Billing and Coding: Botulinum Toxin Injections

Medicare covers botulinum toxin injections when medically necessary and documented according to the Local Coverage Determination; claims must include a valid ICD-10 diagnosis and appropriate product-specific HCPCS codes (J0585–J0589). Cosmetic use is statutorily non-covered (ICD-10 Z41.1 if billed), and strict coding/modifier rules apply (including JW/JZ drug discard documentation, EMG guidance coding, and specific bilateral modifier requirements).

"Botulinum toxin injections are covered when medically necessary as defined by the Local Coverage Determination (LCD) 'Indications of Coverage' and when supported in the patient's medical record."

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