Dysport® (abobotulinumtoxin 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): J0586

Benefit: Medical

Notes: Per 5 units, for various neuro-muscular uses: see prior authorization form for covered conditions.

Length of authorization: 1 injection. Injections must be separated by at least 90 days.