Botox® (botulinum toxin type A)
No prior authorization required for:
- Emergency room
- Skilled nursing facility
Injectable auth/billing notes:
Medications billed with miscellaneous codes will be reviewed. Explanatory notes must accompany the claim.
Priority Health Medicare applies CMS local coverage determination criteria when available for Part B drugs.
No authorization required when billed by neurologists, rehabilitation medicine or physical medicine.
Code(s): J0585, J0586, J0587, J0588
Notes: Per unit, for various neuro-muscular uses. See PA forms for covered conditions.
Length of authorization: 1 injection. Injections must be separated by at least 90 days.