Botulinum toxin products (Botox, Dysport, Daxxify, Xeomin, Myobloc) medical necessity and indications
Defines general and diagnosis-specific medical necessity criteria for botulinum toxin products (multiple brands) including frequency limits and indication-specific requirements (e.g., achalasia, chronic anal fissure, cervical dystonia, detrusor overactivity, chronic migraine excluded for some products). Also lists applicable procedure (J-) and diagnosis (ICD-10) codes for reference.
Revised list of proven indications in Coverage Rationale and Diagnosis-Specific Requirements.
Revised list of unproven and not medically necessary indications for multiple botulinum toxin products.
Added multiple ICD-10 diagnosis codes to Applicable Codes list.
Removed several ICD-10 diagnosis codes from Applicable Codes list.
Updated FDA and References sections to reflect current information.
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