Billing and Coding: Botulinum Toxin Injections

Medicare covers botulinum toxin injections when medically necessary for indications specified in the applicable LCD and when the medical record documents medical necessity, relevant history, exam, and diagnostic tests. Cosmetic uses are statutorily non-covered (ICD-10 Z41.1), specific HCPCS (J0585-J0589) and CPT coding rules (including bilateral modifier rules, EMG guidance codes, and JW/JZ drug-wastage modifiers) must be followed, and dose/frequency must conform to the LCD; deviations may be denied or reviewed.

"Botulinum toxin injections are covered when medically necessary for indications specified in the applicable Local Coverage Determination (LCD) and are supported by documentation in the medical record."

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