Botulinum toxin reimbursement routing — Medical-only reimbursement (Kentucky Medicaid)
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This notice informs Kentucky Medicaid pharmacy and prescriber networks that, effective April 1, 2022, botulinum toxin products will be reimbursed only through the Medical benefit and prior authorization must be obtained via the member's MCO medical benefit or fee-for-service Medical benefit.
Effective April 1, 2022, Kentucky Medicaid will reimburse botulinum toxins ONLY through the MEDICAL benefit.
For service dates after March 31, 2022, if a member is enrolled in an MCO, prior authorization must be sought through the applicable MCO's Medical benefit; fee-for-service claims should be billed via the Department for Medicaid Services' MEDICAL benefit.
Coverage and Payment Routing
Medical-only reimbursement criteria
Coverage/payment routing rule for botulinum toxins
Routing and authorization
- If the member is enrolled in a Managed Care Organization (MCO), prior authorization must be obtained through the applicable MCO's Medical benefit using the MCO-specific contact methods provided.
- If the member is not enrolled in an MCO (fee-for-service), bill via the Department for Medicaid Services' MEDICAL benefit.
MCO contact details (fax, phone, web) for Aetna, Anthem, Humana, Passport by Molina, UnitedHealthcare, and WellCare are listed in the notice.
Affected Drugs / Codes
| Botox | onabotulinumtoxinA |
| Dysport | abobotulinumtoxinA |
| Myobloc | rimabotulinumtoxinB |
| Xeomin | incobotulinumtoxinA |
Prior Authorization and MCO Billing Instructions
Prior authorization and billing routing (effective April 1, 2022)
For service dates after March 31, 2022, obtain prior authorization through the member's MCO Medical benefit if the member is enrolled in an MCO; if the member is not enrolled in an MCO (fee-for-service), bill via the Department of Medicaid Services' MEDICAL benefit.
MCO Medical prior authorization contacts
Contact the member's MCO Medical benefit for prior authorization using the MCO-specific fax, phone, and web resources listed below.
- Aetna — Fax: 855-454-5579; Phone: 888-725-4969; Site: https://www.aetnabetterhealth.com/kentucky/providers/priorauthorization.html (Aetna SKY Fax: 833-689-1422) [[see source]]
- Anthem — Fax: 800-964-3627; Phone: 855-661-2028; Radiology/Cardiology Phone: 877-291-0504; Site: https://providers.anthem.com/kentucky-provider/claims/prior-authorizationrequirements
- Humana — Fax: 888-447-3430; Phone: 866-461-7273; Site: https://www.humana.com/provider/medical-resources/kentucky-medicaid/prior-authorizations
- Passport by Molina — Fax: 833-454-0641; Phone: 800-578-0775; Site: https://www.molinahealthcare.com/-/media/Molina/PublicWebsite/PDF/Providers/ky/medicaid/Pre_Service_Review_Guide_Request_Form.pdf
- UnitedHealthcare — Fax: 855-705-4542; Phone: 877-842-3210; Site: https://www.uhcprovider.com/content/dam/provider/docs/public/admin-guides/comm-plan/KY-Care-Provider-Manual.pdf
- WellCare — Fax: 877-831-2045; Phone: 877-389-9457; Site: https://www.wellcareky.com/providers/medicaid/authorizations.html
Key Definitions
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