Billing and Coding: Botulinum Toxin Types A and B

Medicare covers botulinum toxin injections when medical necessity is documented per the LCD 'Botulinum Toxin Types A and B'; approved formulations include onabotulinumtoxinA, abobotulinumtoxinA, incobotulinumtoxinA, and rimabotulinumtoxinB. Detailed documentation is required (drug type/strength, dosage, covered diagnosis or physician rationale for unapproved use, prior therapy failure except specified exceptions, injection sites, EMG justification if used) and Medicare reimburses the portion used plus allowable pro rata wastage billed with the -JW modifier under stated rounding and vial‑use rules.

"Botulinum toxin injections are covered when medical necessity is documented according to the Local Coverage Determination (LCD) 'Botulinum Toxin Types A and B' Indications and Limitations of Coverage."

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