Billing and Coding: Botulinum Toxins

Coverage for botulinum toxins is determined by the reasonable and necessary requirements of LCD L33274; use for chronic migraine is supported when patient history documents migraines ≥15 days/month. Billing requires the administration CPT code and the botulinum toxin HCPCS code be submitted on the same claim; JW or JZ modifiers must be used for single-dose container waste reporting and appropriate documentation (drug name, dosages, injection sites, response, signatures, and test results) must be maintained in the medical record.

"Botulinum toxin administration is covered when it meets the reasonable and necessary requirements of LCD L33274."

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