AbobotulinumtoxinA (Dysport)

Dysport is covered for FDA‑approved uses—cervical dystonia and upper- and lower‑limb spasticity (including pediatric lower‑limb spasticity in patients ≥2 years)—with treatment limited to the policy’s muscle‑specific dose ranges, site counts, and dosing interval (generally every 12 weeks) and authorizations up to 12 months. Coverage requires documentation of the FDA‑approved diagnosis, age (≥2 years when applicable), no injection‑site infection, no known hypersensitivity to botulinum toxins/excipients or cow’s milk protein, and planned dose/sites/interval consistent with the dosing guidance.

"Cervical dystonia (FDA‑approved indication)"

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