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Botulinum Toxins A and B
Act
by Nov 1, 2026
Effective date
Nov 1, 2026
Identified
Oct 3, 2026
Summary
UnitedHealthcare Community Plan of Indiana (Medicaid) now applies botulinum toxin coverage to Indiana members (previously excluded). Botox and Xeomin are preferred products; Dysport, Daxxify, and Myobloc require step-therapy documentation (failed trial of preferred agents or documented intolerance) to be covered. All new requests require prior authorization with specific diagnosis-based medical necessity criteria and documentation of clinical response.
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What to do
by Nov 1, 2026 · 7 steps
01Billing team must implement prior authorization requirement in billing system for ALL botulinum toxin requests (CPT codes 64612, 64613, 64614, 64615, 64616, 64617, 64642, 64643, 64644, 64645, 64646, 64647) for UnitedHealthcare Indiana Medicaid members.
02Update prior auth submission templates to require: diagnosis, severity documentation, relevant lab/diagnostic evidence, and treatment frequency (maximum every 12 weeks).
03For initial authorizations, obtain signed physician attestation confirming clinical response or intolerance history if requesting non-preferred products (Dysport, Daxxify, Myobloc).
04Providers must document positive clinical response from previous treatment before requesting reauthorization.
05Configure system to deny or flag any botulinum toxin administration more frequent than every 12 weeks.
06Update encounter forms and clinical documentation templates to capture required medical necessity elements.
07Train front desk and clinical staff on new Indiana Medicaid botulinum toxin coverage scope.
If missed: Failure to obtain prior authorization or submit required documentation will result in claim denials.
Original notice
Botulinum Toxins A and B
uhcprovider.com · Always check the source before changing claims.
Related changes
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