Coding for Chemodenervation of the Larynx / Botulinum Toxin
Q: What is the Academy's recommendation for billing Chemodenervation of the Larynx / Botulinum toxin injections of the larynx?
A: Botulinum toxin is most commonly administered in the larynx by percutaneous injection using laryngeal electromyography (LEMG) for guidance. The American Medical Association’s Current Procedural Terminology (CPT®) 2014 changed the coding for laryngeal chemodenervation:
CPT code 64617 [chemodenervation of] larynx, unilateral, percutaneous (e.g., for spasmodic dysphonia), includes guidance by needle electromyography, when performed In 2013, the prior code, 64613 was deleted and divided into two new codes, 64616 and 64617. This change was made to provide greater specificity between injection of the neck muscles (e.g., for spasmodic torticollis) and injection of the larynx. Providers injecting the larynx for spasmodic dysphonia should now report 64617.
CPT codes + 95873 Electrical stimulation for guidance in conjunction with chemodenervation (List separately in addition to code for primary procedure) and +95874 Needle electromyography for guidance in conjunction with chemodenervation (List separately in addition to code for primary procedure) are now part of this service and should NOT be reported in conjunction with 64617.
CPT code 64617 refers to injection of only one side of the larynx. For bilateral injections, report 64617using modifier -50.
J0585 Botulinum toxin, per unit (report the number of units injected)
If Botulinum toxin is injected by direct laryngoscopy, use CPT codes 31570- Laryngoscopy, direct with injection into the vocal cord (s), therapeutic, or 31571-Laryngoscopy, direct, with injection into the vocal cord (s) therapeutic; with operating microscope or telescope.
Reimbursement Issues: Botulinum toxin Injections of the Larynx
Payers will no longer reimburse both chemodenervation and EMG for localization when performed together, as the work of the EMG guidance has now been bundled with the work of the injection. The new relative value units for this service also reflect that change. Check your local Medicare carrier’s Local Coverage Determination (LCD)
Medicare will reimburse for unused ("waste") Botulinum toxin , if the remainder of the vial is discarded. One must code with the correct modifier, typically JW. Remember to report the number of units in the box. For more details, read CMS’ transmittal 1248.
Reviewed June 2008
Revised March 2010
Revised October 2013
Workshops held in cities nationwide will help otolaryngologists, their staff, and other healthcare professionals code correctly, learn risk reduction strategies, and organize business systems.