Coding, Classification & Reimbursement

CPT Coding - Botox Injections

  • 1.  CPT Coding - Botox Injections

    Posted 09-10-2018 14:55

    What CPT codes would you assign for the below botox injections:

    1. Left masseter m: 50 U (2 sites)
    2. Right masseter m: 50 U (2 sites)
    3. Right biceps m: 125 U (3 sites)
    4. Right pectoralis m: 75 U (3 sites)
    5. Right triceps m: 100 U (3 sites)
    Total units: 400 U


    Jaclyn Walzer
    Manager of Coding & CDI

  • 2.  RE: CPT Coding - Botox Injections

    Posted 09-11-2018 04:03
    64642 for the extremity, 64615 for the masseter (it’s hard to tell, but it’s the only one that fits close.), and use your Botox code if y’all bought it. I would include in the notes for reference if patient’s own supply was used.

    Few things. It’s per muscle, not per injection, put a 59 on one of em... Also add your J code for the Botox if your company bought it. It’s chemical denervation.

    Jack Sycz, Jr., CCA
    East Hartford, CT

  • 3.  RE: CPT Coding - Botox Injections

    Posted 09-11-2018 04:06
    Oh... I just realized the pectoralis major... 64646... you’ve got that as well.

    Jack Sycz, Jr., CCA
    East Hartford, CT

  • 4.  RE: CPT Coding - Botox Injections

    Posted 09-12-2018 04:11

    The Masseter muscle is innervated by the Trigeminal nerve.  The CPT code to look at would be 64615.  FYI, some payers have coverage limitations for this code.

    The biceps and triceps muscle chemodenervation injections would be reported with 64642 x 1.

    FYI: CPT section guidelines not "Do not report 64615 in conjunction with 64612, 64616, 64617, 64642, 64643, 64644, 64645, 64646, 64647." Medicare's NCCI bundling edits do bundle 64642 into 64615 but a modifier can be used to bypass the edit.  If the patient is covered by Medicare, you may consider using modifier XS for separate structure, if the documentation supports it.

    CPT section guidelines specify "Trunk muscles include the erector spinae and paraspinal muscles, rectus abdominus and obliques.  All other somatic muscles are extremity muscles, head muscles or neck muscles.  So the pectoralis muscle injection does not meet the CPT criteria for 64646 - chemodenervation of the trunk muscles, so it would not be separately reported as it would be included in either the 64615 or 64642.

    As noted previously, if the Botox was a cost to the practice / facility, it would be billed with J0585 with 400 units of service

    Marvel Hammer