Myobloc® (botulinum toxin type B)
No prior authorization required for:
- Emergency room
- Skilled nursing facility
Injectable auth/billing notes:
Medications billed with miscellaneous codes will be reviewed. Explanatory notes must accompany the claim.
Priority Health Medicare applies CMS local coverage determination criteria when available for Part B drugs.
- Per 100 units; for treatment of cervical dystonia. See prior authorization form.
- No authorization needed when billed by neurologists, rehabilitation medicine or physical medicine.
Length of authorization: 1 injection. Injections must be separated by at least 90 days