Billing and Coding: Botulinum Toxins

Billing for botulinum toxins requires that the administration/injection CPT code and the botulinum toxin HCPCS code be submitted on the same claim, and coverage is allowed only when LCD L38809 reasonable and necessary requirements are met. For Part B separately payable single-dose container drugs, JW (wasted) or JZ (no waste) modifiers are required with documented waste details when applicable, and when botulinum medication is denied associated services on the same claim may also be denied; comprehensive, legible medical record documentation (including drug name, dosages, injection sites, clinical response, and for chronic migraine a history of >=15 migraine days/month) must support medical necessity.

"Botulinum toxin is covered for management of chronic migraine when documentation supports migraines occurring >=15 days per month."

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