Coding for Botulinum Toxin Type A

Q: What is the Academy's recommendation for billing Botulinum toxin A injections of the larynx?

A: Botulinum toxin - A is most commonly administered in the larynx by
percutaneous injection using laryngeal electromyography (LEMG) for guidance. The American Medical Association’s Correct Procedural Terminology (CPT®) 2006 changed the coding for laryngeal chemodenervation:

• CPT code 64613-Chemodenervation of muscle(s); neck muscle (s) (eg, for
  spasmodic torticollis, spasmodic dysphonia). In 2006, this code was editorially
  changed to specify use for spasmodic dysphonia; this code does not include
  use of EMG for localization.
• Add CPT code + 95874-Needle electromyography for guidance in conjunction
  with chemodenervation (list separately in addition to code for primary
  procedure). Add modifier 26 “(Professional Component) to +95874 if you do not own the EMG equipment.
• J0585 Botulinum toxin type - A, per unit (report the number of units
  injected)
• If Botulinum toxin A 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 - A Injections of the Larynx

• Payers should reimburse both chemodenervation and EMG for localization
  when performed together. Good documentation helps!
• Check your local Medicare carrier’s Local Coverage Determination (LCD)
• Medicare will reimburse for unused ("waste") Botulinum toxin – A, if the remainder of the vial is discarded. Remember to report the number of units in the box. For more details, read CMS’ transmittal 1248.

Revised March 2010
Reviewed June 2008