Myobloc® (botulinum toxin type B)

No prior authorization required for:

  • Emergency room
  • Inpatient
  • 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.

Code(s): J0587

Benefit: Medical

Notes:

  • 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