CPT 64644, in plain terms, covers Botulinum toxin chemodenervation of one arm or leg, injecting 5 or more muscles. CPT 64644 is referenced in 6 tracked payer policy changes from UnitedHealthcare, Aetna, and 1 other payer. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 64644 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.
Official descriptor: CPT 64644 on AAPC
UnitedHealthcare is removing a long list of CPT codes from the applicable-code list of its Outpatient Surgical Procedures site-of-service policy for Exchange plans, and it is also removing the link to the Manipulation Under Anesthesia policy. The change takes effect December 1, 2026. The source does not state a new billing requirement for the removed codes.
Effective December 1, 2026, UMR removes more than 500 CPT codes from its Outpatient Surgical Procedures - Site of Service medical policy for commercial plans, and it drops a reference link to the Manipulation Under Anesthesia policy. For those codes, UMR's site-of-service policy no longer applies, so the practice should update its internal UMR site-of-service and prior authorization lists before that date.
Effective December 1, 2026, UnitedHealthcare removes more than 500 CPT codes from its Outpatient Surgical Procedures - Site of Service medical policy for commercial plans, and it drops a reference link to the Manipulation Under Anesthesia policy. For those codes, the site-of-service policy no longer applies under this UnitedHealthcare commercial policy, so the practice should update its internal site-of-service and prior authorization lists before that date.
Aetna Clinical Policy Bulletin 0952 sets coverage rules for ultrasound guidance on selected procedures. CPT 76942 (ultrasonic guidance for needle placement) and 76998 (ultrasonic guidance, intraoperative) are covered when selection criteria are met, and CPT 76937 covers ultrasound guidance for vascular access. The policy lists many nerve blocks, joint, bursa, tendon, aspiration and biopsy procedures as medically necessary with ultrasound guidance, several of them only after an unguided procedure has failed, and it lists procedures for which ultrasound guidance is of no proven benefit and codes that are not covered for specific indications.
Botox (onabotulinumtoxinA) is the only covered botulinum toxin preparation for non-cosmetic indications under this policy. Dysport, Myobloc and Xeomin are considered not medically necessary because a formulary alternative is available. Botox may be considered medically necessary for overactive bladder, detrusor overactivity associated with a neurologic condition, chronic migraine prophylaxis, spasticity, cervical dystonia, primary axillary hyperhidrosis, blepharospasm, strabismus and spasmodic dysphonia when all criteria for the indication are met. Each indication has a 12-month length of approval and a maximum dose per 12 weeks. Revised criteria for detrusor overactivity, migraine prophylaxis and blepharospasm were approved by the Pharmacy and Therapeutics Committee on 05/26/2026.
Botox (onabotulinumtoxinA) is the only botulinum toxin the policy covers for non-cosmetic indications, and prior authorization is required. Dysport, Myobloc and Xeomin are currently considered not medically necessary because a formulary alternative is available. The policy was reviewed and approved on 05/26/2026, and that revision states that the use of samples will not be considered current or stable therapy and revises the maximum cumulative Botox dose for individuals treated for one or more indications.
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