Billing and Coding: Botulinum Toxins Injections

This billing and coding guidance maps specific HCPCS codes to botulinum toxin products (J0585, J0586, J0587, J0588) and instructs providers to report the correct injection CPT code and diagnosis for the treated condition. It specifies modifier and bilateral reporting rules, allowable EMG guidance codes, JW/JZ drug-discard documentation requirements, and notes that cosmetic uses are non-covered (ICD-10 Z41.1 if submitted); dose/frequency must follow the Local Coverage Determination and excessive procedures may be reviewed for medical necessity.

"Claims for onabotulinumtoxinA (Botox®) should be submitted under HCPCS J0585 and billed per unit (100-unit vial supplied)."

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