Neurology & Pain Management Coding Alert

Question: My neurologist injected 50 units of Botox around the forehead and scalp for a patient with a headache. Is there a way I can code for this service?


Tennessee Subscriber
Answer: For injection of Botox for a headache or intractable migraine, you should use 64612 (Chemo-denervation of muscle[s]; muscle[s] innervated by facial nerve [e.g., for blepharospasm, hemifacial spasm]) or 64613 (... cervical spinal muscle[s] [e.g., for spasmodic torticollis]), depending on which muscles your neurologist injected.

Be sure to verify your code choice. Some headaches are actually due to muscle spasms in the neck or the base of the skull, areas not necessarily innervated by the facial nerve.

Also, report J0585 (Botulinum toxin type A, per unit), according to the number of units the neurologist injected (50, in your case), as well as any units documented as waste.

Keep in mind, however, that many payers (including Medicare) won't reimburse for Botox injections for headaches, arguing that this condition doesn't meet medical-necessity requirements.

Check your payer's coverage before deciding whether to submit your claim to a carrier, or have the patient sign an advance beneficiary notice (ABN).