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Botulinum Toxin (CPB 0113, reviewed 2026-07-14)
Effective date
Not stated in the notice
Identified
Aug 12, 2026
Summary
Aetna's botulinum toxin policy addresses coverage for commercial medical plans and requires precertification of Botox, Daxxify, Dysport, Myobloc and Xeomin in applicable plan designs. Each product is medically necessary only for its listed indications, and Aetna considers all other indications experimental, investigational, or unproven. For cervical dystonia and excessive salivation, Aetna considers Myobloc medically necessary only when the member has a contraindication, intolerance or ineffective response to the alternative botulinum toxin agents, and Aetna considers these products ineligible for cosmetic use.
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What to do
Action · 10 steps
01Billing team: Get precertification for Botox, Daxxify, Dysport, Myobloc or Xeomin in applicable plan designs.
02Precertification is requested by calling (866) 752-7021 or faxing (888) 267-3277.
03The medication must be prescribed by or in consultation with a provider specialized in treating the member's condition.
04Aetna considers these products ineligible for cosmetic use, so cosmetic indications are not covered.
05Documentation should show that the member meets the initial criteria for the indication billed.
06For example, for Botox chronic migraine prophylaxis, the member must have headaches 15 or more days per month lasting 4 hours or longer on at least 8 days per month, and must have completed an adequate trial of, or have a contraindication to, two preventive therapies from at least 2 of the listed classes with each trial at least 60 days.
07For Myobloc, documentation should show a contraindication, intolerance or ineffective response to the alternative agents listed for the indication.
08Continuation requires that the member meets all initial authorization criteria and is experiencing benefit from therapy, and for Botox chronic migraine prophylaxis, the member must have achieved or maintained a reduction in monthly headache frequency since starting therapy.
09Approvals may be subject to dosing limits in accordance with FDA-approved labeling, accepted compendia, and/or evidence-based practice guidelines.
10EMG guidance of botulinum toxin injections is medically necessary for cervical dystonia, hand dystonia, laryngeal dystonia or spasmodic dysphonia, limb spasticity and strabismus, and is experimental, investigational, or unproven for bladder dysfunction, blepharospasm, hyperhidrosis and migraines.
Codes mentioned
31513315703157143192432014323643253465055228764611646126461564616646176464664647646506465367345958739587486609J0585J0586J0587J0588J0589S2340S2341
Original notice
Botulinum Toxin (CPB 0113, reviewed 2026-07-14)
aetna.com · Always check the source before changing claims.
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