Billing and Coding: Botulinum Toxin Injections

Botulinum toxin injections are payable when medically necessary, supported by a valid ICD-10-CM diagnosis and appropriate injection CPT code(s) reported with the corresponding HCPCS J-code (J0585–J0589), and when documentation in the medical record demonstrates medical necessity per the LCD DL39836. Cosmetic use is statutorily non‑covered (ICD-10-CM Z41.1) and beneficiaries are liable; specific billing, modifier (JW/JZ, RT/LT, 59) and bilateral/ASC reporting rules apply, and claims lacking required documentation or valid diagnosis codes will be returned or denied.

"Botulinum toxin injections are covered when billed with the appropriate injection/destruction CPT code(s) in conjunction with the corresponding HCPCS J-code for the product administered (J0585, J05..."

Sign up to see full coverage criteria, indications, and limitations.