Billing and Coding: Botulinum Toxins

This billing and coding guidance ties botulinum toxin coverage to the reasonable and necessary requirements in Proposed LCD DL33274; a specific covered indication noted is chronic migraine with history of >=15 headache days per month. Claims for Part B drugs from single-dose containers must include either JW (discarded amounts billed separately with documentation of date/time/amount/reason) or JZ (no discarded amount), except for CAP drugs, drugs not separately payable (packaged OPPS/ASC), or drugs in FQHC/RHC settings or with OPPS status N / ASC indicator N1; medical records must support ICD-10, CPT/HCPCS coding, medical necessity, drug name/dosage/injection sites/frequency, and clinical response.

"Botulinum toxin services are covered when reasonable and necessary as defined by Proposed LCD DL33274."

Sign up to see full coverage criteria, indications, and limitations.