Billing and Coding: Botulinum Toxin Injections

This coding guidance requires reporting the appropriate injection CPT code together with the matching HCPCS product code (J0585–J0589), adherence to bilateral/site modifier rules, and documentation that supports medical necessity per the Local Coverage Determination. Cosmetic uses are statutorily non-covered (ICD-10 Z41.1 if claimed), claims must include a valid ICD-10 code and required referring provider information, and drug discard reporting uses JW/JZ modifiers with supporting documentation (JZ required effective 7/1/2023).

"Report the appropriate injection/destruction CPT code together with the corresponding HCPCS code for the specific botulinum toxin product used (J0585, J0586, J0587, J0588, J0589)."

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