Billing and Coding: Botulinum Toxin Types A and B

This billing guidance permits reimbursement for botulinum toxin types A and B (Botox, Dysport, Xeomin, Myobloc) when medical necessity is documented per LCD L35172 and required documentation elements are present. Records must include drug type/strength, covered diagnosis or physician justification for off‑label use, prior treatment failure when applicable, dosage and anatomic injection sites, EMG necessity if used, and detailed wastage documentation; Medicare reimburses only the portion used plus allowable pro rata wastage with -JW billing and specific rounding rules.

"Botulinum toxin injections are covered when the medical record documents medical necessity consistent with the associated LCD Botulinum Toxin Types A and B (L35172)."

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