Highmark Medicare Services

12102, 12202, 12302, 12501, 12301, 12201

MAC Part A & B

A47789

Article

No

Botulinum Toxin Type A and Type B

A47789

Pennsylvania, Maryland, District of Columbia, DELAWARE

07/11/2008

08/01/2008

N/A

Coding Guidelines

The HCPCS/CPT code(s) may be subject to Correct Coding Initiative(CCI) edits. This information does not take precedence over CCI edits. Please refer to CCI for correct coding guidelines and specific applicable code combinations prior to billing Medicare. 

Botulinum toxin type A is available in 100 unit vials. Procedure code J0585 is reported per unit. 

Botulinum toxin type B is available in 5,000 unit/ml vials. Procedure code J0587 is reported per 100 units. 

If the remainder of a vial of botulinum toxin must be wasted after administering a portion to a patient, a reasonable amount of the discarded drug may be covered along with the amount administered. Medicare expects that the wastage will be minimal.  Patients should be scheduled in such a way as to minimize any waste of botulinum toxin. 

Report a single unit of service for the injection/destruction codes (e.g., 64612-64614, 67345), per body area, per session regardless of the number of injections performed.  Body areas are defined as: 

• One eye (including all muscles surrounding the eye and both upper and lower lids)
• One side of the neck
• One side of the face
• All muscles of one limb and the associated girdle muscles 

Procedure code 64650 is used to report chemodenervation of both axillae. 

Report procedure code 20999 to identify the injection of botulinum toxin into muscles that are not identified with a valid HCPCS code.  Also include an appropriate description of the service in the claim narrative or electronic equivalent. 

Electromyographic guidance may be reported in conjunction with botulinum toxin injection using codes 95874 as appropriate. Only one unit may be reported per body area, per session regardless of the number of injections performed. 

Report the GY modifier to identify services performed for cosmetic reasons (excluded from Medicare coverage). 

Doctor Office Visits

Refer to LCD Botulinum Toxin Type A and B for additional information.

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