Billing and Coding: Botulinum Toxins

Medicare covers botulinum toxin injections for medically necessary treatment of spasticity and focal dystonias (e.g., upper limb spasticity, blepharospasm, hemifacial spasm, cervical dystonia) when the medical record documents necessity and relevant treatment details. Claims must include a valid ICD-10-CM diagnosis, required ordering/referring provider information, and specified documentation (assessment, history, signed notes, dosages/sites/frequencies, EMG justification if used); injections are generally not covered more often than every 90 days and special ABN/modifier rules (-GA, -GX, -GY, -GZ) apply for anticipated denials.

"Medicare covers botulinum toxin injections for medically necessary treatment of spastic conditions including upper limb spasticity, blepharospasm, hemifacial spasm, cervical dystonia, and other foc..."

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