Neurology & Pain Management Coding Alert

Question: Is modifier -50 or -51 appropriate when reporting multiple units of 64613 for Botox injections?

Rhode Island Subscriber

Answer: In this case, neither modifier applies, and you may report only a single unit of 64613 (Chemodener-vation of muscles[s]; cervical spinal muscle[s] [e.g., for spasmodic torticollis]) for multiple injections to the cervical spine.

Note that the descriptor for 64613 refers to the plural "muscles." Accordingly, many payers will allow payment for one injection per site regardless of the number of injections administered, with a site defined as including muscles of a single contiguous body part (for example, a single limb, eyelid, face, neck, etc.). Therefore, if the physician administers two injections to the same site (such as the muscles of the cervical spine), neither modifier -50 (Bilateral procedure) nor modifier -51 (Multiple procedures) applies. You may report only a single unit of 64613.

Also, the CMS Physician Fee Schedule assigns a bilateral indicator of "0" to 64613, indicating that payment adjustment for bilateral procedures does not apply. Therefore, you should never append modifier -50 to 64613 although the fee schedule does allow the bilateral modifier with and adjusted reimbursement for related codes 64612 ( muscles[s] innervated by facial nerve [e.g., for blepharospasm, hemifacial spasm]) and 64614 ( extremity[s] and/or trunk muscle[s] [e.g., for dystonia, cerebral palsy, multiple sclerosis]).

The fee schedule assigns a multiple-procedure indictor of "2" to 64613, thereby indicating that you can append modifier -51 when reporting 64613 with other injections at different sites. Remember, multiple injections to the cervical spinal muscles count as only a single unit. But if the physician reports one unit of 64612 with one unit of 64613, you should use modifier -51 to report multiple procedures with 64613.