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September 26, 2023

Prior Authorization for Botulinum Toxin Procedures: Requesting Number of Units

Botulinum toxins are neuromuscular blocking agents that are used to treat various muscle spasm disorders and contractions such as dystonias and twitches. These toxins are also used in treating overactive skeletal muscles, smooth muscles, and glands. Botulinum toxin injections are also used to treat chronic headaches/migraines that occur ≥ 15 headache days per month.  They produce a presynaptic neuromuscular blockade by preventing the release of acetylcholine from the nerve endings which results in local paresis or paralysis of a given area.

Obtaining a Prior Authorization

Per the CMS Prior Authorization Program for Certain Hospital Outpatient Department Services Operational Guide, the HCPC codes that require prior authorization include:

Administration Code

Paired with 1 of the following:

64612: Chemodenervation of muscles; muscles innervated by facial nerve, unilateral (eg, for blepharospasm, hemifacial spasm)

64615: Chemodenervation of muscles; muscles innervated by facial, trigeminal, cervical spinal and accessory nerves, bilateral (eg, for chronic migraine)





If one of these J codes are paired with any other administration code not listed here, a provider does not need a prior authorization. Per the operational guide:

Use of these botulinum toxin codes in conjunction/paired with any other administration code will automatically be rejected or denied.

The following is a breakdown of each of the J codes listed in the operational guide:

J Code

Name Brand



Report As



onabutlinumtoxin a

100-unit vial 
(10mL = 1 unit)
200-unit vial
(10mL = 2 unit)

1 unit = 1 unit



abobotulinumtoxin a

300-unit vial
(3mL = 10 units)
500-unit vial
(5mL = 10 units)

5 units = 1 unit



rimabotulinumtoxin b


100 units = 1 unit



incobutulinumtoxin a

50-units vial
(5mL = 1 unit)
100-units vial
(5mL = 2 units)
200-units vial
(5mL = 4 units)

1 unit = 1 unit

*Does not require a diluent

When selecting one of these J codes it is important to note the number of units the physician will intend to use on the prior authorization request form cover sheet. The number of units used to treat the condition needs to be reported in the Units section of the prior auth request form:

The requested number of units will then be associated with the unique tracking number (UTN) that is given to a prior authorization request. Be sure to include the exact number of units intended to treat the condition related to the prior authorization request.

Prior authorization is a condition of payment. A prior authorization request is only good for 1 claim or date of service. An affirmed UTN cannot be used for multiple dates or claims. Each date of service requires a prior authorization to be submitted, no earlier than 90 days apart. Prior authorizations cannot be retroactively applied.



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