# Botox injections for chronic migraines



## debrakae (Sep 6, 2012)

HELP!!!!
I have a new provider that is giving Botox injections for chronic migraines. What is the best way to code for this? He is giving a  total of 7 injections to the face and neck areas. Do I just bill for the office visit and the medication or is there a specific code for this procedure?

Any and all help is appreciated. Thanks!


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## thiggs (Sep 6, 2012)

You would bill one line item: 64613 for the injection. Next line item: J0585, under quantity enter number of units used (example = 80 units).  if your provider is using 100 unit vials and uses only 80 units (this is an example), you add a 3rd line item for the wasted Botox.  That would be entered with J0585, modifier JW (wasted product), and number of units would be 20.  It doesn't matter how many injections the provider is giving, it's based on how much product he uses.  Does that help?


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## debrakae (Sep 6, 2012)

This helps very much. Is the JW modifier for the waste only for Medicare or is it for all insurances?


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## ollielooya (Sep 6, 2012)

You're taking on quite a task coding for these procedures.  Your codes for the head and neck will be 64612 and 64613.  Be careful about including an office visit for these procedures as they are usually scheduled ahead, unless, of course a separate and distinguishable issue is being addressed. Check out also the botox website:  www.botoxreimbursementsolutions.com for additional helps.  You'll have to learn the payer's preferences as well concerning whether or not bilateral injections are billable as not all follow the same rules so be prepared to dig into their policies regarding botox.  Good luck!


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## cnsbilling21701 (Sep 7, 2012)

I believe, as long as the physician purchased the Botox and it was not through a specialty pharmacy, that you do not have to document waste in the claim, but bill for the total vial. The waste, should, however, be documented in the patient's records. 

If the Botox is obtained through a specialty pharmacy with the patient's insurance, the waste will need to be documented with the JW modifier.

Someone please correct me if I am wrong. But you shoul be able to get further information from a Botox specialist or sales rep. For instance, I know botoxreimbursementsolutions.com is a good resource.


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## kvangoor (Sep 10, 2012)

Medicare does require the waste to billed on a seperate line and with the JW modifier. At least in MI it does, check the NDC!


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## suemt (Mar 14, 2014)

*New Codes for Botox injections for chronic migraines*

For anyone looking to do this for dates of service after 2013, and again in 2014, there have been quite a few changes.  

64613 and 64614 have been deleted, and 

64615 has been added to specifically code for chronic migraine.  It does not include guidance, and is only reported once per session.  Code the chemodenervation substance separately (for example, J0585 for Botox)


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