Botulinum Toxin Injections

Botulinum toxin injections are covered when used per FDA-approved labeling or, for supported off-label uses, when robust published evidence is provided and documentation requirements are met. Specific coverage criteria, objective severity scales, prior conservative/medication trials, and dosing limits are defined for diagnoses including achalasia, anal fissure, blepharospasm (with or without orofacial dystonia), cervical dystonia, and chronic migraine; multiple general exclusions apply (cosmetic use, certain contraindications, image guidance, and concurrent sedation), and injections must generally be spaced at least 12 weeks apart.

"Botulinum toxin injections (BTIs) are covered when used in accordance with FDA-approved labeling for the specific serotype and dose."

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