Botulinum Toxin Types A and B

Medicare covers botulinum toxin A and B for focal muscle spastic disorders and selected conditions (including CNS-origin spasticity with specified ICD-10 codes, chronic migraine prophylaxis in adults, overactive bladder after anticholinergic failure, severe primary axillary hyperhidrosis, and select achalasia cases) when clinical criteria and documentation requirements are met. Coverage generally requires prior failure of conventional therapies except for specific indications where initial therapy is acceptable; units of different toxin products are not interchangeable and documented FDA-based dosing and response monitoring are required. Several uses are noncovered as investigational or cosmetic (e.g., smooth muscle spasm conditions, tension-type headache, skin wrinkle treatment, certain eye muscle disorders).

"Botulinum toxin is covered for focal muscle spastic disorders and excessive muscle contractions (e."