Botulinum Toxin Types A and B

Botulinum toxin A and B are covered for focal muscle spastic disorders and selected excessive muscular contractions (including certain focal dystonias, blepharospasm, severe writer's cramp, laryngeal spasm, and dysphonia) and specific indications such as chronic migraine prophylaxis, overactive bladder after anticholinergic failure, severe primary axillary hyperhidrosis, and select achalasia cases meeting specified criteria. Coverage for CNS-origin spasticity (e.g., cerebral palsy, stroke, MS) is allowed only when billed with the ICD-10-CM codes in Billing and Coding article A57185; many smooth-muscle/spasm uses and cosmetic indications (e.g., skin wrinkles) are investigational or not covered. Documentation of prior conservative treatment failure (except enumerated exceptions), dosing per FDA/AHFS, recorded clinical response, and appropriate ICD-10/HCPCS coding (including EMG codes when used) is required; Medicare pays one injection per anatomical site and may discontinue therapy after two consecutive unsuccessful treatments.