J0586, Injection, abobotulinumtoxina, 5 units
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Medicare Pricing
Documentation Required
- Medical records must include the legible signature of the physician or non-physician practitioner responsible for and providing the care.
- All documentation must be maintained in the patient's medical record, be legible, include patient identification and dates of service, and be made available to the contractor upon request.
- The submitted medical record must support the selected ICD-10-CM code(s) and the submitted CPT/HCPCS code must accurately describe the service performed.
- Ordering/referring provider documentation must support medical necessity per the LCD and include documentation of unsuccessful or inadequate response to conventional treatments, or that the patient is not a candidate for conventional methods.
- Records should include results of pertinent tests and procedures relevant to the treated condition.
- Documentation must list the name of the botulinum toxin, total dosage, each injection site (muscle) with the dosage, and the frequency of injections.
Key Coverage Criteria
- Botulinum toxin administration is covered when it meets the reasonable and necessary requirements of LCD L33274.
- Use of botulinum toxin for management of chronic migraine is supported when documentation shows a history of migraines occurring greater than or equal to 15 days per month.
- Botulinum toxin is covered for management of chronic migraine when documentation supports migraines occurring >=15 days per month.
- Coverage is permitted only when services meet the reasonable and necessary requirements of LCD L38809.
- Dysport (abobotulinumtoxinA) is proven in the treatment of the following conditions:
- Daxxify (daxibotulinumtoxinA-lanm) is proven in the treatment of the following condition:
20 Active Policies
CGS-L39856, Botulinum Toxin Injections
J15
CGS-L39857, Botulinum Toxin Injections
J15
WPS-L39908, Botulinum Toxin Injections
J8
WPS-L39909, Botulinum Toxin Injections
J8
WPS-L40381, Botulinum Toxin Injections
J8
FIRST_COAST-L33274, Botulinum Toxins
J9
A57715, Billing and Coding: Botulinum Toxins
J9
FIRST_COAST-L40025, Botulinum Toxins
J9
NORIDIAN-L35170, Botulinum Toxin Injections
JE
NORIDIAN-L35172, Botulinum Toxin Injections
JF
NOVITAS-L38809, Botulinum Toxins
JH
A58423, Billing and Coding: Botulinum Toxins
JH
PALMETTO-JJ-L39836, Botulinum Toxin Injections
JJ
NGS-L39832, Botulinum Toxin Injections
JK
PALMETTO-JM-L39836, Botulinum Toxin Injections
JM
SUREST-POL-SUREST-botulinum-toxins-a-and-b, Botulinum Toxins A and B
A59707, Billing and Coding: Botulinum Toxin Injections
A59714, Billing and Coding: Botulinum Toxin Injections
A59726, Billing and Coding: Botulinum Toxins Injections
A59809, Billing and Coding: Botulinum Toxin Injections
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