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36.4.20.8 Botulinum Toxin Type A
Procedure code 1-J0585 no longer requires prior authorization and is considered for reimbursement when submitted with one of the following diagnosis codes:
If a quantity greater than 300 units of botulinim toxin is billed on the same day, supporting medical documentation must be maintained in the client's records for the dosage used and is subject to retrospective review.
EMGs and/or visits, that are billed in conjunction with the administration of botulinum toxin type A, do not require prior authorization and are subject to current reimbursement guidelines. Any supplies billed by the physician for the administration of botulinum toxin type A are not paid separately.
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