• CPT for Botox Injection

    What is the difference between using a 64612 vs. CPT 64615 for injection of Botox for blepharospasm?

    The difference is in the full descriptor of the CPT, which specifies the indication for the procedure. From our Coding Coach: The Complete Ophthalmic Coding Reference:

    64612 is for chemodenervation of muscle(s); muscle(s) innervated by facial nerve (eg, for blepharospasm, hemifacial spasm)

    64615 is for chemodenervation of muscle(s); muscle(s) innervated by facial, trigeminal, cervical spinal and accessory nerves, bilateral (eg, for chronic migraine)

    Use 64612 for blepharospasms. Additional Coding Clues from our Coding Coach for CPT 64612:
    Bilateral procedures will only be considered when both eyes or both sides of the face are injected. In this case, submit the procedure with a 50 modifier. For an ambulatory surgery center (ASC), the appropriate site modifier (-RT and/or -LT) should be appended to indicate if the service was performed unilaterally or bilaterally. Bilateral services must be reported on separate lines using an -RT and -LT modifier (-50 modifier should not be used).