JUL 19, 2023
Covered Diagnosis for Botox Injections for Migraine
We submitted a claim to Medicare for Botox injections for a patient who has migraines. The diagnosis linked was G43.919 migraines, unspecified intractable without status migraines. Medicare denied it, stating it was a noncovered service because this is not deemed a medical necessity. How should we have billed the claim?
Answer:
Payers can set their own unique policies for covered diagnoses; this includes Medicare administrative contractors (MACs). The Academy’s Botox for Migraines Fact Sheet on the Coding Topics webpage cites “Examples of ICD-10 Code Options (These vary by payor. Verify with all carriers including MACs.)”
You can access your MACs current LCDs at aao.org/lcds