Botulinum Toxins

Botulinum toxin products (Botox, Dysport, Xeomin, Myobloc, Daxxify) are covered when used for FDA‑labeled indications for each specific product; select off‑label uses of onabotulinumtoxinA and abobotulinumtoxinA (e.g., achalasia in medically high‑risk patients, chronic anal fissure after failed conservative therapy, essential hand tremor after failed oral therapy, focal dystonias, hemifacial spasm, oromandibular dystonia, select laryngeal dystonia and tic disorders) are considered reasonable and necessary as described. Coverage excludes cosmetic uses (wrinkle treatment), certain procedures (injection into the esophageal body), abductor spasmodic dysphonia, isolated lower‑limb dystonias, and situations contraindicated for toxin or endoscopy; products are not interchangeable and the specific product and supporting documentation must be recorded in the medical record.

"Botulinum toxin products (onabotulinumtoxinA/Botox, abobotulinumtoxinA/Dysport, incobotulinumtoxinA/Xeomin, rimabotulinumtoxinB/Myobloc, daxibotulinumtoxinA/Daxxify) are covered when administered f..."