R68.2 — Dry mouth, unspecified
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- For claims requiring a referring/ordering physician, the referring/ordering physician's name and NPI must be reported on the claim.
- The medical record must include the ordering provider's assessment related to the visit, relevant medical history, results of pertinent tests/procedures, and a signed and dated office visit or operative report.
- For botulinum toxin coverage, medical records must document medical necessity for treatment.
- For spastic conditions other than upper limb spasticity, blepharospasm, hemifacial spasm, cervical dystonia or other focal dystonias, documentation must state the condition was unresponsive to conventional treatment and include the covered diagnosis, dosages, injection sites, frequencies, EMG necessity if used, and description of treatment effectiveness.
Key Coverage Criteria
- Medicare covers botulinum toxin injections for medically necessary treatment of spastic conditions including upper limb spasticity, blepharospasm, hemifacial spasm, cervical dystonia, and other focal dystonias.
- Medicare will reimburse unused portions of reconstituted botulinum toxin when the medical record documents the precise amount administered and the amount discarded.
- Chemodenervation of muscles innervated by the facial nerve for management of blepharospasm or hemifacial spasm.
- Chemodenervation of cervical spinal muscles for management of spasmodic torticollis (cervical dystonia).
- Chemodenervation of extremity muscles for management of dystonias, cerebral palsy, upper and lower limb spasticity, and multiple sclerosis–related spasticity.
- Chemodenervation of extraocular muscles for the management of strabismus.
7 Active Policies
AETNA-CPB-0302 — Xerostomia: Selected Treatments
AETNA-CPB-0604 — Infrared Therapy
ANTHEM-CG-LAB-30 — CG-LAB-30 Outpatient Laboratory-based Blood Glucose Testing
A56472 — Billing and Coding: Botulinum Toxins
A56646 — Billing and Coding: Chemodenervation
Related Codes
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