31570 / 31571 — direct laryngoscopy approaches; not interchangeable with percutaneous 64617
Contralateral side laryngeal injection, same session	64617--50 (bilateral) OR 64617--LT + 64617--RT on two claim lines (ASC)
Chemodenervation of neck muscle(s) at same session (cervical dystonia)	64616--59 or -XS — separately reportable; distinct anatomical structure (neck muscles vs. intrinsic laryngeal muscles) and separate indication; document each injection distinctly
E/M service for SD management (same visit)	Not separately reportable unless a truly distinct E/M for a different diagnosis is documented; if so, append -25 to E/M code only

⚠️ Critical EMG Bundling Rule: Unlike 64616 (neck muscle chemodenervation), where 95873/95874 CAN be separately billed for EMG guidance, 64617 has EMG guidance explicitly built into its descriptor — it is never separately billable with 64617. This is the single most common billing error with this code. The NCCI bundles both 95873 and 95874 with 64617 with a modifier indicator of 0 (cannot be overridden with any modifier).

⚠️ 31573 vs. 64617 — Approach Determines Code: The approach to the larynx determines which code family is used. If the laryngologist injects via percutaneous needle through the neck with LEMG guidance → 64617. If the laryngologist injects under flexible laryngoscopic visualization (transoral or via scope channel) → 31573 + 95874 (if LEMG also used). Document the approach clearly in the operative/procedure note.

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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)
│
├── 64615  Chemodenervation of facial, trigeminal, cervical spinal &
│              accessory nerves, BILATERAL (chronic migraine / PREEMPT)
│
├── 64616  Chemodenervation of neck muscle(s), excluding larynx, UNILATERAL
│              (cervical dystonia / spasmodic torticollis)
│              [Note: EMG guidance NOT included here — 95873/95874 separately
│              reportable with 64616]
│
├── 64617  ◀ Chemodenervation of laryngeal muscle(s), UNILATERAL, percutaneous
│              (spasmodic dysphonia / laryngeal dystonia)
│              [EMG guidance INCLUDED — 95873/95874 NOT separately billable]
│              [Bilateral indicator 1: -50 for bilateral TA injection (ADSD)]
│              [Replaced by context: see 31573 for flexible laryngoscopy approach]
│
│── Laryngoscopy-Based Laryngeal Injection Alternatives (Surgery — Larynx)
│
├── 31570  Laryngoscopy, direct; with injection into the vocal cord(s), therapeutic
├── 31571  Laryngoscopy, direct; with injection into vocal cord(s); with operating
│              microscope or telescope
└── 31573  Laryngoscopy, flexible; with therapeutic injection(s) (eg, chemodenervation
               agent or corticosteroid, injected percutaneous, transoral, or via endoscope
               channel), unilateral [+95874 separately reportable for EMG guidance]

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🏥 ICD-10-CM Commonly Paired Diagnoses

The following represent CMS LCD-covered indications for 64617 per CMS Billing & Coding Article A57185 (Group 9 — Laryngeal Dystonia, updated 2019). All diagnoses must be supported by clinical evaluation including laryngoscopic examination confirming vocal cord involvement. Documentation must clearly link the diagnosis to the procedure and establish medical necessity, including trial of voice therapy when required by payer.

🔴 Spasmodic Dysphonia & Voice Disorders (Primary Indications)

ICD-10-CM	Description	HCC	Notes
R49.0	Dysphonia	❌ No HCC	Most commonly reported code for spasmodic dysphonia regardless of subtype (adductor, abductor, mixed); all three types are captured here
R49.8	Other voice and resonance disorders	❌ No HCC	Use for mixed or atypical voice disorders when R49.0 is too nonspecific for the documented condition

🔴 Laryngeal Spasm & Dystonia

ICD-10-CM	Description	HCC	Notes
J38.5	Laryngeal spasm	❌ No HCC	Directly captures the spasmodic/dystonic mechanism; used in research literature for laryngeal dystonia; covered per CMS A57185 Group 9 AND A52848 Group 7 (for J0589 with 64617)
G24.8	Other dystonia	❌ No HCC	When provider explicitly documents laryngeal dystonia as the underlying mechanism; may be listed alongside R49.0 or J38.5 as the etiologic code

🔴 Vocal Cord Paralysis (Secondary Indication)

ICD-10-CM	Description	HCC	Notes
J38.01	Paralysis of vocal cords and larynx, unilateral	❌ No HCC	Covered per CMS A57185 Group 9; chemodenervation used to treat antagonist muscle in unilateral paralysis (contralateral TA) or to manage synkinesis
J38.02	Paralysis of vocal cords and larynx, bilateral	❌ No HCC	Bilateral vocal cord paralysis; chemodenervation of posterior cricoarytenoid (PCA) to improve airway; covered per CMS A57185 Group 9

🔴 Other Laryngeal Conditions

ICD-10-CM	Description	HCC	Notes
J38.3	Other diseases of vocal cords	❌ No HCC	Includes vocal cord scarring, sulcus vocalis, or other structural issues with spastic component
J38.6	Stenosis of larynx	❌ No HCC	When laryngeal chemodenervation is used to reduce cricoarytenoid joint adduction in subglottic stenosis with dystonic component
J38.00	Paralysis of vocal cords and larynx, unspecified	❌ No HCC	Avoid if laterality is documented; use J38.01 or J38.02 with specificity

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💡 HCC Considerations — Secondary Diagnoses

The primary diagnoses for 64617 — spasmodic dysphonia (R49.0, J38.5) and vocal cord paralysis (J38.01, J38.02) — do not carry HCC weights in the CMS-HCC v28 model. However, the underlying neurological condition driving the laryngeal dystonia may be HCC-relevant when documented and coded as a secondary or additional diagnosis.

Parkinson’s Disease (G20.x)

• Laryngeal involvement (hypophonia, dystonic dysphonia) occurs in PD; some providers use 64617 for PD-related vocal issues
• HCC Category: G20.x codes carry HCC weight; capture for full risk adjustment accuracy
• Documentation Tip: Provider must link the laryngeal dysfunction to PD; distinguish from primary SD

Multiple Sclerosis (G35.-)

• Dysphonia or laryngeal spasm may occur in MS; document the neurological etiology
• HCC Category: HCC 77 — significant RAF impact; capture when MS is documented and managed
• Documentation Tip: G35.- requires specificity in clinical notes even though a single ICD-10 code covers all MS types

Essential Tremor (G25.0)

• Vocal tremor (distinct from SD but may co-occur or be misdiagnosed as SD) is not itself an HCC, but co-existing essential tremor affecting quality-of-life management may be captured
• Documentation Tip: Vocal tremor is a separate diagnosis from spasmodic dysphonia; confirm which condition is being treated to ensure correct code selection (R49.0 for SD vs. R49.8 for tremulous voice)

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🔧 Applicable Modifiers

Modifier	Description	When to Use with 64617
-RT	Right Side	Injection into right laryngeal muscle(s); required by most payers for unilateral claims; typical for right-sided PCA injection (ABSD)
-LT	Left Side	Injection into left laryngeal muscle(s); required by most payers; most commonly used for unilateral ABSD treatment
-50	Bilateral Procedure	When both thyroarytenoid (TA) muscles are injected in the same session — the standard approach for adductor SD (ADSD); bilateral indicator = 1 → 150% payment; for ASC billing, use two separate lines with -RT and -LT
-59	Distinct Procedural Service	Required when billing 64616 (neck muscle) AND 64617 (laryngeal muscle) at the same session — distinct anatomical structures and separate clinical indications
-XS	Separate Structure	Preferred NCCI modifier over -59 when the additional chemodenervation is at a structurally distinct anatomical site (neck vs. larynx)
-25	Significant, Separately Identifiable E/M Service	Append to the E/M code only when a truly separate E/M is rendered for a different diagnosis on the same day; do NOT append to 64617
-52	Reduced Services	If the procedure was initiated but fewer injection sites were completed than planned (e.g., patient intolerance, EMG localization failure)
-53	Discontinued Procedure	If the procedure was started (needle placed, EMG begun) but abandoned entirely before injection due to medical or safety concern
-JW	Drug Amount Discarded	Append to J-code line for discarded vial contents; especially important for SD — typical doses (1.5-5 U) leave significant vial waste from 100-unit Botox vials; document precisely
-JZ	Zero Wastage	Append to J-code when full vial contents were used with no discard; required per CR 13056 since 7/1/2023; realistic only if multiple patients share a vial same-day
-26	Professional Component	NOT applicable to 64617 itself; however, if 31573 is used (alternative approach) and 95874 is billed separately, -26 applies to 95874 when provider does not own the EMG equipment
-GY	Non-Covered / Statutorily Excluded	If botulinum toxin is administered for cosmetic purposes; use Z41.1 as diagnosis
-GZ	Expected Denial — Not Reasonable/Necessary	When claim is submitted without ABN but denial is anticipated; rare for appropriately documented spasmodic dysphonia

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🏨 MS-DRG (Inpatient Context)

CPT 64617 is performed exclusively in the outpatient or office/clinic setting under virtually all clinical circumstances. Laryngeal chemodenervation for spasmodic dysphonia does not require hospital admission and is not an inpatient-level procedure. However, if a patient is admitted with a primary neurological or respiratory condition and receives laryngeal chemodenervation as part of the inpatient management plan, ICD-10-PCS Administration codes would be reported on the UB-04.

ICD-10-PCS Equivalents (Inpatient)

ICD-10-PCS	Description
3E023NZ	Introduction of Other Therapeutic Substance into Muscle, Percutaneous Approach
3E090NZ	Introduction of Other Therapeutic Substance into Ear, Via Natural or Artificial Opening

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 percutaneous injection targeting the thyroarytenoid (TA) or posterior cricoarytenoid (PCA) muscle, 3E023NZ (Muscle, Percutaneous) is the most anatomically specific selection — the chemodenervation agent acts at the neuromuscular junction within the muscle. Some facilities may opt for a larynx-adjacent body part character; consult your facility ICD-10-PCS encoder and coding advisor for the most current guidance. Drug Note: Botulinum toxin (J0585, etc.) is bundled into the inpatient DRG payment under Part A and cannot be billed separately under Part B during an inpatient stay.

Associated MS-DRGs (Inpatient, Driven by Principal Diagnosis)

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
185	Respiratory Neoplasms	Medical (if oncologic etiology of vocal cord involvement)
186	Pleural Effusion with MCC	Medical

Warning

⚠️ As a non-OR procedure, 64617 inpatient does not typically drive the surgical DRG partition. MS-DRG assignment is determined by the principal diagnosis driving the admission. Vocal cord paralysis (J38.01, J38.02) or spasmodic dysphonia (R49.0, J38.5) rarely drive inpatient admission alone; more commonly, an underlying neurological condition (stroke, MS, Parkinson’s) precipitates the admission, with laryngeal injection performed during the stay.

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📝 Coding Examples

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🟢 Example 1 — Adductor Spasmodic Dysphonia, Standard Bilateral TA Injection

Clinical Scenario: A 52-year-old female with adductor spasmodic dysphonia (strained, effortful voice, EMG-confirmed bilateral thyroarytenoid overactivity) presents to the laryngologist for her quarterly botulinum toxin injection. The physician performs bilateral percutaneous thyroarytenoid injections under LEMG guidance: 2 units of onabotulinumtoxinA per side (4 units total).

CPT / HCPCS Codes:

• 64617--50 — Chemodenervation of laryngeal muscle(s), bilateral percutaneous (bilateral TA injection for ADSD) (OR: 64617-RT and 64617-LT on two lines for ASC billing)
• J0585 × 4 — OnabotulinumtoxinA, 4 units total administered
• J0585--JW × 96 — Wastage from one 100-unit vial (100 available - 4 used = 96 discarded)

ICD-10-CM Codes:

• R49.0 — Dysphonia (spasmodic dysphonia, adductor type)

Notes: 64617--50 triggers 150% payment. The -JW × 96 units reflects the significant vial waste inherent to small-dose laryngeal injections — this wastage IS reimbursable per CMS policy. Document the number of units drawn and discarded in the procedure note. Do NOT bill 95873 or 95874 — EMG guidance is already included in 64617.

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🟢 Example 2 — Abductor Spasmodic Dysphonia, Unilateral PCA Injection

Clinical Scenario: A 64-year-old male with abductor spasmodic dysphonia (breathy voice breaks during unvoiced consonants) presents for treatment. The laryngologist performs a right unilateral percutaneous posterior cricoarytenoid (PCA) injection under LEMG guidance: 5 units of onabotulinumtoxinA, right side.

CPT / HCPCS Codes:

• 64617-RT — Chemodenervation of right laryngeal muscle(s), unilateral percutaneous (right PCA injection for ABSD)
• J0585 × 5 — OnabotulinumtoxinA, 5 units administered
• J0585--JW × 95 — Wastage (100-unit vial; 5 used, 95 discarded)

ICD-10-CM Codes:

• R49.0 — Dysphonia (spasmodic dysphonia, abductor type)

Notes: ABSD PCA injection is typically unilateral — bilateral PCA injection can cause dyspnea/airway compromise. Modifier -RT correctly identifies the right side. The higher dose (5 U vs. 2.5 U for ADSD) reflects the larger PCA muscle mass. Laterality modifier is required by most payers.

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🟢 Example 3 — Laryngeal Dystonia with Same-Day Cervical Dystonia Injection

Clinical Scenario: A 58-year-old female with both spasmodic dysphonia AND cervical dystonia presents for combined treatment. The otolaryngologist/neurologist first performs a percutaneous LEMG-guided bilateral TA injection for SD (4 U total), then a right neck injection into the splenius capitis (100 U) and right SCM (75 U) for cervical dystonia.

CPT / HCPCS Codes:

• 64617--50 — Chemodenervation of laryngeal muscle(s), bilateral (SD)
• 64616-RT--59 — Chemodenervation of right neck muscle(s) (cervical dystonia); -59 or -XS to override NCCI bundling edit — distinct anatomical structure (larynx vs. neck)
• J0585 × 179 — OnabotulinumtoxinA, total administered (4 U larynx + 175 U neck)
• J0585--JW × 21 — Wastage (200 U from 2 vials available; 21 discarded)

ICD-10-CM Codes:

• R49.0 — Dysphonia (linked to 64617--50)
• G24.3 — Spasmodic torticollis (linked to 64616-RT)

Notes: 64616 and 64617 ARE separately reportable at the same session with -59 or -XS — they involve structurally distinct muscle groups (intrinsic laryngeal muscles vs. extrinsic cervical muscles) under different nerve territories. By contrast, 64615 + 64617 would also be separately reportable (the larynx is NOT part of the PREEMPT migraine paradigm). Document each injection separately and link each CPT code to its specific diagnosis.

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🟢 Example 4 — Vocal Cord Paralysis with Laryngeal Chemodenervation (Synkinesis)

Clinical Scenario: A 47-year-old female with left vocal cord paralysis following thyroid surgery develops post-paralytic synkinesis causing adductor spasm during phonation. The laryngologist injects 2.5 units of onabotulinumtoxinA into the left thyroarytenoid muscle via percutaneous LEMG-guided approach to relieve synkinetic adduction.

CPT / HCPCS Codes:

• 64617-LT — Chemodenervation of left laryngeal muscle(s), unilateral
• J0585 × 3 — OnabotulinumtoxinA (rounding 2.5 U to whole unit billing per J-code billing rules)
• J0585--JW × 97 — Wastage (100 U vial; 3 administered, 97 discarded)

ICD-10-CM Codes:

• J38.01 — Paralysis of vocal cords and larynx, unilateral (left)

Notes: J38.01 is a covered diagnosis per CMS A57185 Group 9 for 64617. Post-thyroidectomy vocal cord paralysis with synkinesis is a distinct indication from SD — document the clinical diagnosis, laryngoscopic findings, and mechanism (synkinesis) explicitly. Do NOT use R49.0 alone if paralysis is the documented diagnosis — J38.01 is more specific and better supports medical necessity.

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⚠️ Common Coding Pitfalls

• ❌ Do not separately bill 95873 or 95874 with 64617 — EMG guidance is explicitly included in the 64617 descriptor (“includes guidance by needle electromyography, when performed”) and is bundled per NCCI with a modifier indicator of 0 — no modifier can override this; this is the most common billing error with 64617
• ❌ Do not bill 64617 and 31573 for the same larynx at the same session — they represent mutually exclusive surgical approaches (percutaneous vs. flexible laryngoscopy); select the code matching the documented technique
• ❌ Do not skip the -JW modifier on the J-code — standard SD doses (1.5-5 U per side) leave enormous vial waste from 100-unit vials; properly reporting wastage with -JW × discarded units is required per CR 13056 and allows appropriate reimbursement for wasted drug
• ❌ Do not omit laterality modifiers (-RT / -LT) for unilateral 64617 — required by CMS and most commercial payers; bilateral ADSD treatment = -50 (or two lines with -RT and -LT for ASC)
• ❌ Do not bill multiple units of 64617 for multiple muscles on the same side — it is a per-session, per-side code; injecting both TA and interarytenoid on the left = 1 unit of 64617-LT
• ❌ Do not confuse with 64616 — 64616 is for extrinsic neck muscles (SCM, trapezius, splenius capitis); 64617 is for intrinsic laryngeal muscles (TA, PCA, LCA, interarytenoid); the anatomical boundary is the larynx proper
• ✅ Do document the SD subtype (adductor, abductor, mixed) in the procedure note — it determines laterality, target muscle, dose, and the -50 vs. RT/LT modifier selection
• ✅ Do document prior voice therapy failure — most commercial payers require evidence of voice therapy trial before approving 64617 chemodenervation for spasmodic dysphonia
• ✅ Do verify commercial payer PA requirements independently — most commercial insurers (UHC, Aetna, BCBS) require prior authorization for laryngeal chemodenervation; submit with laryngoscopy confirmation report, SD subtype, and prior treatment history
• ✅ Do note that 95865 (diagnostic laryngeal EMG — standalone procedure) may be separately reportable when performed as a distinct diagnostic study at a separate time from the injection; however, when the same needle EMG is used both for diagnosis AND guidance on the same day, it is captured by 64617 and cannot be unbundled

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📌 Quick Reference Summary

Field	Value
Code	64617
Type	CPT - Surgical (Neurolytic/Chemodenervation)
System	Nervous System / Larynx
Body Part	Intrinsic laryngeal muscle(s); TA (ADSD), PCA (ABSD)
Approach	Percutaneous (through neck skin) — do not confuse with 31573 (laryngoscopic)
EMG Guidance	✅ Included in descriptor — NEVER bill 95873 or 95874 with 64617
Laterality	Unilateral — -RT or -LT required; -50 for bilateral TA (ADSD)
Global Period	010 (10 days)
wRVU	1.85
Total RVU (Fac)	4.76
Est. Medicare Payment	~$158.98(2026CF$33.40; CMS RVU26A)
Assistant Payable	No
MUE	1 per side per session
Bilateral Rule	Indicator 1 (150% with -50; standard ADSD bilateral TA = always -50)
Required Companion	J0585 / J0586 / J0588 / J0589 — same claim; doses very small
Drug Wastage	-JW (wastage — common with micro-doses) or -JZ (zero wastage) — required
Bundled EMG	95873, 95874 — NEVER separately billable with 64617
Mutually Exclusive (approach)	31573 (flexible laryngoscopy approach; if that, 95874 IS separately billable)
Separately Reportable	64616 (neck muscle, -59/-XS), 64612 (facial, -59/-XS)
Primary DX	R49.0 (dysphonia), J38.5 (laryngeal spasm)
Also Covered	J38.01, J38.02, R49.8 (CMS A57185 Group 9)
HCC Secondary DX	G35.- (MS → HCC 77), G20.x (Parkinson’s)
PA Required (Medicare)	❌ Generally No (per CMS LCD)
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 A57185 (Group 9 — Laryngeal Dystonia; Updated 2019) · CMS Billing & Coding Article A52848 (Group 7 for J0589) · NCCI Policy Manual for Medicare Services 2026 · CMS CR 13056 — JW/JZ Modifier Requirements (Effective 7/1/2023) · AAO-HNS CPT for ENT: Chemodenervation of the Larynx - Botulinum Toxin (Reviewed October 2023) · AAPC Otolaryngology Coding Alert — Chemodenervation Codes 64616/64617 (2014) · AAPC Otolaryngology Coding Alert — Spasmodic Dysphonia (2025) · AHA Coding Clinic for ICD-10-CM/PCS · Practical Neurology — Botulinum Toxin Billing & Coding Update (April 2026) · Noridian Medicare JE/JF — Botulinum Toxin Pre-Claim Review (Updated 02/22/2026)}