CommercialPrior AuthHigh impact
Botulinum Toxin
Blue Cross & Blue Shield of Mississippi·MS · Neurology, Urology, PM&R (Physical Medicine & Rehab) +3 more·Medical Policy
We identified it
Jun 20, 2026
Summary
BCBS Mississippi has updated their botulinum toxin policy requiring prior authorization for all Botox treatments. Only Botox (onabotulinumtoxinA) is covered - Dysport, Myobloc, and Xeomin are no longer considered medically necessary since a formulary alternative (Botox) is available.
Action Required
Immediately: Billing team must implement prior authorization requirements for all botulinum toxin treatments. Update billing system to flag all Botox claims for prior auth verification before submission. Providers must ensure ICD-10 diagnosis codes are in primary position and meet specific criteria for covered indications (overactive bladder, neurogenic bladder, migraine prophylaxis, spasticity, cervical dystonia, primary axillary hyperhidrosis). Stop billing for Dysport, Myobloc, and Xeomin as these are no longer covered. Claims submitted without proper prior authorization will be denied.