Billing and Coding: Botulinum Toxins

Coverage of botulinum toxin injections follows the reasonable and necessary requirements in LCD DL38809 and requires proper documentation of diagnosis, treatment history, and injection details. Chronic migraine treatment is eligible when the record documents migraines ≥15 days per month; Part B single‑dose drugs must report JW or JZ modifiers with detailed waste documentation when applicable, and services denied for the medication will also be subject to denial.

"Coverage of botulinum toxin services is subject to the reasonable and necessary requirements in Local Coverage Determination (LCD) DL38809."

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