Does J0585 require prior authorization?

No, J0585 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for J0585?

Medicare facility rate: N/A. Non-facility rate: N/A. Work RVU: 0.00.

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`J0585`, Injection, onabotulinumtoxina, 1 unit

HCPCS/CPT

Prior Authorization

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Medicare Pricing

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

Documentation Required

Medical records must include the legible signature of the physician or non-physician practitioner responsible for and providing the care.
All documentation must be maintained in the patient's medical record, be legible, include patient identification and dates of service, and be made available to the contractor upon request.
The submitted medical record must support the selected ICD-10-CM code(s) and the submitted CPT/HCPCS code must accurately describe the service performed.
Ordering/referring provider documentation must support medical necessity per the LCD and include documentation of unsuccessful or inadequate response to conventional treatments, or that the patient is not a candidate for conventional methods.
Records should include results of pertinent tests and procedures relevant to the treated condition.
Documentation must list the name of the botulinum toxin, total dosage, each injection site (muscle) with the dosage, and the frequency of injections.

Key Coverage Criteria

Botulinum toxin administration is covered when it meets the reasonable and necessary requirements of LCD L33274.
Use of botulinum toxin for management of chronic migraine is supported when documentation shows a history of migraines occurring greater than or equal to 15 days per month.
Botulinum toxin is covered for management of chronic migraine when documentation supports migraines occurring >=15 days per month.
Coverage is permitted only when services meet the reasonable and necessary requirements of LCD L38809.
Initial onabotulinumtoxinA dosing for blepharospasm is 1.25–2.5 Units into each of three sites per affected eye.
Initial rimabotulinumtoxinB dosing for cervical dystonia is up to 2,500–5,000 Units divided among affected cervical muscles.

20 Active Policies

CGS-J15-L39856, Botulinum Toxin Injections

J15

CGS-J15-L39857, Botulinum Toxin Injections

J15

CGS-J18-L39857, Botulinum Toxin Injections

J18

CGS-J18-L39856, Botulinum Toxin Injections

J18

WPS-J5-L39908, Botulinum Toxin Injections

WPS-J5-L40381, Botulinum Toxin Injections

WPS-J5-L39909, Botulinum Toxin Injections

NGS-J6-L39832, Botulinum Toxin Injections

WPS-J8-L39909, Botulinum Toxin Injections

WPS-J8-L39908, Botulinum Toxin Injections

WPS-J8-L40381, Botulinum Toxin Injections

FIRST_COAST-L40025, Botulinum Toxins

FIRST_COAST-L40314, Trigger Point Injections

FIRST_COAST-L33912, Trigger Point Injections

FIRST_COAST-L33274, Botulinum Toxins

A57715, Billing and Coding: Botulinum Toxins

NORIDIAN-L35170, Botulinum Toxin Injections

NORIDIAN-L35172, Botulinum Toxin Injections

NOVITAS-JH-L40310, Trigger Point Injections

A58423, Billing and Coding: Botulinum Toxins

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J0585, Injection, onabotulinumtoxina, 1 unit

HCPCS/CPT

Prior Authorization

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Medicare Pricing

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

Documentation Required

Medical records must include the legible signature of the physician or non-physician practitioner responsible for and providing the care.
All documentation must be maintained in the patient's medical record, be legible, include patient identification and dates of service, and be made available to the contractor upon request.
The submitted medical record must support the selected ICD-10-CM code(s) and the submitted CPT/HCPCS code must accurately describe the service performed.
Ordering/referring provider documentation must support medical necessity per the LCD and include documentation of unsuccessful or inadequate response to conventional treatments, or that the patient is not a candidate for conventional methods.
Records should include results of pertinent tests and procedures relevant to the treated condition.
Documentation must list the name of the botulinum toxin, total dosage, each injection site (muscle) with the dosage, and the frequency of injections.

Key Coverage Criteria

Botulinum toxin administration is covered when it meets the reasonable and necessary requirements of LCD L33274.
Use of botulinum toxin for management of chronic migraine is supported when documentation shows a history of migraines occurring greater than or equal to 15 days per month.
Botulinum toxin is covered for management of chronic migraine when documentation supports migraines occurring >=15 days per month.
Coverage is permitted only when services meet the reasonable and necessary requirements of LCD L38809.
Initial onabotulinumtoxinA dosing for blepharospasm is 1.25–2.5 Units into each of three sites per affected eye.
Initial rimabotulinumtoxinB dosing for cervical dystonia is up to 2,500–5,000 Units divided among affected cervical muscles.

20 Active Policies

CGS-J15-L39856, Botulinum Toxin Injections

J15

CGS-J15-L39857, Botulinum Toxin Injections

J15

CGS-J18-L39857, Botulinum Toxin Injections

J18

CGS-J18-L39856, Botulinum Toxin Injections

J18

WPS-J5-L39908, Botulinum Toxin Injections

WPS-J5-L40381, Botulinum Toxin Injections

WPS-J5-L39909, Botulinum Toxin Injections

NGS-J6-L39832, Botulinum Toxin Injections

WPS-J8-L39909, Botulinum Toxin Injections

WPS-J8-L39908, Botulinum Toxin Injections

WPS-J8-L40381, Botulinum Toxin Injections

FIRST_COAST-L40025, Botulinum Toxins

FIRST_COAST-L40314, Trigger Point Injections

FIRST_COAST-L33912, Trigger Point Injections

FIRST_COAST-L33274, Botulinum Toxins

A57715, Billing and Coding: Botulinum Toxins

NORIDIAN-L35170, Botulinum Toxin Injections

NORIDIAN-L35172, Botulinum Toxin Injections

NOVITAS-JH-L40310, Trigger Point Injections

A58423, Billing and Coding: Botulinum Toxins

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`J0585`, Injection, onabotulinumtoxina, 1 unit

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`J0585`, Injection, onabotulinumtoxina, 1 unit

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

J0585, Injection, onabotulinumtoxina, 1 unit

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

J0585, Injection, onabotulinumtoxina, 1 unit

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`J0585`, Injection, onabotulinumtoxina, 1 unit

`J0585`, Injection, onabotulinumtoxina, 1 unit