Botox® (botulinum toxin type A)

No prior authorization required for:

  • Emergency room
  • Inpatient
  • 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

Benefit: Medical

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.