Botulinum Toxin Injections

Botulinum toxin injections are covered when used per FDA labeling or supported by robust published evidence for off-label serotype/dosing, with administration generally limited to no more than every 12 weeks. Specific covered indications with defined diagnostic criteria, objective severity scales, dosing ranges, and documentation requirements are provided for achalasia, chronic anal fissure, blepharospasm (including orofacial dystonia), cervical dystonia, and chronic migraine prophylaxis; several contraindications and exclusions (e.g., cosmetic use, neuromuscular disorders, local infection, certain pain syndromes) and billing limits (one injection paid per site) apply.

"Botulinum toxin use consistent with FDA-approved labeling is covered; off-label dosing or serotype use requires robust published clinical evidence from the qualified health care professional."

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