Billing and Coding: Botulinum Toxins

Medicare covers botulinum toxin injections for specified neurologic and spastic conditions (e.g., upper/lower-limb spasticity, blepharospasm, hemifacial spasm, cervical dystonia, and other focal dystonias) when supported by medical necessity documentation. Billing must use the specific HCPCS drug codes (J0585, J0586, J0587, J0588, J0589), follow FDA-labeled dosing/frequency, adhere to MPFSDB modifier guidance and wastage (JW/JZ) documentation rules, and cosmetic uses are statutorily non-covered.

"Botulinum toxin injections are covered for limb spasticity, including upper- and lower-limb spasticity, when medically necessary."

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