# Botox injection to extremities



## Partha (Nov 18, 2009)

How should provider for botox injection for bilateral upper extremities and one lower extremity? Concerned CPT is 64614

Some payers are not paying more than 1 unit of 64614...


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## sparkles1077 (May 25, 2010)

I am researching similar information.  I was wondering if other organizations bill this as bilateral for profee?  I understand that some carriers pay this as two units.  Others pay the bilateral when there are two lines and a modifier 50 is on the second line.  So for the example below you could bill:

64614 x 2 (upper extremities)
64614 (lower extremity)

or
64614
64614-50 (upper extremities)
64614 lower extremity

Partha - which carriers were not paying more than one unit?

I would appreciate any help!!!
Thanks,
Diana CPC
Physician Auditor


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## RebeccaWoodward* (May 26, 2010)

Excerpt from CPT Assistant December 2008...

...the language of the descriptor code for 64614 allows for chemodenervation of muscles of single or multiple extremities, as well as muscles of the trunk, if performed. This code should be reported only one time for chemodenervation of any of these areas within a single session. Modifier 50 should not be appended to code 64614. Therefore, as stated in CPT Assist April 2001  codes 64612-64614 should be reported only one time per procedure, even if multiple injections are performed in sites along a single muscle or if several muscles of single or multiple extremities are injected.


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## sparkles1077 (May 26, 2010)

Thanks - I did just find the same article!!!!

Diana


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