Botulinum Toxin Types A and B Policy (L35170) - R14 - Effective October 01, 2019, and associated Billing and Coding: Botulinum Toxin Types A and B Policy (A57185) - R2 - Effective October 01, 2020

This Local Coverage Determination (LCD) and Billing and Coding Local Coverage Article (LCA) has been revised under contractor numbers: 01111 (CA), 01211 (AS, GU, HI, NMI), 01311 (NV), and 01911 (CA, HI & Territories).

Medicare Coverage Database (MCD) Number: L35170 and A57185

Effective Date: LCD Botulinum Toxin Types A and B Policy (L35170) - October 01, 2019; Billing and Coding: Botulinum Toxin Types A and B Policy (A57185) - October 01, 2020

Summary of Changes: LCD - Under Coverage Indications, Limitations and/or Medical Necessity removed 17, "Due to the short life of Botulinum toxin, Medicare will reimburse the unused portion of these drugs only when vials are not split between patients. Use modifier JW to code for drug wastage on a separate line of the claim form. The documentation must show in the patient's medical record the exact dosage of the drug given, exact amount and reason for unavoidable wastage, and the exact amount of the discarded portion of the drug" and 18, "Scheduling of more than one patient is encouraged to prevent wastage of Botulinum toxins. If a vial is split between two patients, the billing in these instances must be for the exact amount of Botulinum toxin used on each individual patient. Medicare would not expect to see billing for the full fee amount for Botulinum toxin on each beneficiary when the vial is split between two or more patients." Also corrected grammatical and typographical errors.

Billing and Coding - Under Article Text added 'anatomic' to bullet, "A complete anatomic description of the site(s) injected." Added language to provide guidance on the unused portion of these drugs.

Visit the Noridian Active LCDs webpage or Noridian Medicare Coverage Articles webpage to view the locally hosted document or access it via the CMS MCD.

            Last Updated Thu, 21 Apr 2022 13:17:20 +0000