64645 Insurance Policy Changes

CPT 64645, in plain terms, covers Add-on: botulinum toxin chemodenervation of 5 or more muscles per further arm or leg, billed with the primary extremity code. CPT 64645 is referenced in 4 tracked payer policy changes from Aetna and Blue Cross & Blue Shield of Mississippi. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 64645 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Official descriptor: CPT 64645 on AAPC

Aetna · Identified Aug 16, 2026Medium impact
Spasticity Management (CPB 0362, reviewed 2026-05-26)
Aetna considers neurosurgical procedures medically necessary for refractory spasticity only when the member has good intrinsic lower extremity motor power but is limited in ambulation by spasticity, has the functional capacity and motivation to take part in post-operative rehabilitation, and has tried and failed non-surgical medical management including baclofen or other muscle relaxants. Aetna considers selective posterior rhizotomy experimental, investigational, or unproven when the member has concomitant dystonia or rigidity, profound lower extremity weakness where the spasticity helps the member stand, progressive neurological disorders, choreoathetosis or cerebellar ataxia, severe damage to the basal ganglia, or severe fixed joint deformities or scoliosis. Acupuncture, botulinum toxin, thalamic stimulation, cryoneurolysis, dry needling, extracorporeal shock wave therapy, mirror therapy, pulsed radiofrequency, transcranial direct current stimulation and several other techniques are considered experimental, investigational, or unproven because the effectiveness of these approaches has not been established.
Aetna · Identified Aug 14, 2026Medium impact
Ultrasound Guidance – Selected Indications (CPB 0952, reviewed 2026-04-27)
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.
Aetna · Identified Aug 13, 2026Medium impact
Plantar Fasciitis Treatments (CPB 0235, reviewed 2026-04-27)
Aetna considers combined steroid/anesthetic injection medically necessary for the treatment of plantar fascia when conservative treatments (such as stretching exercises, over-the-counter silicone heel shoe inserts, and 2 to 3 weeks of non-steroidal anti-inflammatory drugs) have failed. Endoscopic plantar fasciotomy is considered medically necessary as an alternative to conventional open plantar fasciotomy for members with intractable plantar fasciitis or heel spur syndrome who have failed a 6-month trial of conservative therapy. Aetna considers a list of other approaches experimental, investigational or unproven for plantar fasciitis, including extracorporeal shock-wave therapy (ESWT), botulinum toxin, dry needling, Graston technique, low-level laser therapy, platelet-rich plasma and hyaluronic acid.
Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026Medium impact
Botulinum Toxin
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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REFERENCE DATA

Payers with rules2

Payers requiring prior auth2

CalViva Health · Effective December 31, 2025
Prior authorization required
CalViva Health CMS-0057-F prior authorization requirements
Community Health Plan of Imperial Valley · Effective December 31, 2025
Prior authorization required
Community Health Plan of Imperial Valley CMS-0057-F prior authorization requirements

FREQUENTLY ASKED QUESTIONS

Does CalViva Health require prior authorization for 64645?

CalViva Health lists 64645 on CalViva Health CMS-0057-F prior authorization requirements for medicaid managed plans (list dated December 31, 2025). Verify with the payer before scheduling.

Does Community Health Plan of Imperial Valley require prior authorization for 64645?

Community Health Plan of Imperial Valley lists 64645 on Community Health Plan of Imperial Valley CMS-0057-F prior authorization requirements for medicaid managed plans (list dated December 31, 2025). Verify with the payer before scheduling.

What insurance policy changes affect CPT 64645?

There are 4 tracked policy changes affecting CPT 64645, including updates from Aetna, Blue Cross & Blue Shield of Mississippi. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for CPT 64645?

Payers that have issued tracked updates for CPT 64645 include: Aetna, Blue Cross & Blue Shield of Mississippi.

How do I get notified when CPT 64645 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to CPT 64645. You will get an email when new policy changes reference this code: daily or weekly, your choice, on every plan.

Why do payers change policies for CPT 64645?

Payers revise policies for individual billing codes to align with updated clinical guidelines, CMS rule changes, fraud and abuse prevention measures, or network cost-management goals. Changes can affect medical necessity criteria, place-of-service restrictions, bundling rules, or whether a code requires prior authorization.

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Prior authorization lists, coverage criteria, NCCI edits and Medicare coverage articles for 64645 in one place.

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All billing codes J3590 C9399 J3490 99215 99213 99202

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Spasticity Management (CPB 0362, reviewed 2026-05-26)

Ultrasound Guidance – Selected Indications (CPB 0952, reviewed 2026-04-27)

Plantar Fasciitis Treatments (CPB 0235, reviewed 2026-04-27)

Botulinum Toxin

Prior authorization required