Contractor Information
Contractor Name:
Highmark Medicare Services, Inc.
Contractor Number:
12102, 12202, 12302, 12501, 12301, 12201, 12401
Contractor Type:
MAC Part A & B
Article Information
Article ID Number
A47789
Article Type
Article
Key Article
No
Article Title
Botulinum Toxin Type A and Type B
Primary Geographic Jurisdiction
Pennsylvania, Maryland, District of Columbia, NEW JERSEY, DELAWARE
Original Article Effective Date
07/11/2008
Article Revision Effective Date
09/01/2008
Article Ending Effective Date
N/A
Article Text
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).
Coverage Topic
Doctor Office Visits
Coding Information
CPT/HCPCS Codes
J0585 | BOTULINUM TOXIN TYPE A, PER UNIT |
J0587 | BOTULINUM TOXIN TYPE B, PER 100 UNITS |
Other Information
Other Comments
Refer to LCD Botulinum Toxin Type A and B for additional information.
Revision History
Revision History Explanation
| Date | Article # | Description |
|---|---|---|
08/29/2008 |
A47789 |
Article effective 09/01/2008 for New Jersey Part A. Effective 09/01/2008, New Jersey Part A will be added to the other jurisdictions already effective: DC Part A and DCMA Part B; Maryland Part A and Maryland Part B; Pennsylvania Part A; and Delaware Part B. |
08/01/2008 |
A47789 |
Article effective 08/01/2008 for DC Part A, Maryland Part A, and Pennsylvania Part A. Article is now effective for DC Part A and DCMA Part B; Maryland Part A and Maryland Part B; Pennsylvania Part A; and Delaware Part B. |
07/11/2008 |
A47789 |
Article release date. |