Botulinum Toxins

Botulinum toxin products (Botox, Dysport, Xeomin, Myobloc, Daxxify) are covered when used for each product's FDA‑approved indications and for specific listed off‑label indications (e.g., achalasia in high‑risk patients or as a bridge, chronic anal fissure after failed conservative therapy, focal dystonias, hemifacial spasm, selected tics) with required documentation. Coverage excludes cosmetic uses (wrinkle treatment), certain procedures (localization for easily targeted muscles), specific nonrecommended anatomic approaches (injection into esophageal body), select dystonia indications (isolated lower limb dystonia, abductor spasmodic dysphonia), and use when contraindications to the product or required procedures exist; claims must meet CMS medical necessity rules and applicable NCDs.

"Botulinum toxin products (onabotulinumtoxinA Botulinum toxin A - Botox, abobotulinumtoxinA - Dysport, incobotulinumtoxinA - Xeomin, rimabotulinumtoxinB - Myobloc, daxibotulinumtoxinA - Daxxify) are..."