Billing and Coding: Botulinum Toxin Injections

Botulinum toxin injections are payable when performed for indications and in accordance with medical necessity as specified in the applicable Local Coverage Determination; each product must be billed under its specific HCPCS code (J0585–J0589) with appropriate injection CPT codes and documentation. Cosmetic use is statutorily non-covered (ICD-10 Z41.1 if filed), claims must include valid ICD-10 codes and required referring/provider identifiers, and modifier/documentation rules (including JW/JZ and laterality/bilateral modifiers) must be followed or services may be denied or returned.

"Botulinum toxin injections are covered when performed for diagnoses and indications listed in the applicable Local Coverage Determination (LCD) and when medical necessity is documented in the medic..."

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