CPT® Code 64650

Chemodenervation of the eccrine glands, specifically in both axillae, is a medical procedure aimed at addressing severe focal hyperhidrosis, which is characterized by excessive and localized sweating. The eccrine glands, which are responsible for producing sweat, are distributed across most areas of the body, with common sites for this procedure including the axillary region, scalp, face, neck, and palms of the hands. The process begins with identifying the areas of excessive sweating through a diagnostic method that involves applying an iodine solution to the skin, followed by dusting the area with starch powder. After allowing 10-15 minutes for the reaction, the presence of sweat will cause the treated areas to turn dark purple, indicating the locations that require intervention. Once the reactive areas are marked, the starch-iodine compound is removed, and the skin is prepared with an antibacterial solution to minimize the risk of infection. The procedure involves the injection of reconstituted botulinum toxin type A into the dermis at intervals of 1.5-2 cm within the identified regions. This targeted approach effectively reduces the activity of the eccrine glands, thereby alleviating the symptoms of hyperhidrosis. For coding purposes, CPT® Code 64650 is specifically designated for chemodenervation of eccrine glands in both axillae, while 64653 is used for similar procedures in other areas of the body, with the latter code being reported once per day regardless of the number of areas treated.