Injections of botulinum toxin type A (Botox A), also known as Botox®, and botulinum toxin B are a limited benefit when used for U.S. Food and Drug Administration (FDA) approved indications.
Botulinum toxin type A injections may be covered for the following but not limited to:
- prophylaxis of chronic migraine headaches
- dystonia conditions such as, facial myokymia (craniofacial dystonia), oromandibular (jaw-closing) dystonia, cervical dystonia (repetitive contraction of the neck muscles), laryngeal dystonia (spasmodic dysphonia)
- axillary hyperhidrosis (severe underarm sweating) that cannot be managed by topical agents
- palmar hyperhidrosis
- spasticity resulting from cerebral palsy
- lower and upper limb spasticity
- sialorrhea (excessive salivation or drooling) associated with Parkinson's disease, for patients refractory to or unable to tolerate systemic anticholinergics
- chronic anal fissure if unresponsive to conservative therapeutic measures
- overactive bladder
- esophageal achalasia
- Frey’s Syndrome/gustatory sweating
- Hirschsprung’s disease
Botulinum toxin type B, also known as Myobloc, may be covered for the treatment of sialorrhea associated with Parkinson’s disease.
Botulinum toxin injections are not covered for headaches except as noted above and not covered for myofascial pain, fibromyalgia, or low back pain. Botox injections are not covered when used for cosmetic procedures.
To expedite the review process, providers may attach a Letter of Attestation in lieu of clinical documentation to the authorization request.
Botox® is a registered trademark of Allergan, Inc.